Diagnosing and Treating Sacroiliac Joint Dysfunction

Getting an accurate diagnosis for SI dysfunction requires an individual to go a major medical center with an experienced team of spine specialists. A skilled team is necessary for proper diagnosis and treatment since the source of SI pain can often be difficult to determine because pain from sacroiliac dysfunction can mimic other conditions, such as sciatica from a herniated disc, arthritis in the hip, and other kinds of lower back pain. In addition, it can sometimes be difficult for diagnostic imaging tests to isolate just the SI joint, and so imaging studies may appear normal.

A diagnosis of what is leading to lower back pain starts with a doctor getting a complete medical history, including finding out about any injuries a person may have had, along with asking for details about the site(s) and severity of the pain and the duration and onset of the symptoms as well as how it impacts sleeping, walking, and/or sitting. During the exam, a doctor may place a person in positions that put gentle pressure across the SI joint or may ask an individual to move into poses that cause discomfort and to point to where the pain is felt. The doctor will likely feel for tenderness over the SI joints, legs, hips, spine, and buttocks. Basic neurological tests are often performed to locate any weakness in the muscles.

Further tests may be completed to search for medical issues that cause similar symptoms – like a herniated disc, hip problems, or inflammatory conditions such as arthritis – and to confirm the diagnosis of SI joint dysfunction. One diagnostic test may include injecting a numbing medication into the SI joint (described below). Other important information can be learned from results of the following:

• Physical exam: provocative tests may indicate dysfunction
• Injection into the SI joint with a numbing medication, sometimes along with cortisone (a steroid to reduce inflammation), may be included as a diagnostic test. If the injection brings no relief, it is unlikely that the SI joint is the cause. If pain decreases after the injection, it may confirm that the SI joint is the source of the pain. The injection, therefore, may also be therapeutic as well as diagnostic.
• Arthrogram: Often obtained during injection, can demonstrate the patency of the joint.

Once a diagnosis has been confirmed at Och Spine at NewYork-Presbyterian atthe Weill Cornell Medicine Center for Comprehensive Spine Care, a person with SI joint dysfunction will receive an individualized treatment plan from our team of specialists.

Treatment Options for SI Joint Dysfunction

Treatment for SI joint dysfunction will vary depending on its cause and the severity of pain. Treatment options should be conservative at first before surgery is considered. SI joint dysfunction that leads to muscle or ligament strain and pain will often get better on its own with time, self-care, and home remedies such as:

• Hot or cold compresses
• Over-the-counter pain medication such as ibuprofen and acetaminophen
• Pain medication
• Reduced activity and rest
• Specific back exercises and/or stretching routines

Medical Therapy

In cases where there is structural damage to the spine, the following medical therapies can help:

• Alternative treatment like acupuncture and massage
• SI belt
• Joint injections of a steroid to reduce inflammation
• Physical therapy to strengthen the core muscles surrounding the spine and to teach pain-free ways of moving
• Prescription medications for pain, including non-steroidal anti-inflammatory medications (NSAIDs) and opioids if necessary

SI joint dysfunction responds well to the conservative therapies mentioned. It is important to realize that an individual with SI joint dysfunction needs to avoid activities that cause pain. This may be a challenge for athletes who are anxious to return to their sport, but it is important to let inflammation in the joint subside. Similarly, even if an individual is feeling better, a course of anti-inflammatory medications should be completed.

Also, a doctor or physical therapist may prescribe strengthening exercises that may need to be followed for months or even become part of a lifelong habit.

Surgery (see Surgery for SI Joint Dysfunction)