What is Sacroiliac Joint Dysfunction?
The sacroiliac joint, or SI joint, straddles the two main bones in the pelvic area — the sacrum and the ilium — and connects the spine to the pelvis. Shaped like a triangle, the large sacrum bone sits at the base of the spine, while the ilium is the uppermost part of the hip bone.
SI joint dysfunction occurs when this joint becomes unstable or inflamed, causing back, pelvic, groin, and hip pain. The condition typically results from inflammation (sacroiliitis) due to aging, or too much or too little movement. Pain may be particularly acute when you stand up after sitting, walk up a hill or stairs, or twist your body in bed.
How is SI Joint Dysfunction Diagnosed?
To identify whether SI joint dysfunction is the source of back pain, a combination of physical and imaging tests are used. The physical exam entails putting pressure on the sacrum or hips; if the pain worsens or goes away temporarily, then SI dysfunction may be at the root of the discomfort.
Since SI joint dysfunction isn’t typically spotted on an X-ray or MRI, an orthopedic specialist can diagnose the condition by injecting a local anesthetic into the lower back or buttocks. If the pain subsides significantly, then the ache was most likely caused by a compromised SI joint.
What is Sacroiliac Joint Fusion?
If sacroiliac joint pain does not respond to physical therapy or medication, the next step may be sacroiliac joint fusion surgery. To begin this minimally invasive procedure, the surgeon makes a small incision in the side of the buttocks. This opening allows the surgeon access to the hip bone.
After drilling a hole into the sacrum and ilium, the surgeon stabilizes the sacroiliac joint with either an implant, a bone graft, or both. For a bone graft, bone shavings from the ilium are collected to fill the space after the cartilage and soft tissue are removed from the joint. Both methods are intended to promote bone growth and strengthen the joint as the implant or grafted fragments fuse with the bones.
Recovery Time for Sacroiliac Joint Fusion
Full recovery from sacroiliac joint fusion surgery typically takes up to six months. For four weeks following the procedure, patients may be advised to use a cane or walker. Your doctor may also recommend wearing a pelvic brace to relieve pressure on the joint and ensure it fuses properly.
A physical therapy program of stretching and strengthening exercises can build up your range of motion as well as increase strength in the core muscles, lower back, and legs. Aerobic activities such as swimming, walking on an elliptical machine, or pedaling a stationary bike may be incorporated into your fitness regimen later.
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Sacroiliac Joint Dysfunction: FAQs
What is sacroiliac (SI) joint dysfunction and what causes it?
Sacroiliac joint dysfunction occurs when the SI joint — which connects your spine to your pelvis — moves too much (hypermobility) or too little (hypomobility), causing pain in the lower back, buttocks, or groin. Common causes include injury or trauma, arthritis, pregnancy, poor posture, leg length differences, or repetitive stress.
What are the symptoms of SI joint dysfunction, and how is it diagnosed?
Symptoms often include pain in the lower back or buttocks; sometimes it radiates into the hip, groin, or leg. Pain often worsens with prolonged sitting, standing, walking, or changing positions. Diagnosis involves a medical history, physical exam with provocation tests, ruling out other causes, and sometimes imaging or diagnostic injections.
What treatments are effective for SI joint dysfunction?
Treatment usually starts conservatively: rest, ice or heat, NSAIDs, activity modification, physical therapy to strengthen core, hips, and pelvic muscles, manual manipulation, or use of supports/devices. When conservative care isn’t enough, options may include injections (corticosteroid), radiofrequency ablation, or in select cases, SI joint fusion.
How long does it take to recover, and what can I do to improve healing?
Recovery varies depending on severity, cause, adherence to treatment, and whether surgery is needed. Many patients begin to feel some relief within several weeks of conservative therapy. Full recovery, especially after surgical intervention, may take several months. To support healing, follow physical therapy, avoid aggravating activities, maintain proper posture, and use ergonomic adjustments.
