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Sacroiliac Joint Dysfunction

Sacroiliac joint dysfunction, or SI joint pain, is one of the most common causes of low back pain. The spine is made up of five areas, cervical, thoracic, lumbar, sacral, and coccyx. The spine attaches to the pelvis at the sacroiliac joint. The sacrum is a triangular shaped bone at the lower portion of the spine and joins the two large bones of the pelvis, or ilia, to form the SI joint. Several large, very strong ligaments hold the SI joint together. There is little motion involved with the SI joints as most of the motion is either at the hips or lumbar spine. The SI joints play a major role in the body, as they are responsible for supporting the entire weight of the upper body when standing. Thus the functions of the SI joints are to act as shock absorbers and to provide just enough flexibility to take the stress off the pelvis and spine.

Severe trauma can result in an SI disruption. In an SI disruption, the ligaments are torn and an unstable situation develops. An SI disruption requires stabilization surgery. When the SI joint develops dysfunction, it is usually a result of abnormal motion, whether too much (hypermobile) or too little (hypomobile).

The symptoms of SI joint dysfunction are low back pain, hip pain, thigh pain, and sciatic type leg pain. The pain is usually worse with staying in the same position for a long period of time, bending forward, during sex, and associated with periods.

The hypermobile form occurs when the SI joint ligaments are stretched, sprained, or torn. This can occur due to hormonal imbalance, pregnancy, multiple pregnancies, altered gait, scoliosis, polio, hip arthritis, and lumbar fusion patients. The hypomobile form occurs as a result of aging or degeneration of the joint, infection, inflammatory disease, and arthritis (e.g. rheumatoid arthritis, ankylosing spondylitis).

The diagnosis is made by physical examination, and the definitive diagnosis is confirmed by an SI joint injection with an anesthetic solution. X-rays, CT scan, MRI scan and bone scan may also be helpful for differentiation of the causation for the SI joint pathology.

Treatment is dependent upon the cause. In the acute phase of SI joint dysfunction, rest, ice/heat, non-steroidal anti-inflammatory’s, and physical therapy are of benefit. If symptoms do not respond then SI joint injection, manual therapy, chiropractic care, yoga, Pilates, and SI joint belt may be the next stage of treatment. Surgery is considered only as a last resort, for those cases not responsive to non-operative care.

To learn more about Dr. Cotler or to schedule an appointment, please call us on (713) 523-8884.

Howard B. Cotler, MD, FACS, FAAOS is board certified and recertified in Orthopedic Surgery. He is a fellow of the American Academy of Orthopedic Surgery and the American College of Surgeons.

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