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OAS Health Blog

The Sacroiliac Joint and Low Back Pain

November 22, 2013

The sacroiliac joints are the main load bearing structures that connect the spine with the pelvis and lower extremities. Sacroiliac joint dysfunction typically presents with localized pain in the lower back or upper buttock, but can also radiate to the posterior thigh and to the front or side of the hip. It is a frequent cause of low back pain that becomes more common the older you are; however is often undiagnosed because even when the condition causes severe pain imaging studies of the sacroiliac joint are usually normal, but will show all the other degenerative changes in the spine, which can cause pain in a similar pattern.

There are many physical examination tests that may indicate the sacroiliac joint as the cause of pain, but there is no one physical test that is diagnostic. If the sacroiliac joint is suspected, the diagnostic "gold standard" is a fluoroscopically (X-ray) guided injection into the joint. This can usually be performed in the office and under local anesthesia. When pain is severe and significantly limits patients' function, a fluoroscopically-guided steroid injection with local anesthetic can both diagnose and treat the pain. Many patients are successfully treated with only one injection; however for those who only experience temporary relief there are other treatments that can provide sustained relief. One of those is called radiofrequency ablation. Through a special needle the nerves that transmit the pain signals from the sacroiliac joint can be heated so they no longer send pain signals. This procedure can eliminate the pain until the nerves regrow, which can take more than a year. This nerve lesioning procedure can be repeated and is usually part of a comprehensive rehabilitation plan.

Physical therapy can help strengthen the pelvic and abdominal muscles that support the joint and use modalities that increase circulation to the region. Osteopathic and chiropractic assessment and treatment may be helpful in diagnosing and treating the sacroiliac joints motion restrictions and addressing coexisting muscle and ligament imbalances. Medications such as oral and topical anti-inflammatories can be beneficial, as well as pain medication when needed.

Back pain can be very disabling and frustrating, but the key to successful treatment is an accurate diagnosis. Diagnosing pain from a herniated disc, an arthritic facet joint, a muscle or ligament, or the sacroiliac joint is the first step to the best recovery.

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