Pinpointing the Source of Back & Hip Pain
Struggling with back and hip pain affects how you live your life. In fact, the pain can keep you from enjoying your favorite activities or spending time with family. Back pain can have many causes, like muscle strain, arthritis, bulging discs, or skeletal irregularities. An experienced doctor can pinpoint the source of your pain and help you find relief. Usually, treatments are simple, but sometimes, surgery may be needed to resolve your pain.
One commonly overlooked source of hip and back pain is sacroiliac joint dysfunction. Also known as SI joint dysfunction, this condition affects as many as 25% of people who complain of lower back pain. Since the symptoms of SI Joint Dysfunction often mimic other common back problems, the correct diagnosis may be overlooked.
What is the Sacroiliac Joint?
The sacroiliac joint connects the hip bones to a triangular bone just below the lumbar spine, known as the sacrum. It is responsible for transferring weight and absorbing shock between the upper body and legs. It helps prevent the impact of our day-to-day movements from jolting the spine.
Unlike other joints, the SI joint doesn’t have much motion. Ligaments and muscles provide a network of support to help the joint with shock absorption, stability, and bending. When the joint experiences too much or too little movement, dysfunction occurs.
What is SI Joint Dysfunction?
Commonly known as SI joint pain, this condition begins with SI joint inflammation or irritation. In many cases, this occurs due to the the natural aging process of the spine and joints. Other causes include:
- Sudden traumas or injuries such as a fall or car accident
- Ankylosing spondylitis, a form of arthritis affecting the spine and sacroiliac joints
- Hormones released during pregnancy that loosen the SI joints
- Improper movements while exercising or lifting heavy objects
- Osteoarthritis and other forms of arthritis that break down the cartilage which lubricates the SI joints
- Lower back surgery, such as a lumbar fusion, adding pressure on the SI joint
- Obesity and inactivity
- Bacterial infections
- Gout, or a buildup of uric acid in the joints
- Poor nutrition and health habits
Symptoms of Sacroiliac Joint Dysfunction
Aggravation of the SI joint has several symptoms. They may appear gradually from wear and tear or suddenly as the result of an injury. The severity of symptoms can range from mild to severe. Look out for these warning signs:
- Stabbing, dull, or sharp lower back pain felt on one side of the body. In some cases, the pain will migrate into both sides of the back.
- Radiating pain through the buttocks, hips, and groin. It may also spread down the side of the thigh all the way to the knee.
- Tenderness or muscle tightness in the hips and buttocks.
- Worsening pain while standing, walking, jogging, or climbing stairs.
- Pain while moving to a different position such as standing or bending.
- Reduced range of motion and stiffness in the hips, pelvis, lower back, and groin.
- Instability while moving which makes it feel like the pelvis could buckle.
Diagnosis and Treatment
As mentioned earlier, back pain can occur because of a variety of reasons. Getting the correct diagnosis ensures the proper treatment for your symptoms.
Diagnosing Your Sacroiliac Joint Pain
Unfortunately, diagnosis of sacroiliac joint dysfunction can’t be achieved with one simple test. Since the body is complex and lower back pain has multiple causes, it is crucial to have a complete evaluation. This prevents misdiagnosis and the prescription of incorrect treatments.
Diagnosing your back pain often starts with the doctor reviewing your complete medical history. This includes previous health conditions, injuries, and medical procedures. Questions about your current health are also important. Your doctor needs to know when the symptoms started, the exact areas of pain, if you recently had any injuries, and what movements make the symptoms worse.
In addition, the doctor examines any previous diagnostic images like X-rays or CT scans. He may even prescribe more if necessary.
The Physical Examination
After obtaining this information, the doctor performs a physical examination including certain SI joint provocative tests. These tests help confirm any SI joint dysfunction by using pressure and movements to see if it reproduces the pain that you feel. Typically, a confirmed diagnosis involves positive results of three or more of the following tests:
- FABER Provocative Test: While lying down, the doctor puts the foot of your affected side across your body. Then the doctor applies a downward force to the knee away from the center of the body.
- Thigh Thrust: As you lie on your back, you raise your unaffected leg with the knee bent at a 90-degree angle. The doctor flexes the affected leg at the hip.
- Compression Provocative Test: While lying on your unaffected side, the doctor will apply compression across the SI joints to see if it produces any pain.
- Gaenslen Provocative Test: While lying on an exam table, your unaffected leg is bent at the hip with the knee toward the chest. The doctor then puts pressure on your affected knee.
- Distraction Provocative Test: Lying flat, the doctor applies upward pressure to each hip in a movement designed to stretch the SI joint.
- Palpation Test: The doctor applies pressure over each SI joint using his thumb. This helps determine the areas of tenderness in the joint.
In addition to these tests, the doctor will also examine the position of your spine and any other areas suspected of causing your pain. A sacroiliac joint injection may be ordered. This test injects a numbing solution to the SI joint to determine if it is the pain source.
Treatment for SI Joint Dysfunction
Treatment focuses on restoring range of motion and pain relief. Most people respond well to conservative approaches. In more extreme cases, surgical treatments may be necessary.
Since no single approach works for everyone, doctors often combine treatments for the best results. The most common treatments include resting the area, using anti-inflammatory medications for pain relief and decreased swelling, and applying ice and heat to the affected area.
In addition, a physical therapist can prescribe exercises to strengthen and increase flexibility in the area. Physical therapy also provides education and insights into how your daily activities contribute to SI joint pain. The physical therapist may also recommend using a brace to support the SI joint.
If these conservative approaches don’t give relief, surgical treatments may be the next step. One of the most common surgical treatments is the SI joint fusion procedure. This minimally invasive surgery stabilizes the SI joint using screws and rods. Expect a 3 to 6 month recovery period for this procedure.
When you run out of options for your SI joint pain, our multidisciplinary team at the Advanced Spine Center has the next step. Having a combined experience of over six decades, these doctors know the most effective methods for getting you back to the life you love. If you are ready to return to a pain-free life, schedule a consultation with the experts at the Advanced Spine Center.