One of the most common, but underdiagnosed, causes of back pain is a painful sacroiliac joint. The term used to describe this is “sacroiliac joint dysfunction.”
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The sacroiliac joint is located between the sacrum and the iliac bone. From the outside, these two joints are dimples on each side of the low back, at approximately the level of the belt line. Compared to other joints in the body, there is little motion. This is because the sacroiliac joints are held by several very strong ligaments. One exception to this is near the end of pregnancy, close to delivery when hormones are produced which cause the sacroiliac joints to relax. For this reason, it is very common for pregnant women to develop sacroiliac joint dysfunction near the end of pregnancy or even after delivery.
When the source of pain emanates from the sacroiliac joint, pain can occur in the low back, buttock, hip, groin, and leg – usually not below the calf. For example, it is not uncommon for right sacroiliac joint dysfunction to result in right-sided low back pain, right buttock pain, right hip pain, right groin pain and right thigh pain.
There are many causes of sacroiliac joint dysfunction. Some of these may include trauma, differences in leg length, pregnancy, altered gait patterns, arthritis, and infection. Sacroiliac joint dysfunction is diagnosed by history and physical examination. Write down your symptoms before going to visit your physician to be prepared for your appointment.
Certain physical examination maneuvers make it more likely that sacroiliac joint dysfunction may be the cause of your back pain. The doctor may also order diagnostic injections of the sacroiliac joints to confirm this is the source of your pain. These diagnostic injections into the sacroiliac joints must be done with x-ray guidance or fluoroscopy. If not, the needle might be misplaced. Patients with sacroiliac joint dysfunction frequently have x-rays and MRIs which are normal.
Other treatments include physical therapy, sacroiliac joint braces, orthotics, radiofrequency and manipulation. Acetaminophen (Tylenol) or non-steroidal anti-inflammatory medications (Aleve, Ibuprofen, Motrin etc.) may also be used. Review the dosages with your physician. On rare occasions, patients suffering from intractable pain may be candidates for fusion of the sacroiliac joints.
Jose Veliz MD is the medical director of Palomar Spine & Pain, in Escondido, CA (North San Diego County).