Sacroiliitis is a common condition that we properly diagnose and effectively treat at American Neurospine Institute, PLLC. Read on to learn more about this often overlooked condition and the treatment options available to alleviate the pain.
Sacroiliitis is the inflammation of one or both sacroiliac joints located at the lower part of the spine, where it connects to the ilium (top part of the pelvis) in the hip. These bones carry the weight of the upper body when walking or standing. Sacroiliitis is a common source of pain affecting the:
- Lower back
- One or both hips
- One or both legs
- Feet (not common)
Sacroiliitis is challenging to diagnose since other conditions also affect the same areas. It has often been mistaken for various other causes of back pain, such as spinal stenosis, osteoarthritis, or a ruptured disk.
What are the Symptoms of Sacroiliitis?
The most common symptom of sacroiliitis is lower back pain, buttock, groin, hips, and legs, which a low-grade fever may accompany.
The pain and discomfort caused by sacroiliitis become worse when you:
- Climb stairs or walk up an incline
- Stand, walk or twist for long periods
- When standing from a seated position
- Take long strides or run
- Rolling over in bed
- Placing weight on one leg more than the other
What Causes Sacroiliitis?
Various factors cause sacroiliitis, including:
- Injury: Damage to the sacroiliac joints from sudden impact from a car accident or a fall leading to inflammation.
- Pyogenic sacroiliitis: Rarely, a particular type of staph bacterial infection can infect the sacroiliac joint.
- Pregnancy: Pregnancy hormones loosen the ligaments and muscles of the pelvis in preparation for childbirth leading to altered gait and inflammation. Additionally, pregnancy weight can add more stress to the joint, leading to the wearing of the joint.
- Infections: Though rare, some infections, such as Urinary tract infection (UTI), can spread through your bloodstream to the sacroiliac joint, causing inflammation.
- Gout or gouty arthritis: This can affect the sacroiliac joints due to high levels of uric acid
- Arthritis: Osteoarthritis and ankylosing spondylitis (inflammatory
- arthritis) may occur in the sacroiliac joints. Sacroiliitis is an early symptom of ankylosing spondylitis.
Other causes include:
- Repetitive stress from activities, particularly in high-level athletes
- IV drug use/drug addiction
- Preexisting spine or back conditions
How Is Sacroiliitis Diagnosed?
There are various options for diagnosing sacroiliitis, done in combination for an accurate diagnosis. During your diagnosis, your doctor will perform a physical exam which may include applying pressure to the sacroiliac joint, hip, spine, and leg, and ask you to make various hip joint movements. You will also be asked about any existing inflammatory disorders.
Your doctor will also perform diagnostic tests, including:
Blood tests: This helps check for signs of inflammation.
Steroid injection: This injection works two ways; one as a diagnostic test and the other as a pain reliever. The injection administers a numbing medication into the joint. If the injection stops pain, it is an indicator that there is a problem with your sacroiliac joint. An X-ray guides the spinal needle to the injection location.
Imaging tests: They can be ordered by your doctor to show inflammation signs, to identify if an injury is causing the source of pain, and to check whether there are any changes to the sacroiliac joint. The imaging tests include CT scans, X-rays, or MRI scans. Imaging tests are also used to check for ankylosing spondylitis or other types of arthritis.
How Is Sacroiliitis Treated?
Your doctor may recommend the following treatments:
Your physical therapist will recommend specific exercises to help with recovery. This rehabilitates the affected joint and helps to stabilize and strengthen muscles around the sacroiliac joints, helping improve the full range of motion and flexibility. The exercises should never go beyond the patient’s level of mild discomfort. They include:
Flexibility exercises are recommended when acute symptoms are under control and may include knee chest pulls, pelvic rocks, and side bends.
Stabilization exercises help with sacroiliac joint dysfunctions to improve posture, stabilize the pelvis, and muscle training.
Your physical therapist may recommend low-impact exercises to prevent recurrences such as light jogging and water aerobics after rehabilitation.
Your doctor may prescribe the following medications:
- Non-steroidal anti-inflammatory drugs are prescribed early in sacroiliitis to relieve pain.
- A steroid injection may also be administered to decrease pain and inflammation. The injections can be administered three to four times yearly and are best accompanied by physiotherapy.
- Muscle relaxers for inflammation and pain relief caused by osteoarthritis.
- TNT inhibitors help relieve sacroiliitis associated with spinal inflammatory arthritis and significantly improve joint function and activity.
Rest helps improve your condition. Avoid strenuous activities and maintain a proper posture. You may be given instructions on using a sacroiliac joint belt to relieve pain when doing your daily chores or activities.
Other therapies include:
Ice or heat therapy every three hours for 15 to 20 minutes every session to ease pain and inflammation. Your doctor may also recommend electrotherapy, radiofrequency ablation, soft tissue massage, and acupuncture to fotolleviate pain and inflammation. If you have mobility issues, you might use a crane or crutch until your symptoms improve.
This is the last resort and is rarely required. It is an option for severe sacroiliitis when nonsurgical procedures are not responsive. The procedures include:
Sacroiliac Joint Fusion: A minimally invasive procedure that fuses two bones with a fusion device to stabilize the joint and increase weight-bearing capacity.
Radiofrequency denervation: This is also known as radiofrequency ablation. The treatment works by using radio waves that heat specific nerve tissues to temporarily turn off their ability to cause pain.
Electrical stimulation: An electrical stimulator is implanted into the sacrum to release harmless mild electric impulses to repair injured muscles and reduce pain.
Recovery depends on the severity of the condition and overall health. Regular activity and a positive attitude help improve recovery, which may take 2 to 4 weeks. To prevent recurrences, lifestyle changes can also help.
What Complications Are Associated with Sacroiliitis?
If sacroiliitis is left untreated, it may result in psychological issues such as depression and insomnia. It may also lead to loss of mobility for some people. Sacroiliitis associated with ankylosing spondylitis can progress over time and cause your spine to fuse and stiffen.
How Can Sacroiliitis Be Prevented?
You can prevent sacroiliitis and avoid recurrence by:
- Regular exercises to stretch and strengthen muscles
- A healthy diet and maintaining a healthy weight
- Quitting smoking
- Proper lifting techniques such as lifting with your knees
- Maintain good posture when standing, sitting, sleeping, and moving
- Stress management and relaxation techniques such as breathing exercises.
- Improving Workplace Ergonomics like good posture or sitting on a good chair.