Back, buttock and leg pain are common presentations of pain in Australians. Interestingly, in up to 15-30% of people who experience pain in these areas, the sacroiliac joint is a major source of pain.
The sacroiliac joint is a large joint that connects your legs/pelvis, to your back (see the image below). The sacroiliac joint must support all the weight ofyour upper body and transfer those forces to your legs. So, it often takes a lot of strain! Particularly when you are running, jumping, or sometimes even simply walking.
The pain from the sacroiliac joints is often felt when walking, particularly up an incline or trying to go upstairs. Jolting movements such as jumping, or twisting can commonly flare SIJ pain. The pain is often felt into the low back, buttock, occasionally into the groin, and at times into the leg but rarely below the knee.
In some patients, they may have experienced an injury to the sacroiliac joints in the past. This could be through an accident, fall, or even through childbirth. Some people are born very flexible and if this usually very tough joint becomes a little loose, it can be a significant cause of pain as it moves around.
Finally, people who have had spinal surgery in the past often have extra stresses going through the SIJ causing dysfunction and pain.
Unfortunately, diagnosing sacroiliac joint pain can be difficult. Images such as X-ray and MRI do not show the joint very well. Often the pain does not occur exactly where the joint is but can be felt anywhere from the low back to the legs.
Examples of where that pain can be felt is in the image below.
Your doctor will ask you questions about your pain, examine you, and look at your images, to try and work outwhether the sacroiliac joint may be a source of discomfort for you. Even with all these things, we cannot be 100% sure the joint is involved.
To help work out the contribution of the SIJ to your pain, we use diagnostic blocks. This is a small procedure under sleeping sedation where we put local anaesthetic on the nerves that go to the SIJ to turn off temporarily pain signals from the SIJ. This will last 4-6 hrs ONLY but we will use this time for you to see if your pain has significantly reduced and help confirm how much the SIJ pain contributes to your overall pain.
If the SIJ is thought to be a cause of pain, we can use simple medications to try and dampen your pain and ideally you work with a dedicated expert physiotherapist in sacroiliac joint pain to try and strengthen your SIJ, surrounding muscles and tissues, to reduce your discomfort. For some people, their pain from their SIJ is too much to be able to perform exercises and rehabilitate the area. In these situations, we recommend considering a further procedure such as a radiofrequency ablation which is a procedure to attempt to dampen the pain from this joint to allow you to perform rehabilitation on the joint.
The procedure has approximately 70% chance of providing 6-12 months relief of pain. While this is not a permanent fix, for many this allows them to become stronger and reduce their pain themselves. And if the pain recurs, the procedure can be repeated when required. Some patients prefer having a procedure once or twice a year to taking medication every day.
Sacroiliac joint pain explained below in a more detailed version above, and a briefer version below.
It is important to be aware that at times, the cluneal nerves or other ligaments around the sacroiliac joint may also be involved in your pain and may require treatment as well.
For example, the cluneal nerves run over the top of the pelvis and often become irritated and cause pain in people who experience sacroiliac joint dysfunction. There are also several local ligaments that can benefit from prolotherapy (glucose or sugar-based injections) into local tendons and muscles. We offer all these procedures, and more, at Resolve Pain.
Please see the below pictures for the cluneal nerve, areas that pain can be experienced from these, and the large number of ligaments around this area.
Here is a video regarding Cluneal Nerve radiofrequency ablation (please be aware the content is not ours specifically - but a link for more information for you)