Dr. Sean Riley: Sacroiliac dysfunction, SI joint irritation, sacroiliacitis, they all mean the same thing. Quick anatomy lesson. Here is the front side of our pelvis. This is the pubic bone here, the pubic synthesis. Here’s the top of your pelvis here. But if we flip this around, here’s your sacrum or your tailbone, and then to the side of that is the pelvis or the ileum. The joint made up of those two structures is called the sacroiliac joint. Many times, SI joint means the same exact thing and this kind of hits home for us right now. Many times I’ll go through phases in practice where I’ll see just a ton of lumbar disc patients or cervical radiculopathy patients, whatever the case may be, and I’m currently seeing quite a few SI issues right now. I think the youngest one that I’m treating is 14 all the way up to an 83-year-old.
It’s something that affects … It not age specific, it’s not gender specific. Essentially, what it means is that joint has got overloaded. To simplify things, most of you have sprained an ankle with sports or just day-to-day type stuff and when you put too much stress and irritation on that joint a few things are going to happen, you’re going to create a localized inflammatory response. What I mean by localized is typically you’re going to have swelling, irritation within the joint. When you sprain an ankle, that’s pretty easy because I can look down and I can see how that has started to balloon, might get a little red. Well, with the SI joint you really don’t see that irritation and that swelling but there’s a bit of localized swelling and irritation to the joint.
Also, like the sprained ankle, it hurts, I mean, it’s quite painful. It’s quite painful. Think about if you were to jump around on a sprained ankle, you continue to walk, you’re going continue to aggravate that joint, it’s going to be uncomfortable. Guess what? Same thing applies to this SI joint but many times it’s irritated by that, me sitting on my butt. The longer I sit on my butt, the more irritation and pressure that I put on this, and so you’re going to have continued pain and discomfort so there’s localized inflammation, it’s very painful. Also, very similar to the ankle, you have diminished range of motion. It’s swollen, you’re not going to be able to move as well as it should. Same thing happens here.
The mechanics of this joint potentially may break down, it doesn’t function as well as it should. This joint should be stable but there also should be a bit of mobility within that joint. SI joint dysfunction, sacroiliacitis, SI joint pain, it’s irritation of this SI joint. There’s a host of things that cause it. I talk about cumulative type injuries, we do the same things over and over again, whether I’m sitting on my butt, I’m using improper mechanics, if I’m doing a lot of bending and lifting, those types of things. Because once that joint gets overloaded, you’re there, it’s injured, and then you’re trying to manage the symptoms from there.
The 14-year-old that I’m seeing, it’s not related to sitting. He’s an athlete and so, just like any other joint, when we put too much stress and pressure on that, it creates an irritation and then it gets inflamed and it hurts. The trauma related to some type of sporting event, obviously if you fell just a certain way. Trauma, cumulative trauma are the two biggies but also there’s another underlying issue and it goes back to biomechanical deficiencies or limitations that we may have. What happens is I go about my day-to-day life and I’m hoping that my core is strong, my glutes are working properly, I have proper mobility in my hip or my thoracic spine. Well, that’s not always the case, there’s typically a breakdown in the chain.
What happens is, when I start to lose motion and if I start to get weak in another area, a compensation may occur and, unfortunately, that compensation may occur in this SI joint so I don’t do these things that I need to be doing. I don’t have enough flexibility. I get a little weak throughout my core and then I go about my day-to-day activities and then decompensation occurs and I have an SI joint irritation. What’s very frustrating on this type of injury, if you will, many times it doesn’t take very much. We just go about our day-to-day lives with these small little limitations or deficiencies, the joint gets slightly overloaded and you start to hurt. I think many times our brain is wired to feel like there needs to be a significant event or some type of activity that contributes to this, and this is one of those things that’s secondary to some of these limitations. They can be quite painful.
How do I treat this? We talk about diagnosis, having it properly diagnosed, history, orthopedic examination. The exam obviously is very important and then we can start working into treatment options. Just like with any inflammatory response, some form of anti-inflammatory would be a good option for us initially, whether it’s over-the-counter ibuprofen or something a little bit stronger. Anything medication related, I think it’s very important that you obviously consult your physician to make sure whatever you’re taking is okay and good for you, but we want to figure out how to manage the inflammation so ibuprofen’s a good first line defense. Ice, very super simple. We’ve talked about this in the past, 20 minutes on, 20 minutes off, just to the affected area.
The goal of that is to start to reduce the inflammation, promote that healing process. Then obviously, physical therapy is going to be a great option and chiropractic. I spoke earlier about the mechanics of the joints are altered the joint doesn’t move as well as it should. Manipulation is a fantastic option to get in there and start to mobilize that joint, reestablishing proper motion. Any time I’m treating the area, if it’s not moving I want to figure out how to get that joint moving again appropriately so it has the ability to function properly. Physical therapy. We talked about these deficiencies or limitations. Many times there could be weakness in one of the glute muscles, the hip joint isn’t moving as well as it should, and that’s where that compensation may come, so obviously physical therapy from mobility/stability type exercises can manage that.
I will say that most of the time the things I just spoke about, conservative options are typically really, really effective to manage SI joint conditions. In more extreme circumstances and more chronic conditions, pain management physicians potentially may do an injection, some form of an ablation where they maybe might burn the nerve root a little bit. Still conservative but we’re starting to use needles and so forth. I would say those are more common, more chronic type conditions. Obviously, the patient hopefully has exhausted all their conservative options and they might need to move on to that interventional pain management position. Then very, very extreme circumstances. I’ve seen a few patients where they’ll actually need to be fused or there’ll be some form of surgical intervention in this area. Been in practice a long time, not seen that very much. Very, very uncommon. Like I said, conservative options very affective for treating SI joint dysfunction.
To recap quickly, SI joint dysfunction is irritation of the SI joint. There’s a host of things that contribute to it, from trauma to the cumulative trauma, the stuff that we do every day. NSAIDs, ice, physical therapy are going to be your first things, first line of defense for this, typically very effective the outcomes. Then also, we need to talk about maybe activity modification. If you do sit a lot, maybe start changing how much you sit and so forth. Pain management could be an option. On the more serious cases and extreme circumstances, surgical intervention could be an option. So SI joint irritation, very common, something that we treat frequently here at Tulsa Spine and Rehab with good results. If you need us, come check us out.
