Pain of or relating to the spine comes in many forms and is often generalized to either low back, mid back, or neck pain. The sacroiliac (SI) joints are often the cause of lower back and buttock pain as well as radiating symptoms down the leg, particularly in women. The sacroiliac joints are where the pelvic bones join with the sacrum, which is the base of the spine. They are not hinge joints like the knee or ball-and-socket joints like the shoulder that allow motion. Rather, these joints are designed for support. Together they sustain a large amount of stress as they support the weight of the upper body. Just like other joints in the body, they can become painful.
Symptoms relating to a problem at the SI joints include pain in the lower back and buttock on the affected side. This pain is not along the spine itself, but more in the soft tissues that support and stabilize the spinal column. Depending on the severity, sharp and shooting pain can radiate down the leg on the affected side as well. These symptoms often worsen with prolonged standing, stair climbing, or uneven weight distribution (think new moms who always hold their baby on one hip). If a patient’s symptoms are more midline back pain and radiating numbness, tingling, and/or weakness, the problem is likely more related to the spinal column itself.
The true source of the pain and recommended treatment plan can differ based on who you talk to as the nature of SI joint pathology is evolving. Some physicians feel that SI pain is general discomfort in the joint and the surrounding region that can be largely treated the same way with oral anti-inflammatories, some physical therapy, and perhaps a cortisone injection if symptoms persist.
Other physicians differentiate the pain by classifying it as either sacroiliitis or SI joint dysfunction. Sacroiliitis occurs when inflammation is present in the joint. For younger people, this typically means they have some kind of autoimmune response occurring causing ankylosing spondylitis (or a fusing of the vertebrae and related structures in the spine). Older patients can develop osteoarthritis, or general degeneration of a joint, not unlike that of hips, knees, and shoulders. These changes would show up on an x-ray, and an MRI would show swelling in the joint itself. Physicians who make this differentiation treat these patients with anti-inflammatory medications and a cortisone injection if symptoms persist to address the inflammation present. Alternatively, the pain could be thought of as more SI dysfunction where no structural abnormality exists on an x-ray or MRI, but discomfort is present due to instability of the joint. This is common in younger females who typically have increased ligamentous laxity compared to their male counterparts. Pregnant and postpartum women often struggle with some degree of SI dysfunction. These patients are typically treated with physical therapy to help stabilize the joint by strengthening the surrounding muscles.
Fortunately, these symptoms are most often treated conservatively regardless of your treating physician. With proper attention, patients will get relief of their symptoms and be back to their regular activity. If you have undiagnosed low back pain giving you grief, make an appointment to be seen by one of our specialists at the OAW Spine Center today!