Sacroiliac Joint Dysfunction and Sciatica

Sacroiliac joint dysfunction is characterized as a sharp, stabbing pain which radiates from the pelvis and hips, down into the lower back or lumbar spine and throughout the legs. Patients might experience tingling sensations or numbness. The sacroiliac joint is generally attributed to causing between 15 to 30 percent of chronic low back pain cases. Approximately 80 percent of adults will experience some type of low back pain throughout their lifetimes. Low back pain is also ultimately considered to be one of the most general causes of disability as well as the most common cause of missed workdays. 

What are the Sacroiliac Joints?

The sacroiliac joints are situated where the sacrum and ilium come together. The sacrum is the triangle-shaped bone close to the base of the spine, just over the coccyx or the tailbone. Among the three bones that make up the hip structure, the ilium is at the top of the pelvis. The sacroiliac joints support the weight of the human body, maintaining it around the pelvis. This reduces pressure and functions as a shock absorber. The bones of the sacroiliac joints are all jagged to remain in alignment. 

Gaps between the bones of the sacroiliac joints are filled with fluid for lubrication. These gaps are also filled with free nerve endings which are in charge of transmitting pain signals. It may be debilitating when the sacroiliac joints come out of alignment. All the bones at the sacroiliac joints are connected by muscles and ligaments which promote stability and permit for limited motion. This motion is essential for women to give birth and for people to stay standing vertically. 

What Causes Sacroiliac Joint Dysfunction?

Irritation, swelling, or inflammation of one or more sacroiliac joints is commonly referred to as sacroiliac joint dysfunction, sacroiliac joint disease, or sacroiliitis. Moreover, sacroiliac joint dysfunction or disease may cause sacroiliitis. This can be a health issue which encompasses a variety of other injuries and/or underlying conditions. These include: 

• Walking patterns
• Injury
• Gout
• Ankylosing spondylitis
• Osteoarthritis
• Pregnancy

What are the Symptoms of SI Joint Dysfunction?

Every person experiences symptoms of SI joint dysfunction differently and the signs can vary from person to person, depending on the source of the sacroiliac joint dysfunction. Common signs and symptoms of SI joint dysfunction include: 

• low back pain
• pain in the buttocks, hips, and pelvis
• pain in the groin
• painful symptoms in the SI joints
• pain when standing from a sitting position
• stiffness
• burning sensations
• weakness
• numbness
• pain radiating down into the thighs and legs
• feeling like the legs may buckle and not support the weight of the body

How is Sacroiliac Joint Dysfunction Diagnosed?

SI joint dysfunction can be hard to diagnose. Because the joints are situated deep within the human body, it often makes it difficult for healthcare professionals to properly diagnose the health issue. Moreover, damage due to trauma or injury to the sacroiliac joints doesn't appear on imaging tests like CT scans, MRIs, or X-rays. And the signs and symptoms are much like other health issues, such as sciatica, bulging or herniated discs and arthritis of the hip. The healthcare professional may perform a variety of tests so as to diagnose SI joint dysfunction and determine other health issues, including: 

• Provocative tests are frequently utilized by healthcare professionals to determine whether the painful symptoms are originating from the SI joint. The maneuvers are utilized to isolate the SI joint as the source of pain.
• Injecting a numbing drug and/or medication, such as lidocaine, to the sacroiliac joint. This can ultimately help determine if the patient has an SI joint health issue if the painful symptoms are reduced after a brief period of time.
• Imaging tests, including X-rays, MRIs, and CT scans.

Diagnosing SI Joint Disorders - Provocative Testing

How is Sacroiliac Joint Dysfunction Treated?

Physical therapy, chiropractic care, stretches and exercises, such as yoga, and massage can help stabilize and strengthen the SI joints and alleviate painful symptoms. Another treatment suggestion involves the utilization of cold packs for pain relief. Utilize heat with a heating pad or heat wrapping, or a soak in a warm bath after the painful symptoms are more manageable. It is also possible to put on a sacroiliac belt to help support the sacroiliac joint which might help alleviate painful symptoms. 

Medicine and Non-surgical Treatment

If sacroiliac joint dysfunction signs and symptoms can't be managed with physical therapy, chiropractic care, stretches and exercises, and/or massage, or whether it is brought on by an underlying health issue, your healthcare professional may recommend the utilization of medicine and non-surgical treatment. These treatment approaches can include: 

• anti-inflammatory medications, including nonsteroidal, anti-inflammatory drugs (NSAIDs)
• muscle relaxants
• oral steroids, but only for short-term utilization
• tumor necrosis factor inhibitors (TNF inhibitors)
• corticosteroid injections
• radiofrequency ablation, which utilizes energy to deactivate the nerves which are causing pain and discomfort

Healthcare professionals consider surgery to be the last resort for sacroiliac joint dysfunction if none of the other treatment approaches mentioned above helped reduce painful symptoms. With sacroiliac joint surgery, small plates and screws are utilized to hold the SI joint together so the bones fuse or grow together. The healthcare professional may suggest this surgery if the pain and discomfort become constant and other treatment approaches haven't been effective. Furthermore, it's fundamental for patients to receive a diagnosis for them to follow-up with treatment for their SI joint dysfunction.

Differential Diagnosis of Hip Pain and Discomfort

Sacroiliac, or SI, joint dysfunction is believed to be a common cause of low back pain and hip/thigh/leg pain. Because of the painful symptoms along the lower extremities, SI joint dysfunction may feel similar to sciatica. However, sciatica is caused by the compression or impingement of the sciatic nerve. Accurately diagnosing sacroiliac joint dysfunction can be difficult. A positive diagnosis for SI joint dysfunction is generally determined through the utilization of provocative testing and/or an injection. Proper diagnosis is important for proper treatment. - Dr. Alex Jimenez D.C., C.C.S.T. Insight

The purpose of the article was to discuss SI joint dysfunction and sciatica. SI joint dysfunction is often confused with the symptoms of sciatica, however, diagnosis and treatment differ for this health issue. The scope of our information is limited to chiropractic, musculoskeletal and nervous health issues as well as functional medicine articles, topics, and discussions.

Curated by Dr. Alex Jimenez