By Thomas Mango, MD, Allied Bone and Joint
Often the SI joint is missed as the cause of back pain as most practitioners focus on the spine itself.
Proper diagnosis can help limit unnecessary surgery.
Back pain? You are not alone:
- Visits to the doctor regarding back pain account for 15 million visits annually.
- It is second only to the common cold for office visits.
- Back pain is the fifth ranked cause of hospital admission on an annual basis.
- Direct and indirect costs related to back pain exceeded $86 million.
The spine includes 24 vertebra from the base of the skull to the pelvis. There are discs between each vertebra which act as cushions between the bones. The spine protects the spinal cord and allows nerves to exit at each level.
While issue do arise from the spine area itself, back pain can also be the result of irritation of other sites in the body rather than the spinal column. One of the most common is the sacroiliac joint. It is an irregular joint surface connecting the pelvis to the spine that relies on both ligamentous and muscular support. It is estimated that 22 percent of back pain is related to the SI joint and in post-spine surgical patients that percentage could be as high as 43 percent.
Common causes of SI joint dysfunction include lumbar fusion, motor vehicle accidents, pregnancy, falls, lifting injuries, and even repetitive injuries. Pain can present over the SI joint sulcus which is the dimple in one’s back. It may present as lower back pain or even sciatic-like symptoms. It can even present as pain radiating into the pelvis and groin area.
SI joint dysfunction often presents as an inability to stand for long periods of time, trouble walking or running, leg stiffness in the hamstrings, disturbed sleep patterns, disturbed sitting patterns, and pain in changing positions from sitting to standing. Finally, it can present simply as pain in ascending stairs.
Often the SI joint is missed as the cause of back pain as most practitioners focus on the spine itself. Proper diagnosis can help limit unnecessary surgery.
Diagnosis is made by a careful history and a directed physical examination. Patient’s identifying pain with one finger pressed to their SI joint below the level of L5 are definitely candidates for a further examination.
There are five distinct provocative tests that can be performed by the physician to help identify SI joint problems. Each of these five tests can be easily performed in your doctor’s office. If these tests combined with an appropriate history lead your physician to diagnose an SI joint dysfunction problem, non-surgical treatments include:
- Pain medications,
- Chiropractic care,
- Physical therapy care and
- SI belt.
- More invasive treatments can include an SI joint injection and/or a radiofrequency ablation. (This is a procedure where the small nerves that give pain sensation to the SI joint are neutralized by the use of a catheter.)
Physical therapy and or chiropractic care include proper body mechanics, gait and balance training, posture and body mechanics training, as well as soft tissue mobilization, manual manipulation, and strengthening.
The most accurate and effective test is a bit more invasive and involves a
diagnostic/therapeutic injection. This procedure may provide long-term relief as well as provide your doctor with diagnostic information that could be used for surgical intervention.
When surgery is needed
Surgical treatment for SI joint dysfunction includes fusion of the SI joint. This can be performed through a percutaneous procedure where metal rods are inserted across the SI joint to allow it to fuse together and to prevent any more abnormal motion. This can be done as an outpatient basis and affords return to function in six to either weeks.In the proper individuals this procedure has been found to be 94 percent effective.
In summary, all back pain is not caused by the spine. If your history is suggestive of an SI joint problem, a detailed physical exam with regard to the SI joint should be performed. Conservative care should always be commenced first. However, if these treatments are not effective, diagnostic/therapeutic injections can be performed. And finally, if all attempts at treating the dysfunction fail, there is a surgical alternative.
Dr. Thomas Mango is a board-certified orthopedic spine surgeon specializing in minimally invasive surgery. He provides a full line of spine care services for the cervical, lumbar and thoracic spine ranging from conservative care to injections and surgery. Contact Allied Bone and Joint at (574) 247-4667 or request an appointment for more information.