What is sacroiliitis?
An inflammation of one or both sacroiliac joints is known as sacroiliitis. This condition happens when the lower spine and pelvis connect. In other words, we can say that a sacroiliac joint is the union of the sacrum and ilium. The sacroiliac joint is bound by thick ligaments distributing the weight from the upper body and spine to the legs and pelvis.
A sacroiliac joint disorder can either be unilateral or bilateral, affecting one or both the joints. One can experience pain in the lower back or buttocks that further extends down to one or both legs. This pain is difficult to diagnose since it often gets mistaken for other causes of lower back pain. Standing for a longer period of time or climbing stairs at times can worsen this condition. Any pain caused by sacroiliitis means that there is either too much or not enough motion in the sacroiliac joints.
Sacroiliitis is often interchangeably termed with sacroiliac joint dysfunction as they both have similar symptoms. Sacroiliitis belongs to a group of inflammatory disease. Being a part of other form or type of arthritis such as ulcerative colitis.
The main function of sacroiliac joints is to provide shock absorption for the spine through a gliding type motion.
Sacroiliitis pain is often confused with sciatica. Sacroiliitis is closely linked to spondyloarthropathies, which can also be seen in the course of both non-rheumatic and rheumatic diseases.
Causes of Sacroiliitis
The various causes for sacroiliac joint pain include the following:
- Infection – In a few cases, the sacroiliac joints get infected, which leads to inflammation. However, sacroiliac joint pain due to an infection is rare.
- Arthritis – Osteoarthritis or wear and tear arthritis can occur in the joints. It is a type of inflammatory arthritis that affects the spine.
- Pregnancy – It is one of the contributory factors in sacroiliitis. Due to the added weight during pregnancy, it causes stress on the joints that lead to an abnormal wear. These joints must loosen to accommodate the upcoming childbirth. The ligaments that connect one bone to another at times would become inflamed or torn. If these ligaments tear, then it causes too much motion, which ultimately results in chronic pain. Moreover, improper walking and wrong body positioning can greatly affect the sacroiliac joints.
- Injury – Accidents such as a heavy impact road accident or fall can also damage these sacroiliac joints.
- Lifting heavy objects – When you incorrectly lift something, the muscles are not prepared for the activity. Hence, you may experience lower back pain.
- Obesity – The heavy weight of an individual also causes sacroiliac joint pain. The only solution to get rid of the pain is to maintain a healthy weight according to one's body mass index (BMI).
Other causes that lead to sacroiliac pain:
Symptoms of Sacroiliitis
An individual suffering from sacroiliitis may come across the following signs:
- Pain and stiffness in the thighs, lower back, and buttocks
- Pain that extends to the hips and shoulders
- Pain while walking (since the swinging motion causes strain in the sacroiliac joints)
- Skin inflammation
- Inflammation in one or both eyes
The pain in the sacroiliac joints can worsen due to:
- Prolonged standing
- Constantly climbing stairs
- Sitting at one place for a longer time
- Bearing the weight of your body completely on one leg
- Sudden change of one's position from being seated to standing
The sacroiliac joint pain can extend to the groin, legs, and feet. At times, sacroiliitis pain is felt on one side of the buttocks. This pain starts from being mild and then moving on to moderate pain.
How different is ankylosing spondylitis from sacroiliitis?
Ankylosing spondylitis is a type of arthritis that affects the spine. The symptoms include stiffness from the neck down to the lower back, a bony fusion that may lead to an overgrowth of the bones leading to an abnormal joining of these bones, and severe ligament and tendon pain. The symptoms may turn from mild to severe. Diagnosing this condition at an early stage helps in bringing out the correct treatment to reduce the stiffness and prevent deformity.
The symptoms tend to worsen during the early morning hours, which leads to a sleep disturbance for the affected individual. All patients who have ankylosing spondylitis should undergo physical therapy that is similar to sacroiliitis. Physical therapy helps to improve spine mobility and physical functioning. The long-term treatment of ankylosing spondylitis aims to preserve a person's physical functioning and improve the quality of life both at home and work.
Sacroiliitis is the inflammation of the sacroiliac joints, which is a very common thing in ankylosing spondylitis. However, the thing to note is that sacroiliitis is not just specific to ankylosing spondylitis. Sacroiliitis can also be seen in other inflammatory arthritis. Hence, it does not necessarily mean that if someone has sacroiliitis, that person also has ankylosing spondylitis.
Diagnosis of Sacroiliitis
Your doctor will try to identify the cause of pain by moving your legs in different positions and to gently apply stress on the joints. They may also press the areas around your hips and buttocks. During the initial stages, it becomes difficult for the doctors to diagnose sacroiliitis because the conventional methods of radiographs may show normal results.
Various techniques currently used to diagnose sacroiliitis include:
- Computed tomography (CT)
- Magnetic resonance imaging (MRI)
- Blood tests
- Anesthetic injections or numbing
- Conventional method tomography
Here are some more details about a few of the diagnostic tools for sacroiliitis:
1) Anesthetic injections – A numbing injection is administered into your sacroiliac joints. If this injection stops the pain, then the problem lies in your sacroiliac joints. However, this test is not completely reliable since there are chances of this medicine leaking into nearby areas.
2) Imaging tests – The doctor would suggest a pelvic X-ray to identify the damage in the joints. The doctor may recommend an MRI if he or she suspects ankylosing spondylitis. The sacroiliac joints are located deep in the buttock region, which is covered with thick muscle. Hence, an X-ray is conducted to better visualize the joints. Imaging tests are reliable in identifying any inflammation of the sacroiliac joints.
3) Magnetic resonance imaging (MRI) – The MRI has the ability to differentiate the degrees of inflammation and localized edema. It is a good visualization of the complex anatomy of the sacroiliac joint. At times, an MRI is enough to diagnose and verify the severity of the condition.
4) Computed tomography (CT scan) – This method is good at reflecting the established changes in the bones.
5) Blood tests – These tests are usually recommended by your doctor if he or she suspects an existing infection that contributes to the inflammation.
Treatment of Sacroiliitis
The treatment for sacroiliitis helps people with their mobility to a great extent. Hence, there should not be any delay in starting the course of treatment. The treatment completely depends on the root cause of sacroiliitis and the various signs and symptoms associated with it. However, there are certain medications and therapy your doctor might recommend. They include:
1) Pain-relieving medications – Over-the-counter pain relievers are not that effective in relieving your sacroiliac joint pain. For this reason, doctors usually prescribe a stronger version of such drugs.
2) Muscle relaxants – The muscle spasms often linked with sacroiliitis can be reduced with the help of cyclobenzaprine.
3) Tumor necrosis factor (TNF) therapy - This therapy includes etanercept and infliximab that block certain cell proteins and act as inflammatory agents. The therapy helps reduce one's pain, stiffness, and swollen joints.
4) Physiotherapy – A physical therapist can help you in various light stretching and strengthening exercises that would help the flexibility of the joints as well as make your muscles become more stable. Specific pelvic exercises such as training the muscles of your trunk are useful in dealing with sacroiliitis. Strengthening of the pelvic floor muscles is very important because it opposes movements of the coxal (hip and pelvic) bones and stabilizes the sacral region. One can also go for light and low-impact aerobic exercises, which are designed to prevent the recurrence of pain.
If the above procedures do not help in relieving the pain, the doctors would then prescribe surgical and other procedures:
1) Electrical stimulation – An electrical stimulator is implanted into the sacrum. This helps in reducing pain caused by sacroiliitis.
2) Joint injections – There are certain steroids that can reduce joint pain. One of them is corticosteroids. A corticosteroid injection is done with fluoroscopic guidance. It is a real-time X-ray machine, which shows the physician the correct placement of the needle in the joint. This injection includes a numbing agent and a steroid, which is an anti-inflammatory medication. However, this injection should not be taken often in a year since it can weaken the bones and tendons. These injections are often accompanied by physical therapy to restore the range of motion.
3) Radiofrequency denervation – This procedure can damage the nerve tissues causing pain in the joints.
4) Joint surgery – Majority of the cases of sacroiliitis are treated without surgery. For a complicated pain that does not show a positive response to non-surgical procedures, surgery is considered as the best option. Such surgery is called as the sacroiliac joint fusion, which is meant to stabilize the sacroiliac joint.
There are certain home remedies you can do for the pain. They include:
1) Alternating ice and heat – An alternating application of ice and heat can help in easing your lower back pain. It is also called as a passive treatment.
2) Rest – Take adequate rest when such pain arises. Avoid carrying out any heavy activities, which can further worsen your condition. Maintain proper posture and do not bear weight on one leg, especially the one that hurts.
3) Sleeping position – Maintaining a correct sleeping position can also help relieve your pain. Individuals with lower back pain find it best to sleep on their sides with a pillow placed between their knees. This position helps in keeping the hips aligned.
4) Ginger – A few naturopaths recommend the use of ginger to help manage one's pain and joint swelling. Ginger is loaded with compounds called as gingerols. It specifically aids in reducing joint inflammation and swelling, thereby relieving one's pain.
5) Aromatherapy – Massage is also found to be useful in relieving pain. The essential oils used in an aromatherapy are found to be very useful in enhancing the mobility of the joints. Such essential oils include clove, ginger, and nutmeg.
How to Prepare for Your Appointment
Before visiting the doctor, there are certain key points one should ensure so that it becomes easier for the doctor to proceed with the physical examination and diagnosis.
- Take note of your symptoms: Although some signs might seem unrelated to your condition, make sure that you inform the doctor about it. Any small information is of great help to the doctor.
- Family history: Make sure that you tell your doctor about cases wherein someone in your family has gone through the same symptoms, recent major stresses, changes in lifestyle, and certain medical history.
- List any questions you have: During your doctor's appointment, you can ask anything about your condition. You can also ask about certain treatment methods and expectations for any tests that you might go through.
- Medications: Don't forget to tell your doctor about vitamins, supplements, or medications that you are currently taking.
Any delays in treating sacroiliac joint pain due to incorrect diagnoses or a delay in reaching out to the physician can cause a major impact to the joints.
The recovery period for an individual suffering from sacroiliitis varies. It depends on the severity of the condition as well as the ability of the individual to comply with the course of treatments. However, once the person starts the treatment, there are chances that the pain may go away within a short period of time. If the individual's condition gets worse, then it may take several weeks for the condition to be cured. Typically, such cases can take up to 2-3 weeks.