Low Back Pain: Is the Sacroiliac Joint to Blame?

Andrew Fanous, MD, is a board-eligible neurosurgeon. He has a special interest in surgical management of spine disorders and tumors.

It’s an uncomfortable fact of life: About 8 in every 10 people will experience back pain at some point in their lives. That pain can be debilitating and interfere with work and other daily activities.

Many different problems can lead to back pain, so it can be challenging to pinpoint the culprit. But in as many as 30% of cases of low back pain, the sacroiliac joint is to blame.

Never heard of it? You’re not alone. Nicknamed the SI joint, the sacroiliac is often overlooked as a potential source of pain. Here’s what you should know about SI joint pain — and how to treat it.

What is the SI Joint?

The SI joint connects the lower part of the spine to the pelvis. It plays an important role as a shock absorber, transferring weight from the upper body to the legs.

Sometimes, the SI joint becomes inflamed, causing pain on one or both sides of the lower back. The pain can radiate into the hips and, sometimes, even down the legs.

 SI joint pain strikes both men and women. It is more common in people who:

• Are pregnant or postpartum (due to changes in the ligaments during pregnancy)
• Are overweight and/or sedentary
• Have arthritis
• Have experienced injuries to the spine, including significant trauma (such as from a car accident) or more minor injuries (such as lifting a heavy object or twisting the wrong way)
• Have had previous spinal fusion surgery

Diagnosing Sacroiliac Joint Pain

It can be hard to figure out what’s causing your back pain without a doctor’s input. If your doctor presses on the area of the SI joint and you feel a sharp pain, that’s one clue that the joint may be involved.

To diagnose SI joint pain, your doctor will guide you through a series of 5 physical tests during your office visit. If at least 3 of those 5 movements cause pain, there’s a good chance the SI joint is causing your pain.

In these situations, we often inject an anesthetic into the joint. If the medication relieves the pain by 50% or more, it’s very likely that the SI joint is the source of your pain.

SI Joint Pain Treatments

When a patient has SI joint pain, we try simple treatments first. These include:

• Anti-inflammatory medication
• Physical therapy
• Supporting the joint with a brace
• Steroid injections

For some patients, these treatments work to manage pain. But when patients continue to have discomfort, we recommend surgery for a long-term fix.

SI Joint Fusion Surgery

During SI fusion surgery, we place grafts onto the joint that lock it in place and prevent it from moving. Since the joint doesn’t have much range of motion normally, the procedure has no effect on a patient’s ability to walk, run or engage in physical activity.

Of course, we don’t want to perform surgery on people who won’t benefit from it. That’s why we try more conservative treatments first. And before we suggest surgery, we undertake a detailed diagnostic process to make sure that the SI joint is the true cause of the pain.

The surgery itself is minimally invasive, requiring only one small incision. It takes less than an hour, and patients usually go home the same day.

Studies have found that more than 90 percent of people express satisfaction and significant pain relief after SI fusion surgery. The use of pain medication has been also shown to drop significantly after SI fusion surgery.

Back Pain Treatment Experts

Nobody should have to let back pain rule their life. If you are experiencing low back pain, we can help determine if it’s related to the SI joint or some other cause — and help find the right treatment options to ease your pain and get you moving again.

Read more information about the Inova Spine Program, or call 703-776-4700 to learn about our world-class treatments for back and neck pain.