Everything to Know About Sacroiliac (SI) Joint Dysfunction (2024)

Sacroiliac (SI) joint dysfunction describes pain due to abnormal movement (too much or too little) or misalignment of the SI joint. It can cause sharp, stabbing pain that starts in the hips and pelvis and radiates into the lower back and down the thighs.

Pain is the main symptom of SI joint dysfunction. It can be felt on one side of the body in the lower back and the hip, buttock, and leg on the same side. While rare, SI joint dysfunction can also affect both sides of the lower body.

SI joint dysfunction can be caused by various conditions, including osteoarthritis (OA), ankylosing spondylitis (AS), trauma, repetitive stress to the joints, older age, pregnancy, abnormal walking patterns, leg length differences, and scoliosis (abnormal curvature of the spine).

SI joint dysfunction is a treatable and manageable condition. It is treated with both nonsurgical and surgical therapies. This article will cover SI joint dysfunction causes, symptoms, treatment options, and more.

What Causes SI Joint Dysfunction?

Causes and risk factors for SI joint dysfunction include:

• Osteoarthritis: Because OA is associated with aging, it can affect the SI joints and spine. Years of wear and tear on these joints can lead to cartilage damage. Cartilage is the covering of a bone's surface at a joint.
• Ankylosing spondylitis and other types of inflammatory arthritis: AS is a type of arthritis that mainly affects the spine but might also affect the hips and the SI joints. SI joint inflammation is a hallmark symptom of AS. Additional types of inflammatory arthritis that might lead to SI joint problems are psoriatic arthritis. inflammatory bowel disease-associated arthritis, and reactive arthritis.
• Injuries, including trauma and spinal injuries: Various injuries can lead to SI joint dysfunction, such as sports injuries, automobile accidents, or spinal injuries.
• Repetitive stress: Some sports and work activities put repeated stress on the SI joint, including contact sports and heavy lifting. Jobs that require prolonged sitting or standing might also contribute to SI joint problems.
• Older age: Degeneration of the SI joints can be seen on imaging, even in adults with few or no symptoms. Degeneration refers to a breakdown or loss of body parts due to aging.
• Pregnancy and childbirth: Pregnancy weight gain, hormonal changes that cause the ligaments of the SI joints to relax, and pelvic changes from childbirth might contribute to SI joint pain. For some people, ligaments may remain loose after giving birth and lead to instability of the SI joints.
• Abnormal walking patterns or leg length differences: Gait problems and leg discrepancy can put pressure on one side of the pelvis, causing wear and tear and misalignment of the SI joints.
• Scoliosis: Scoliosis is a condition that causes a sideways curvature of the spine. It can affect the alignment of the pelvis and SI joints.
• Prior back surgery: A 2017 study found that SI joint was a common finding after spinal fusion surgery, especially multiple-level surgery. Other types of lower back surgery that may lead to SI joint dysfunction include hip replacement surgery and discectomy.
  

Symptoms: How Does SI Joint Dysfunction Feel?

SI joint dysfunction occurs either as hypermobility (too much movement) or hypomobility (too little movement). With hypermobility, there is extended movement of the SI joints, leading to pain and instability of the pelvis, with pain in the lower back and hip that radiates into the groin area. With hypomobility, mobility is limited, and pain is felt in the buttocks and the back of the leg.

The pain can vary in intensity and severity and be felt in the lower back, pelvis, buttocks, or tailbone. It can sometimes be described as numb, popping, or clicking pain in the groin area or just below the waist.

SI joint pain can affect one or both sides of the lower body. Unilateral SI joint pain is four times more likely than bilateral.

The most common symptoms of SI joint dysfunction are:

• Low-back pain that is dull, achy, and ranges from mild to severe on one or both sides
• Pain that spreads into the buttocks, groin, or upper thighs
• Worsening pain with movement or putting pressure on the SI joint (i.e., walking, climbing steps, or bending down)
• Stiffness that affects range of motion in the lower back, hips, and pelvis
• Sciatica-like pain starting in the lower back and going into the buttocks and thighs—pain might feel hot, sharp, or stabbing and may include numbness and tingling
• Pelvic instability, in which the pelvis feels like it will give way with standing and walking or getting up from a sitting position
• Excruciating pain with transitional movements (i.e., climbing stairs or getting up from a sitting position)
• Severe lower back, hip, and buttock pain after sitting for extended periods
• A low-grade fever with prolonged morning stiffness and inflammatory pain if sacroiliitis is present
  

What Triggers SI Joint Flares?

SI joint pain is triggered by activities that involve the lower back, hips, pelvis, and legs. This can include walking, climbing steps, and sitting and standing for long periods.

Certain physical activities can cause sacroiliitis, including:

• Jobs where you sit, stand, or walk around for long periods
• Heavy labor jobs that require heavy lifting or repetitive movements that put stress on the SI joints
• Sports that involve repetitive movements, including gymnastics, ice skating, and tennis
• High-impact exercises, such as running and jumping, that put stress on the back and pelvis
• Bicycling because it involves sitting in a front-leaning position

SI dysfunction flare (worsening symptoms) triggers include:

• Poor posture
• A sedentary lifestyle
• Footwear, including high heels and footwear without proper arch support
• Eating a diet high in inflammation-producing foods (such as processed and junk foods), especially if you already live with inflammatory arthritis
• Pregnancy because of hormonal and physical body changes
• Being overweight as excess body weight can add to excess stress on the SI joints
  

At-Home Treatment to Soothe SI Joint Pain

Treatment for SI joint dysfunction varies depending on the pain and symptom severity. For most people, home remedies can help ease symptoms.

At-home remedies for managing SI joint pain include:

• Over-the-counter (OTC) pain relievers: A pain reliever like Tylenol (acetaminophen) can treat mechanical joint pain (joint pain from stress or stress), whereas an nonsteroidal anti-inflammatory pain reliever (NSAID) like Advil or Motrin (ibuprofen) or Aleve (naproxen sodium) can also reduce inflammation. OTC topical pain relievers can offer pain relief with fewer side effects.
• Ice and heat therapy: Cold and hot therapies can be a nondrug alternative for managing SI joint pain. They can relax tense muscles and relieve pain and inflammation. Start with ice therapy to reduce swelling and then apply heat to improve blood flow and relax joints.
• Weight loss: Excess weight stresses joints, including the spine, hips, pelvis, and SI joints. Losing excess weight could improve joint alignment and reduce stress on joints.
• Improve posture: Poor posture places stress on the lower back and pelvis, but good posture can reduce that strain. Good posture means sitting and standing up straight with the shoulders, back, and hips aligned.
• Diet changes: Consider avoiding foods that increase inflammation, such as refined sugars, junk foods, and fast foods.
• Stay active: Regular exercise can help improve the strength and flexibility of the spine, pelvis, and hips. Depending on your SI joint pain severity, you may want to start slow and consider low-impact exercises, such as walking and swimming.
• An SI joint brace: A brace or SI joint belt might help to reduce SI joint pain. These belts compress the pelvis and limit the movement of the SI joints.
• Avoiding activities that cause pain: Avoiding activities that worsen SI joint pain or lead to sacroiliitis can reduce pain and prevent inflammation.

Medications That Target Sacral Back Pain

If your SI joint pain cannot be managed with self-care and at-home treatments, your healthcare provider might recommend medications to manage pain and inflammation.

Medications that might help target SI joint and sacral back pain include:

• Prescription NSAIDs
• Muscle relaxers to relax tense muscles and reduce muscle spasms
• Oral and injected corticosteroids to help reduce inflammation
• Disease-modifying antirheumatic drugs (DMARDs) to manage inflammatory conditions like AS and rheumatoid arthritis (RA)

Surgery for Severe SI Joint Dysfunction

Surgery is a treatment of last resort for SI joint dysfunction. It is considered after you have tried all the nonsurgical options available and are still experiencing severe pain that affects walking and your ability to perform daily activities.

Surgery to treat SI joint problems is typically an outpatient procedure that involves the insertion of titanium implants across the SI joint to provide stability.

Recovery and Long-Term Management

Your recovery time will depend on the surgical approach, the severity of symptoms before the surgery, your overall health, and your surgeon's preference for rehabilitation.

Following surgery, you will be given information and advice on walking, resuming daily activities, and what activities and movements you need to limit and for how long. You may still have pain and symptoms following the surgery, but these should improve within a few weeks.

Depending on your pain levels and the healing of the surgical site, physical therapy typically begins six to 12 weeks later. Full recovery can take up to six months, and during that time, your healthcare provider will want you on nonsurgical therapies (i.e., pain medications, activity modification, and physical therapy).

Gentle Stretches and Exercises

Research shows that focusing on key muscles and muscle groups can best treat and improve SI joint pain. For example, the hamstring (a muscle at the back of the thigh) provides stability to the SI joints because of its direct connection to ligaments involved in joint stability.

Exercises should also focus on assessing and addressing weaknesses of the SI joints and nearby muscles and muscle groups.

Following are seven gentle stretches and exercises to try for SI joint symptoms.

Knee to chest: This exercise helps strengthen the muscles of the lower back, hips, and buttocks. It is performed as follows:

1. Start by lying flat on your back.
2. Grab your left knee and pull it forward to the chest until you feel the stretch in the back of your leg.
3. Hold for a minute, and then relax the bent leg.
4. Repeat with the other leg.

Double knee to chest: This involves both knees. It is performed in this way:

1. Lie face up and grab both knees.
2. Pull them toward your chest as far as possible without lifting your back off the floor.
3. Hold for at least one minute.

Quadriceps stretch: This exercise stretches the quadriceps and muscles around the hips and knees. Its steps include:

1. Support yourself using the back of a chair or a wall with one hand and bend the opposite knee.
2. Grab the leg above the ankle and pull backward to the buttocks, letting that knee fall toward the other.
3. Keep your belly tight, with your buttocks tucked and hold this position.
4. Relax and then switch legs.

Seated hamstring: This exercise stretches the hamstrings, hips, and calves. It involves:

1. While on the floor, sit up straight, with your legs extended in front of you.
2. Bend one knee and let that leg fall out to the side.
3. Bend forward using your hips. with your chest and chin up.
4. With your toes pointed up toward your nose on the extended leg, reach toward your toes.
5. Hold and then switch legs.

Seated butterfly: The seated butterfly stretches the inner thigh, groin, knee, and hip muscles. Do it as follows:

1. While on the floor, sit up straight and tall, with your knees bent.
2. Drop your legs to the side (keeping your knees bent), and bring the soles of your feet together.
3. Grab your ankles and slowly lean forward, with your spine straight.
4. Place the elbows on the tops of the thighs and press down until you feel the stretch.

Cat-cow stretch: This stretch can keep the spine mobile. It involves:

1. Start on your hands and knees with the knees under the hips and your hands just over your shoulders.
2. Round your back up to the ceiling with your head down slightly and buttocks turned in.
3. Come back to your original position.
4. Let your tummy lower toward the floor while arching your back and keeping your head up slightly with your eyes straight ahead.
5. Alternate between the two poses.

Seated spinal twist: This stretch improves posture and spinal mobility. Do it in this way:

1. Sit on the floor with your legs extended.
2. Bend your right knee up and put your right foot on the outside of your left leg.
3. Sit up straight and tall while hugging the right knee to the chest.
4. Gently twist to the right at the hips while looking over your right shoulder.
5. Hold for five breaths.
6. Relax and repeat on the other side.

Physical Therapy

Physical therapy can help manage SI joint pain with exercises that improve the strength and flexibility of the spine, hips, and pelvis. A physical therapist can help you find safe and practical exercises to best manage symptoms and pain. Continuing with a home exercise program might prevent symptom recurrences.

Chiropractic Care

A chiropractor can diagnose and treat SI joint dysfunction. They use spinal manipulation techniques to help relieve pain and improve mobility and function.

Manual manipulation therapies used by chiropractors have been reported to reduce pain and disability as soon as one month after treatment. This includes both hand and instrument techniques used by chiropractors to treat lumbar spine problems.

Spinal manipulation has risks, including fracture, disk herniation, and blood vessel dissection. Chiropractors are not physicians.

Specialists Who Understand SI Joint Dysfunction

Your primary healthcare provider is the first person you might see if you are experiencing low-back, hip, groin, and buttock pain. After getting a complete medical history, including symptoms experienced, a physical exam, and imaging, your provider may refer you to another specialist to confirm and adequately treat you.

Depending on the results of such testing, you may be referred to a rheumatologist, orthopedist, physical therapist, or pain management doctor, whose specialties include:

• Rheumatologist: A rheumatologist is a healthcare provider who specializes in diagnosing and treating inflammatory diseases like AS and RA that cause systemic inflammation. If your SI joint pain is caused by inflammatory arthritis, your rheumatologist will prescribe treatments to reduce inflammation and manage underlying causes of sacroiliitis and SI joint pain.
• Orthopedist: An orthopedist specializes in diagnosing and treating musculoskeletal system conditions. This provider can diagnose and treat SI joint dysfunction and might be your best option for managing SI joint pain not related to inflammatory arthritis.
• Physical therapist: A physical therapist can offer various nonsurgical therapies to help you manage pain and build strength in the pelvis, spine, and hips. You can also work with a physical therapist to rebuild your strength after surgery.
• Pain management doctor: A pain management professional can offer advanced treatment techniques to help you avoid surgery. Treatments include steroid injections, pain medicines, behavioral therapies, and alternative therapies like acupuncture and spinal manipulation. Some of these therapies might also help you recover quicker after surgery.

A diagnostic method that can help confirm SI joint dysfunction involves the injecting a numbing medicine into the affected SI joint. If the injection brings relief, the SI joint is likely the source of pain. If it does not, other tests will be done to ascertain the cause of your symptoms.

A second helpful test is an arthrogram, a type of joint X-ray that uses a contrast dye injected into a joint to take detailed images of the SI joint. It is sometimes used with an SI joint injection.

Summary

The SI joints are the small and robust joints next to the sacrum and the iliac portion of the pelvic bone. They act as shock absorbers for the lower back and hips. Sometimes, these joints can cause pain due to arthritis conditions, degeneration (older age), trauma, repetitive stress, pregnancy, abnormal walking patterns, and other causes.

Pain is the main symptom and typically affects one side of the body. Sometimes, the pain is sharp and stabbing. It might start in the hips and pelvis and radiate into the back and legs. While rare, SI joint dysfunction can also affect both sides of the lower body.

SI joint pain is triggered by activities involving the lower back, hips, pelvis, and legs, such as walking, climbing steps, and getting up after sitting for a long time. If you work in certain occupations, such as heavy labor jobs and those that require a lot of sitting or standing, you are at a higher risk for SI joint problems.

SI joint dysfunction is a manageable and treatable condition. Surgery is rarely needed. You can manage it at home with OTC pain relievers, ice and heat therapy, improving posture, making dietary changes, and using an SI joint brace, as well as with physical therapy. You will also want to avoid activities that worsen pain.

Your healthcare provider can prescribe medications to treat pain and its underlying cause, such as inflammatory arthritis.Physical therapy and chiropractic care can help relieve pain and reduce misalignment of the SI joint. A physical therapist or a chiropractor can also educate you on gentle exercises and stretches to reduce and prevent further pain.

Contact your healthcare provider if you are experiencing low-back, hip, or pelvic pain. They can perform tests and refer you to the appropriate specialists to help you manage pain and other symptoms of SI joint dysfunction.