Is Your Lower Back Pain Actually Sacroiliac Joint Pain?
Dr. Nabil Ebraheim is an orthopaedic surgeon practicing in Toledo, Ohio. Dr. Ebraheim specializes in the diagnosis, treatment and rehabilitation of injuries, diseases and disorders of the bodys musculoskeletal system. As an orthopaedic surgeon, Dr. Ebraheim tends to bones, ligaments, muscles, joints, nerves and tendons.... more
A large percentage of patients with lower back actually suffer from sacroiliac joint related problems. Pain of the sacroiliac joint is an underrated problem: that's because it often stimulates other conditions associated with the lower back, spine, and hip.
Often times, sacroiliac joint pain is overlooked. Symptoms of pain originating in the sacroiliac joint include low back pain, buttock and thigh pain, and difficulty and discomfort while sitting. Patients experiencing these symptoms can spend months or even years in treatment without the correct diagnosis. There is only one way to confirm the diagnosis, which is injection of the sacroiliac joint.
The lumbar spine is connected to the sacrum, and the sacrum is connected to the ilium through the sacroiliac (SI) joints. These SI joints are weight bearing joints which distribute weight from the spine to the lower extremities through the hip joints. Ligaments of the sacroiliac joint include the anterior sacroiliac ligaments and, most importantly, the strong posterior SI ligaments. Finally, there is a muscle, called the piriformis muscle, which attaches to the trochanter of the hip and the sciatic nerve that sits in front of the piriformis muscle.
Irritation of the sciatic nerve by the piriformis muscle is called piriformis syndrome and is often caused by sitting for long periods of time or climbing stairs. Other conditions that stimulate sacroiliac joint pain can be broken down by location: either the hip or the spine. Conditions associated with the hip include trochanteric bursitis and the above mentioned piriformis syndrome. Conditions of the spine include myofascial pain, lumbosacral disc herniation or bulge, and lumbosacral facet syndrome
SI joint pain is usually under-diagnosed and can be mistaken for other causes of back pain. Thankfully, there is a test which can help diagnose sacroiliac joint pain. Faber test is helpful but not specific in determining the presence of sacroiliac joint problems. To administer this test, the patient lies supine with the leg of the affected side externally rotated and abducted, and the foot of the affected side is placed on the opposite knee. Then, the flexed knee is pressed upon firmly but gently, testing the opposite anterior superior iliac crest. If there is pain in the sacroiliac area, this indicates a problem with the SI joint. Patients should also be checked for leg length discrepancy, as this can cause SI joint pain.
Unfortunately, clinical examination and radiological studies may not be reliable in the diagnosis of SI joint problems. Again, the best way to properly determine that the pain originates in the SI joint is by an injection. If the pain improves after the injection into the SI joint, then the pain can be attributed to the SI joint
Most sacroiliac joint pain is due to mechanical dysfunction. Normally, there will be slight microscopic movement of the joint measuring only a few degrees. However, movement of the joint increases with wear or injury to the ligaments of the joint, which can present as pain.
Treatment for sacroiliac joint pain include anti-inflammatory medications, physiotherapy, use of an SI joint brace, steroid injections, radio-frequency ablation, or SI joint stabilization or fusion (surgery).
