Are you feeling pain in your hips, groin, and buttocks? It could be SI joint pain. But what is the SI joint and why is it hurting? We’ll discuss the answers here so you can better manage the pain brought about by SI joint dysfunction. First, we’ll understand where the SI joint is found in the body and know how it works. Next, we’ll know more about SI joint dysfunction for you to have a good understanding as to why that part of your body hurts. We’ll also discuss how SI joint pain is diagnosed what are the treatments available for SI joint dysfunction.

What is the SI Joint and Where is it Found in the Body?

The SI joint or sacroiliac joint is found in your pelvis. This joint is the linking point of the pelvis or iliac bone and the sacrum. The sacrum is the spine’s lowest part, found just above your tailbone. The SI joint functions to transfer forces and weight between the legs and the upper body. It is a vital part when it comes to the transfer of energy between your torso and legs.

How Does the SI Joint Function?

There is a network of muscles and ligaments that make it possible for the SI joint to be stable. They also help in limiting motion. The normal motion of the SI joint is at around 2 to 4 mm at any direction. Men have more stiff ligaments in the SI joint compared to women. Women need this mobility for childbirth. The primary motion of the joint is rotation. This decreases as we grow older. With pregnant women, the motion is increased.

SI Joint Pain: Why is it Hurting?

Now that you have an idea of the SI joint, where it’s located and how it functions, you will have an easier time understanding how the joint can degenerate or get injured. In this section, we’ll delve deeper into the causes of sacroiliac join pain commonly felt in the pelvic area.

What Causes SI Joint Pain?

SI joint injury or strain can be caused by rapid rotation, vertical compression, or a combination of the two. An example of this is when you carry heavy objects. You may also have an SI joint injury if you fall on your backside. Such injuries can develop ligamentous laxity. This means the joint gets to move in an abnormal motion which causes pain.

When you’ve recently had a lumbar spine surgery, it can also be the cause of the SI joint pain. It could be that the ilio-lumbar ligament has been injured in the process. Other reasons for SI joint pain are scoliosis, traumatic birth, trauma, vigorous exercise, gait abnormalities, and discrepancy of the leg length.

If you have TB, gonorrhea, staphylococcus, and other infections, you may also experience pain in your SI joint. Autoimmune disorders can also cause the pain. Some examples of autoimmune disorders are psoriatic arthritis, Reiter’s Syndrome, juvenile rheumatoid arthritis, and ankylosing spondylitis.

What are the Symptoms of SI Joint Dysfunction?

Some of the symptoms associated with SI joint dysfunction are pain in the lower back, pain in the groin, buttocks, and hips, as well as stiffness and instability of the lower back.  The pain that you feel in your lower back if you have SI joint dysfunction feels aching and dull. It can be mild while some cases may be more severe. Usually, you’d only feel the pain on one side. However, there are also cases where pain is apparent on both sides.

The pain that is felt in the hip area, along with the areas of the groin and buttocks are common areas where the SI joint pain is felt. It can also be felt on the side and upper back of the thigh. The pain may also be present on one side only or on both sides. Stiffness of the lower back is another symptom of SI joint pain. With this, your lower back’s range of motion is reduced. You can also feel the stiffness in your groin, pelvis and hips. You’ll find that it’s difficult to bend at the waist or climb the stairs, running, or even if you put weight on one side of your body.

How is SI Joint Dysfunction Diagnosed?

SI joint dysfunction cannot be diagnosed with one test alone. That’s why it’s important that you have several diagnostic tests so that the doctor can have a better picture of your condition. A combination of the results of the tests can help in arriving at a more accurate diagnosis. There are times that it will be difficult to diagnose SI joint dysfunction. This is because it may seem like other conditions such as facet joint arthritis, lumbar herniated disc, and others.

Getting a Medical History and Physical Exam

The first thing that is done when diagnosing SI joint pain is getting the patient’s medical history. This includes as much information as the doctor can get about the current symptoms that the patient is experiencing. Other than that, information on injuries, activities, sleep, and diet will also be considered in the diagnosis.

Once the patient’s medical history has been collected, the next step to follow is a physical exam. There is a way to confirm if the SI joint is the source of the pain that the patient is experiencing. This is through a sacroiliac joint injection. With this procedure, a numbing solution which is typically bupivacaine or lidocaine, is injected into the SI joint. If the patient feels relief from the pain, then it can be known for sure that the SI joint is the pain source.

Diagnostic imaging like MRI, CT scans, and X-ray are also used so that the source of the pain can be determined. Diagnostic imaging, while less invasive, cannot accurately determine the pain source. The best way to diagnose SI joint dysfunction is a combination of all these tests, especially the injection tests.

How is SI Joint Pain Treated?

The treatments available for SI joint pain are usually focused on relieving the pain that the patient is experiencing. Also, the treatments aim to restore the normal motion of the SI joint. For most of the SI joint dysfunction cases, surgery is not necessary as the nonsurgical treatments are effective enough to correct the condition.

Hot or Cold Compress

Initially, SI joint pain can be treated by allowing the patient to have a rest period. One to two days is enough for this. More than two days may make the stiffness of the joint worse. Next, heat or ice may be applied to the patient’s pelvis and lower back. This helps in reducing inflammation and alleviating discomfort and pain. Heat can help in reducing spasms and muscle tension.

Medication for Pain

There are pain relievers that are available over the counter. Acetaminophen is an example of this pain reliever. Naproxen, ibuprofen, and other NSAIDs are also available for SI joint pain treatment. If the pain is only mild or moderate, you may opt for these over the counter meds. However, if the pain is severe, have an appointment with your doctor and ask if you should have prescription meds that can combat acute and severe pain.

Braces and Supports

If the SI joint is hypermobile or too loose, then the doctor may recommend for the patient to wear a pelvic brace. This brace is like a wide belt. It can help the patient especially when the SI joint is really painful and inflamed. The brace will make the SI joint and its surrounding areas more stable. When wearing braces or supports, don’t forget to ask your doctor on the recommended length of time you should be wearing them. If you have to wear them for 16 hours, for example, make sure that you follow it. This will make the treatment an effective one.

Final Thoughts

There are other treatments for SI joint pain. Before trying any of the treatments, make sure that you get an accurate diagnosis of your condition. When you feel pain in your pelvic area, go to your doctor so that a diagnosis can be made. Don’t be afraid to ask your doctor questions. Also, provide as much information as you can about your symptoms so that it can be determined if what you have is SI joint pain.

Dr. Flory

Dr. Tymothy L. Flory graduated from Logan College of Chiropractic in St. Louis, Missouri. Before opening Atlas Brain Spine, Dr. Flory practiced Upper Cervical Chiropractic in Seattle, Washington. Dr. Flory completed Board Certification of the National Upper Cervical Chiropractic Association in 2012 and is currently a Credentialed Instructor for the organization.