Back Pain: Sacroiliac Joint Pain and Dysfunction

Back pain, one of the most common reasons for missed work, is suffered by one half of working Americans in any given year*. "Almost all of us suffer back pain at some point in our lives," says Dr. Kaliq Chang, interventional pain management specialist with Atlantic Spine Center. "But back pain is not a specific disease. The back is a complex structure and pain is a symptom that can be caused by any number of problems - sprained ligaments, strained muscles, ruptured discs, irritated joints. The sacroiliac joint is often overlooked but it is the source of many cases of lower back pain."

Main Content

There are two sacroiliac joints, one on either side of the spine. They link the sacrum, the lowest part of the spine above the tailbone, to the right and left iliac (pelvic) bones. The joints are small and very strong, reinforced by strong ligaments that surround them, and do not have much motion.

The sacroiliac joints support the entire weight of the upper body when we are erect and they absorb impact forces during walking, preventing those forces from reaching the spine. The joints are subject to a great deal of stress, which can lead to wearing of the cartilage layer covering the bone and degenerative arthritis, the most common cause of sacroiliac joint pain. Other causes of sacroiliac joint pain include loosening (laxity) of the joint, degenerative sacroiliitis (inflammation) and conditions that affect the normal walking pattern.

"The terms 'sacroiliac joint dysfunction' and 'sacroiliac joint pain' are often used interchangeably but are not quite the same thing," says Dr. Chang. "Sacroiliac joint dysfunction is abnormal motion of the sacroiliac joints. It often causes pain but not always. Sacroiliac joint pain is pain that starts from the sacroiliac joints. It may be caused by joint dysfunction or it may have other causes, such as arthritis or inflammation."

Pain that originates in the sacroiliac joint may be felt in the lower back, buttocks, or legs. It may be felt on one side or both.

Sometimes standing up triggers the pain, sometimes sitting for a long time is particularly uncomfortable, and sometimes sleeping is disturbed. A physical examination, imaging tests, and diagnostic injections may be used to pinpoint the source of pain. "When we identify the sacroiliac joint as the source of pain, we typically recommend conservative - non-surgical - treatment," says Dr. Chang. Those treatments might include:

• Cold, heat and rest: Ice or cold packs can be used to reduce inflammation, while rest reduces irritation. When inflammation and acute pain have subsided, a return to normal activities may be possible and a heat wrap or hot bath may further help the healing process.
• Physical therapy and exercise: Physical therapy can strengthen the muscles around the sacroiliac joint, which increases the range of motion, and low-impact aerobic exercise can help increase the flow of blood to the area, which stimulates healing.
• Pain medications: Acetaminophen and anti-inflammatory drugs (such as ibuprofen or naproxen) can reduce the swelling that contributes to pain.
• Support or brace: A pelvic belt can be used to stabilize a joint that is too loose until the inflammation and pain subside.
• Joint injections: Numbing injections into the sacroiliac joint are used diagnostically to help identify the cause of the but are also useful in providing immediate pain relief. Typically, an anesthetic is injected along with an anti-inflammatory medication.

"When these conservative therapies fail to bring lasting relief, there is a minimally invasive interventional procedure available that removes the nerves sensing pain signals to the joint, "says Dr. Chang. At Atlantic Spine Center we offer a procedure called an endoscopic sacroiliac denervation. In this procedure the branches of sensory nerves that provide innervations to the sacroiliac joint are excised through a minimally invasive endoscopic approach, providing a thorough destruction of the sensory nerves to the joint without fusing or altering the bones of the joint. It is much more comprehensive than a sacroiliac radio frequency ablation and much less invasive than a sacroiliac joint fusion. Dr. Chang adds that this procedure is not provided by most interventional pain management physicians.

Kaliq Chang, MD, is a board-certified physician who is fellowship-trained in pain management at Atlantic Spine Center. Atlantic Spine Center is a nationally recognized leader for endoscopic spine surgery with several locations in NJ and NYC.