Sacroiliac Joint Pain

Anatomy

The right and left sacroiliac joints are located at the base of the spine, between the sacrum and the adjacent right and left hip bones (iliac bones). Two major ligaments hold each sacroiliac joint together:

  • The iliolumbar ligament stretches from each iliac crest to its adjacent fourth and fifth lumbar vertebrae, bilaterally.
  • The sacroiliac ligament stretches from the sacrum across to its adjacent iliac spinal process, bilaterally.

Causes of Sacroliac Sprain Injury

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Strain and sprain of the two ligaments of the sacroiliac joint are common causes of low back (lumbar), sacral, and other pelvic pain. Sacroiliac joint pain is usually due to:

  • Postural wear-and-tear—by far the most common cause—and
  • Traumatic injury (e.g. a vehicular accident, a ski fall, a horse riding accident, a parachute landing fall mishap, a yoga training accident).

Sacroiliac joint ligament sprain injuries are usually bilateral, even though the low back pain may be more pronounced on one side than the other.

The low back pain related to sacroiliac joint ligament sprain is commonly accompanied by misalignment of one or more of the following:

  • The sacroiliac joints—usually bilateral
  • Other pelvic bones and joints—or
  • Lumbar vertebrae

Pain Symptoms

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The dull to sharp low back pain generated by sacrolilaic joint dysfunction can be very localized directly over the most problematic sacroiliac joint—or both. Often, there is an associated lumbar vertebral pattern with low back pain and paralumbar muscular spasm. Often, the ligament pain of SIJ sprain injury spreads or projects in a shooting, radiating pain pattern that can often be confused with neuropathic “sciatica” of degenerative disc nerve root compression.

Other Physical Findings

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Sacroiliac joint pain is often accompanied by:

  • Restricted mobility
  • Difficulty sitting or standing for extended periods—or
  • Difficulty walking or twisting.

Other physical findings usually associated with sacroiliac joint sprain and misalignmen include:

  • A functionally short leg accompanied by a slight limp and leg abduction weakness—and
  • Compensatory scoliosis with its usual pain patterns, including shoulder drop; and back, neck, and head strain.

Treatment

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Treatment of sacroiliac joint sprain pain is often coordinated with treatment of a co-existing lumbar ligament sprain. Osteopathic Manual Therapy (OMT) often can resolve sacroiliac joint misalignment. In about 30% of the cases (1), OMT can produce a stable pelvis without having to resort to any further types of treatment.

However, if the misalignment repeatedly reoccurs following treatment, then there is undoubtedly a sacroiliac ligament sprain, which is readily treated by Prolotherapy—the definitive treatment for such an injury. Prolotherapy is directed to sacral and iliac ligament attachments—depending on the patient’s history and findings on examination and X-ray.
Platelet-Rich Plasma (PRP) Therapy would be more appropriate if there is significant ligament or tendon tearing.
Wearing a Sacroiliac Belt may be helpful during initial stages of Prolotherapy treatment to stabilize a lax sacroiliac joint and minimize pain. It helps to maintain reduction of the sacroiliac misalignment, keeping the joint in place between treatments. This is useful, especially, when the dysfunctional joint pain is unbearable during course of Prolotherapy.
Occasionally, the presence of a coexistent anatomically (developmentally) shortened leg needs to be determined and treated with appropriate orthotic prosthetic devices.

If there is evidence of a significant neurological component to the sacroiliac joint dysfunction, appropriate neurological tests and consultations may be necessary, as well.

CAUTION: The pain related to sacroiliac sprain injury can mimic that of neuropathic sciatica caused by degenerative disc disease. Therefore, only a through physical examination and radiological interpretation can differentiate between the various musculoskeletal versus neuropathic causes of such pain—regardless of what an MRI imaging study may show. In the event of a “Perfect Storm” when there is a collision of both severe sprain injury and disc compression producing very acute, severe symptoms, definitive neurological testing and surgical consultation may be required.

References

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1. Clark GB. Building a Rationale for Evidence-Based Prolotherapy in an Orthopedic Medicine Practice. Part IV. Diagnosing Linked Prolotherapy Targets by Applying a Data-based Biotensegrity Model. J Prolo, 3(3) August; 722-735;2011.

Sacroiliac Joint Pain Symptoms

Gary B. Clark, MD, MPA | 1790 30th Street, Suite 230, Boulder, CO | (303) 444-5131