Is my lower back pain coming from my sacroiliac joint?

James Viapiano, MD

Pain Medicine

Those who struggle with mild, moderate or severe pain in the lower back have probably seen sciatica, or lumbar disc herniation, listed as a possible reason for their discomfort. But it’s rarer to see sacroiliac joint pain, or SI joint pain, listed as a potential cause.

James Viapiano, MD, who specializes in pain medicine, explained how sacroiliac joint pain develops, what symptoms to watch for and what treatments can bring relief.

What is the sacroiliac joint?

“The sacroiliac joint is a diathroidal joint,” Dr. Viapiano said, “like an elbow, hip, or knee joint.”

At each side of the hipbones there is a narrow joint where those bones meet the sacrum, or the lowest part of the back and pelvis. Strong ligaments, a fibrous capsule and a fluid called synovial fluid all ensure that these ligaments can carry the entire weight of a human body.

In fact, the sacroiliac joint is so strong that it’s possible for the hipbones or pelvic bones to fracture before the sacroiliac ligaments are damaged enough to tear.

What causes SI joint pain?

“There are a few kinds of SI joint pain,” Dr. Viapiano said. “We see some overlap in the events that cause different kinds of pain.”

Causes of sacroiliac joint pain include:

• Motor vehicle accidents
• Slips and falls
• Lifting or twisting
• Vaginal childbirth
• Pregnancy
• Previous lumbar spine surgery, which can cause sacroiliac joint degeneration
• Joint stresses caused by leg length differences, joint replacement, or scoliosis
• Osteoarthritis
• Previous iliac crest bone graft
• Prior infection of the sacroiliac joint

What are the symptoms of sacroiliac joint dysfunction or damage?

“The main symptom is pain,” Dr. Viapiano said. “How that pain shows itself is really where the differences lie.”

SI joint pain may only occur on one side of the body, or it may be on both sides. For mild or moderate cases, this pain is usually focused right around the ‘dimple,’ or dip in the posterior hip area near the pelvis.

More severe cases may involve pain that is felt throughout the pelvic and posterior area and even down into the thigh. It’s not common, but in some cases, patients have had pain all the way to their feet.

“It’s not uncommon for pain to worsen when moving from sitting to standing or climbing the stairs, or to feel stiffness when either sitting or walking for a long time. Any transitional movement like that can aggravate an already painful joint problem,” Dr. Viapiano said.

Unfortunately, this significant cause of lower back pain is often missed, as its symptoms may mimic or overlap with pain caused by other joints in the lower back or nerves from the spine. This is one reason it’s often initially thought to be caused by sciatica.

What is the treatment for sacroiliac joint pain?

The main treatment for SI joint pain is physical therapy, including stretching and a stabilization exercise program. Using sites like Spine-Health.com, you can often perform versions of these exercises from the comfort of home. In a severe case that doesn’t respond to other treatment, trans-sacroiliac joint fusion or a transcutaneous electrical nerve stimulation (or TENS) may be helpful.

Otherwise, the direct cause of the joint degeneration or dysfunction will often be targeted. For example, a pelvic stabilization belt can help during pregnancy and corrective footwear for leg length discrepancies help to relieve joint stress as well.

“Image-guided joint injection, either with or without steroids, may be used to help with diagnosis or for a therapeutic intervention,” Dr. Viapiano said. “Radiofrequency ablation, a minimally invasive way to essentially stop the affected joint from sending those pain signals to the brain, may also be used for persistent pain.” 

How can I treat sacroiliac joint pain at home?

While it’s important to see a doctor about your persistent SI joint pain, there are some steps you can take to minimize your discomfort at home.

Extra-strength Tylenol or NSAIDs like ibuprofen can help with the pain, but only take these if you’re not taking any medications that might have negative interactions or contraindications.

Heating pads or cold packs may provide temporary relief from painful inflammation.

Finally, keep moving. Don’t try to go on bed rest or spend your time sitting or lying down – both things can actually make the problem worse, as well as causing added stiffness once you are up and moving again. Take short, easy walks, making sure that you’re gently encouraging your body to maintain your usual level of activity, or even a little more.

And, of course, schedule an appointment with your primary care physician (or pain specialist if you are seeing one) to discuss your sacroiliac joint pain and what you can do to treat it.