What Is Sacroiliac Joint Dysfunction?
Sacroiliac (SI) joint dysfunction is a condition that happens when one or both small, firm joints at the base of the spine don't move properly. Some doctors may also call it by other names, such as SI joint syndrome, SI joint disorder, SI joint disease, SI joint strain, and SI joint inflammation.
You may not have ever known you had an SI joint, much less where it is, until it starts to ache. Then, it's hard to miss how much you use it to move around and do your everyday activities.
You have two SI joints. They connect your pelvis with the lower part of your spine. Most joints, like the knee and hip, have a wide range of movement, but the SI rotates and tilts only slightly. That lets it do its main job: to stabilize and support your pelvis, help transmit the weight of your upper body to your legs, and act as a "shock absorber" when you walk or run.
SI Joint Dysfunction Causes
The most common cause of SI joint dysfunction is injury from a car accident or fall. But it can also happen from:
- Sports injuries such as a football tackle
- Stress or injury to the joint over and over, such as from jogging for many years
- A spinal injury
- Age-related wear and tear
- Spinal surgery, especially operations that fuse the lower part of the spine, called the sacrum
- Pregnancy. The hormones a woman's body makes near the time of delivery can cause the pelvis to relax and change position. Weight gain, changes in posture, and the childbirth process can also cause problems in the joint.
Half of people with SI joint pain can trace it back to a specific event, like a car accident or sports injury. Other times, though, there's no obvious reason for the problem.
SI joint dysfunction risk factors
Factors that raise your chances of having SI joint dysfunction include:
- Having one leg that's shorter than the other
- Abnormal walking patterns
- Scoliosis (abnormal curvature of the spine)
SI Joint Dysfunction Symptoms
Pain is often the main symptom, usually in the lower back, buttock, and sometimes the back and upper leg. Aches from SI joint dysfunction typically appear on one side of the body rather than both sides. You may also feel:
- Numbness
- Tingling
- Weakness
- Like your legs are buckling or giving way
- Trouble sleeping
- Problems sitting for long periods or sitting on one side
- Pain as you stand
SI joint inflammation
Inflammation in the SI joint can happen due to osteoarthritis, pregnancy, or injury. Doctors also call it sacroiliitis. If you have this condition, you may often feel stiff when you wake up. While it's normal to feel some stiffness after sleeping or sitting still, the stiffness from sacroiliitis usually lasts over an hour each time you wake up. Without treatment, sacroiliitis pain can limit movement, disrupt sleep, and bring about mental health issues like depression.
What causes SI joint pain to flare up?
Some conditions can raise your chances of swelling in the SI joints, including inflammatory arthritis like ankylosing spondylitis and psoriatic arthritis. You're also more likely to have swelling if you have inflammatory bowel diseases such as Crohn's disease and ulcerative colitis.
SI Joint Dysfunction Diagnosis
Low back and leg pain have many possible causes, so you'll need to work with your doctor to figure out if your SI joint is the reason you hurt.
Diagnosing SI joint dysfunction can be challenging. Its symptoms are similar to those of other common back and spine issues. Doctors typically reach a diagnosis through a physical exam to rule out other causes and may use an injection to block the pain.
SI Joint Dysfunction Treatment
Treatments for SI joint dysfunction usually focus on methods without surgery to restore normal movement in the joint.
SI joint pain relief
- Ice, heat, and rest
- Medicines like acetaminophen and anti-inflammatory drugs (ibuprofen or naproxen) that can ease swelling and pain
- Manual manipulation by a chiropractor, osteopathic doctor, or other qualified practitioner who can help when the SI joint is "stuck" but may cause irritation if the joint is overly mobile
- Supports or braces for a loose SI joint
- Physical therapy that strengthens muscles around the joint and improves movement
- Gentle, low-impact aerobic exercises that improve blood flow to the area
- Water therapy that eases serious pain and stress on the joint
SI joint injection
An SI joint injection involves injecting a local anesthetic and steroid medication into the SI joint. The numbing medicine can provide temporary pain relief for several hours. But once it wears off, the pain will likely return. Steroids may offer longer-lasting relief, typically starting to work after 24-48 hours.
Living With SI Joint Dysfunction
Give yourself a break from activities to allow your joint to return to normal. The longer you rest, the better it will heal. If you need to be active, think about using an SI belt or lumbar brace for support.
SI joint stretches
- Lie on your back with both knees bent and feet flat on the floor, bending your knees at about a 90-degree angle.
- To stretch, keep one leg flat on the floor while pulling your other knee to your chest.
- Press your lower back to the floor and hold the stretch for 15-30 seconds.
- Relax and lower your knee to place your foot on the floor again.
- Repeat the stretch two to four times with each leg.
Other stretches you can try:
- Piriformis stretch
- Lower abdominal strengthening
- Hamstring stretch in a doorway
- Alternate arm and leg (bird dog)
SI joint pain exercises
Physical therapy plays a key role in your recovery. It can help relieve pain and build strength. Consult your doctor or physical therapist for specific exercises to follow. Here's an example of a lower back exercise:
- Lie flat on your back with your knees bent and feet flat on the ground.
- Slowly rotate your knees to the right side, stopping if you feel pain or discomfort.
- Then rotate back to the left side.
- Return to the starting position and rest.
- Repeat the exercise 10 times.
How to sit with SI joint pain
Sitting in a chair with SI joint pain can put extra strain on your pelvic area. To avoid this, keep your hips level and avoid leaning to one side. Tilting one side of your pelvis higher can make the pain worse.
For a good sitting posture:
- Sit with your chest up and relax your shoulder blades.
- Keep your knees slightly apart.
- Make sure your sitting bones are on the same level.
- Add a cushion if the chair doesn't properly support your lower back.
SI Joint Dysfunction Complications
Sacroiliitis can make some actions harder. Among these are:
- Bending
- Lifting
- Staying in one position
- Getting up from sitting
The constant pain can also lead to depression and trouble sleeping.
Takeaways
SI joint dysfunction is when the joint at the base of the spine, connecting to the pelvis, doesn't move properly, causing pain in the lower back, hip, or upper leg. This pain often stems from injury and can make simple actions like bending, sitting, and getting up hard. Treatment for SI joint dysfunction generally includes non-surgical options such as rest, physical therapy, manual manipulation, and injections, with surgery as a last resort. Proper posture, regular gentle exercise, and a personalized care plan can improve symptoms and help you feel better.
SI Joint Dysfunction FAQs
- What should you not do with SI joint dysfunction?
If you have SI joint dysfunction, avoiding activities that could strain the joint, such as kicking, twisting, and running, is important. Don't lift heavy objects, especially if you don't do it regularly, and avoid long trips without lower back support. When sitting or standing, make sure not to shift your weight to one side. Limit extended twisting movements and avoid sleeping on one side without proper support. It's also best to steer clear of very soft surfaces when sitting, climb stairs one step at a time, and avoid sitting cross-legged to prevent strain on your hips and lower back.
- What is the one-finger test for SI pain?
Also called the Fortin test, it's a test that doctors use to help diagnose SI joint dysfunction. You'll use one finger to show your doctor exactly where you feel pain. The test is positive for SI joint dysfunction if the pain is within 1 centimeter of the posterior superior iliac spine, usually slightly below and toward the center of this point on the affected side.
- What's the best sleeping position for SI joint dysfunction?
Lying on your back and placing a pillow under your legs can help ease pressure on the SI joint.
