Having lower back pain radiating to the leg does not always mean you have herniated disc. People with sacroiliac joint (SI Joint) dysfunction can experience similar pain. Therefore, proper diagnosis is crucial in order to identify the origin of the pain. A specialist can help diagnose your condition accurately and get you on the path for lasting relief.
What is SI joint pain?
The sacroiliac joints are located between the iliac bones and the sacrum, connecting spine to the hips. These joints provide support, stability, and absorbing impact when walking. There are strong ligaments and muscles supporting the SI joints. As we age our bones and ligaments stiffen and the cartilage might wear down, the bones may rub together causing pain. Sacroiliac joint pain can mimic other conditions, such as a herniated disc or hip problem. Accurate diagnosis is important to determine the source of pain. The sacroiliac joint is suspected as a common cause of lower back or leg pain, although difficulty in accurate diagnostic testing left many in the medical profession skeptical.
- Lower back or buttock pain that may radiate to the hip, groin, or thigh
- Pain in the hip when going from sitting to standing, sitting for long periods, or changing sleeping position
- Feeling of leg instability especially when walking up stairs or walking for long periods
- Disturbed sleep patterns due to pain
- Unable to sit for long periods or have to sit on one side
- Worsened pain when exercise or during yoga
Who is at risk?
- People who sit or drive in the same posture for long periods
- Major trauma or impact that causes injury to the ligaments and joints near the hip
- A history of other spinal diseases
- People with difference in their leg lengths
- People who have symptoms that similar to disc herniation but the MRI does not show evidence of disc herniation
- People with a history of spinal surgery and have recurrent radiating leg pain
- People with a history of joint diseases, such as rheumatoid
Diagnosis and treatment
Diagnosing sacroiliac joint dysfunction can be difficult because the symptoms mimic other common conditions. There is no single test that can diagnose sacroiliac joint dysfunction. For this reason, it is important that a combination of patient’s history, physical examination, and diagnostic test results are taken into consideration together to form an accurate diagnosis.
1) Non-surgical treatments
- Medication such as pain relievers, non-steroidal anti-inflammatory medication (NSAIDs), and muscle relaxants
- Physical therapy
- Pain intervention
- SI joint injection: A local anesthetic is injected with an anti-inflammatory medication to reduce inflammation and help alleviate pain. This method can also be used for diagnosis or finding source of pain (pain generator).
- SI joint rhizotomy: provide lasting low back pain relief by disabling the sensory nerve that goes to the facet joint
2) Surgical treatment
If nonsurgical treatments and joint injections do not provide pain relief, your physician may recommend minimally invasive SI joint fusion surgery (MIS). This minimally invasive technique reduces blood loss, pain, and recovery time. The outcome is better than open surgery.
Sacroiliac joint dysfunction is one of the most common cause of back or radiating leg pain. Sacroiliac pain can mimic other conditions, such as a herniated disc or hip problem. Accurate diagnosis is important to determine the source of pain. Most SI joint pain can be treated by non-surgical treatments. But in rare cases, surgery is needed in order to relieve pain. This can be done by minimally invasive surgery (MIS).
Reference: Capt. Dr. Tayard Buranakarl, an orthopedic surgeon, Bangkok Spine Academy