Injuries and Diseases
|There are many potential causes of back
pain. Effective treatment of back pain almost always follows
an accurate diagnosis. When an accurate diagnosis is followed
by appropriate treatment that is specific for that condition,
the outcome is usually very favorable. One of the potential
causes of back pain is sacroiliac
The sacroiliac joint is one of the largest joints in the
body. It forms a space between the sacrum, or base of
the spine, and the ileum or wing of the pelvis. The sacroiliac
joint is crossed by very strong ligaments which hold the
joint together. The joint is further stabilized by the
front of the pelvis. There, a much smaller joint known
as the pubic symphysis is located.
In the majority of people, the sacroiliac joint moves
only to a small degree. The joint surfaces are very different
from the surfaces of the shoulder joint or hip joint,
which are very smooth. The sacroiliac joint surfaces are
irregular. The surfaces are not unlike the irregular surfaces
that we see in corrugated cardboard. One side matches
up with another and sliding within the channels occurs.
This can happen while we are changing positions in bed,
standing from the sitting position or doing most any other
activity of daily living. However, when the joint moves
in an unusual position, pain can occur.
The theory associated with this joint as a generator of
pain is that the bone on one side of the joint can slide
out of position with respect to the bone on the opposite
side of the joint. When this happens, it can be present
for just a few moments or it can last a long time.
Symptoms usually include the following:
Pain over the side of the back, low in the back, on the
same side as the sacroiliac joint
Pain can be referred from this joint down into the buttock
or back of the thigh.
People can feel as if there is a rotation of their hip
joint and that their leg, on that side,
turned as well.
In some situations, pain can be felt at the front of the
pelvis, down near the pubic bone.
The individual with this condition can also complain of
pain that is brought about by movement
In addition to changes in the position of the joint that
precipitate pain, an actual inflammation in the joint,
similar to an arthritis can cause pain. In these situations,
there may be no changes in the position of the joint itself,
but the pain is generated because of the inflammation.
Symptoms in this situation would more likely be limited
to pain in the low back on the side of the sacroiliac
joint and possibly referred to the buttock.
An injection of medicine into the joint can also be very
helpful. Sometimes, an injection can resolve the problem
entirely. Injections into the joint are technically difficult,
because the joint is very narrow. A specialized x-ray
machine is needed to confirm the placement of the tip
of the needle in the joint and also that the medication
was delivered where it needs to be.
In most cases, a combination of physical therapy and this
type of injection is effective. In case it is not, another
line of treatment could include performing a procedure
to eliminate the ability of the nerve endings in that
joint to transmit the sensation of pain. As a last resort,
for a chronically unstable joint, surgery can be performed
to permanently immobilize the joint in the proper position.
This can be very effective as well. But again, it is reserved
only as a last resort.