The sacroiliac joint, often known as the SI joint, is the joint that links your lower spine to your pelvis. SI joint can sometimes cause lower back and/or leg pain. Leg pain caused by dysfunction of the sacroiliac joint can be difficult to distinguish from radiating leg pain caused by a lumbar disc herniation (sciatica), as the symptoms can be quite similar.

For many years, the sacroiliac joint was thought to be a common cause of low back and/or leg pain, irrespective of the fact that accurate diagnostic testing was difficult, leaving many medical practitioners skeptical. It is currently believed that the sacroiliac joint is responsible for 15% to 30% of occurrences of lower back pain.

  • Primary mechanisms of SI joint dysfunction:
  • Initial treatments for sacroiliac joint pain:
Primary mechanisms of SI joint dysfunction:

The primary mechanisms of SI joint dysfunction include:

  • Too much movement in the sacroiliac joint (hypermobility or instability) can cause the pelvis to feel unstable and cause pain. Too much motion causes pain in the lower back and/or hip, that can radiate into the groin.
  • Too little movement (hypomobility or fixation) can lead to muscle tension, discomfort, and mobility impairment. The pain is usually felt on one side of the low back or buttocks, and it can radiate down the back of the leg (like sciatica).

Sacroiliac joint inflammation (sacroiliitis) can cause pelvic pain and stiffness. Sacroiliac joint dysfunction may lead to inflammation, or inflammation may occur as an infection, rheumatoid disease, or other cause. Young and middle-aged women are more likely may experience sacroiliac joint dysfunction. Women who are pregnant or have recently given birth may be more susceptible to sacroiliac joint pain.

Initial treatments for sacroiliac joint pain:

Initial treatments for sacroiliac joint pain typically include:

  • A brief period of rest. 1 to 2 days of rest may be advised. It is not advised to rest for more than a couple of days as this may worsen stiffness, leading to further pain, and resulting in general deconditioning.
  • Applying ice or heat. Ice helps reduce inflammation and alleviate pain and discomfort when administered to the pelvis and low back. Heat applied to the joint may help reduce pain by reducing muscle tension or spasms.
  • Pain medication. For mild to moderate pain management, over-the-counter pain medicines (such as paracetamol) and anti-inflammatory medications (NSAIDs, such as ibuprofen, diclofenac, naproxen, etoricoxib) may be recommended. During episodes of severe, acute pain, prescription medications such as muscle relaxants and narcotic painkillers may be taken. These medications must be used with caution, as they are highly addictive and can cause severe side effects.
  • To reduce sacroiliac joint pain, a series of stretching and strengthening exercises may be prescribed. These exercises are intended to restore the joint’s natural movement by: relaxing tensed muscles and ligaments that limit natural motion at the joint and conditioning the surrounding muscles and ligaments to better support the joint. Because the SI joint is supported by a number of muscles, exercises may target the pelvis as well as the lower back, groin, hamstring, thigh, and/or abdominal muscles. Aerobic exercise is an essential element of any exercise program. Aerobic exercise is intended to increase the heart rate for a minimum of 20 minutes. Aerobic exercise improves circulation, which distributes a variety of nutrients and oxygen throughout the body and speeds up the healing process of the sacroiliac joint’s weakened or injured soft tissues.
  • It is common practice to combine rehabilitative exercise with other therapies and pain management techniques to achieve optimal pain relief. Physical therapy (PT) interventions comprise of repetitive exercises, manual joint mobilisation, manipulation, bracing, massage, patient education, aerobic conditioning, general therapeutic exercise, and electrotherapeutic modalities such as heat, ultrasound, and transcutaneous electrical nerve stimulation (TENS).

Sacroiliac joint injections may be recommended if the symptoms are not getting improved.

Sacroiliac (joint that links your lower spine to your pelvis) joint injection

  • What is a sacroiliac joint injection?
  • What are the risks of the procedure?
  • Will the injection be painful?
  • How do I prepare for the procedure?
  • What actually happens during the procedure?
  • How will I feel after the injection?
What is a sacroiliac joint injection?

A sacroiliac joint injection is a steroid and local anesthetic injection into the sacroiliac joint. Due to the numbing medication used during this procedure, you may have temporary pain relief that lasts for several hours afterward. However, as the numbing medicine wears off, your pain will most likely return. The steroid medication may provide longer-lasting pain relief and usually starts working after 24-48 hours.

What are the risks of the procedure?

There is a minimal risk of bleeding, infection, or allergic reaction to the medications used, as with most procedures. Additional short-term complications may occur. The local anesthetic may cause temporary numbness or weakness in your legs (numbing medicine). If this impairs your ability to walk safely, you will be required to stay in the clinic until it resolves. For a few days after the injection, you may have increased pain, including localized pain at the injection site. Diabetics may experience short-term blood sugar elevations as a result of steroid medication.

Will the injection be painful?

The most unpleasant aspect of the procedure, according to most patients, is the stinging/burning of the numbing medicine (this lasts only a few seconds). Minor soreness for a week following the procedure is expected.

How do I prepare for the procedure?

You may take your medications as prescribed. Before coming in, diabetics should check their blood sugar levels at home. If you are taking blood thinners such as warfarin (Coumadin), clopidogrel (Plavix), dabigatran (Pradaxa), rivaroxaban (Xarelto), apiquis (Eliquis), or any others should be discontinued well in ahead of the procedure if you’re taking them. The doctor will advise you when you should stop taking the medication. Please inform the doctor that you are taking blood thinners and contact your prescribing doctor before discontinuing this medication.

What actually happens during the procedure?

You will be assisted to the procedure table and made as comfortable as possible while laying face-down. Your injection site is cleansed with an antiseptic solution such as betadine or chlorhexidine, and then your skin is covered by sterile drapes. A local anesthetic is used to numb the skin (numbing medicine). A needle is inserted into the sacroiliac joint using X-ray or ultrasound guidance. The needle is then removed after a local anesthetic (numbing medicine) and steroid are injected into the joint. The injection site will be cleansed, and a bandage will be applied. You may go home shortly after.

How will I feel after the injection?

Your pain may be relieved immediately following the injection of local anesthetic. Your pain may return once the numbing medicine wears off. You may experience some soreness at the injection site, and your pain may worsen for a day or two after the procedure. The steroid medication takes 2-3 days to start affecting most people. You may take your usual painkiller.

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