Sacroiliac Joint Pain

THE CLINICAL SYNDROME

Pain emanating from the sacroiliac joint commonly occurs after the pain lifts while in an awkward position, putting strain on the joint and supporting ligaments and soft tissues. The sacroiliac joint is also susceptible to the development of arthritis from variety of conditions that have in common the ability to damage the joint cartilage. Osteoarthritis of the joint is the most common form of arthritis that results in sacroiliac joint pain. However, rheumatoid arthritis and posttraumatic arthritis are also common causes of sacroiliac pain secondary to arthritis. Less common causes of arthritis-induced sacroiliac pain include the collagen vascular diseases, such as ankylosing spondylitis, infection, and Lyme disease. The collagen vascular diseases will generally present as a polyarthropathy rather than as a monarthropathy limited to the sacroiliac joint, although sacroiliac pain secondary to the collagen vascular disease ankylosing spondylitis responds exceedingly well to the intra-articular injection technique described here. Occasionally, the clinician will encounter patients with iatrogenically induced sacroiliac joint dysfunction due to overaggressive bone graft harvesting for spinal fusions.

SIGNS AND SYMPTOMS

The majority of patients presenting with sacroiliac pain secondary to strain or arthritis will present with the complaint of pain that is localized around the sacroiliac joint and upper leg. The pain of sacroiliac joint strain or arthritis radiates into the posterior buttocks and the back of the legs. The pain does not radiate below the knees. Activity makes the pain worse, with rest and heat providing some relief. The pain is constant and characterized as aching in nature. The pain may interfere with sleep. On physical examination, there will be tenderness to palpation of the affected sacroiliac joint. The patient will often favor the affected leg and exhibit a list to the unaffected side). Spasm of the lumbar paraspinal musculature is often present, as in limitation of range of motion of the lumbar spine in the erect position that improves in the sitting position due to relaxation of the hamstring muscles. Patients with pain emanating from the sacroiliac joint will exhibit a positive pelvic rock test. The pelvic rock test is performed by placing the hands on the iliac crests and the thumbs on the anterior superior iliac spines and then forcibly compressing the pelvis toward the midline. A positive test is indicated by the production of pain around the sacroiliac joint.

Sacroiliac joint pain radiates into the buttock and upper leg.

TREATMENT

Initial treatment of the pain and functional disability associated with sacroiliac joint pain should include a combination of the nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors and physical therapy. The local application of heat and cold may also be beneficial. For patients who do not respond to these treatment modalities, the following injection technique with local anesthetic and steroid may be a reasonable next step.

Injection of the sacroiliac joint is carried out by placing the patient in the supine position and properly preparing the skin overlying the affected sacroiliac joint space with antiseptic solution.

Correct needle placement for injection of the sacroiliac joint.

Disorders of the sacroiliac joint can be distinguished from pain emanating form the lumbar spine by having the patient bend forward while seated. Patients with sacroiliac pain can bend forward with relative ease due to relaxation of the hamstring muscles in the seated position. Patients with lumbar spine pain will experience an exacerbation of pain when bending forward while seated.

The above injection technique is extremely effective in the treatment of sacroiliac joint pain. Coexistent bursitis and tendonitis may also contribute to sacroiliac pain and may require additional treatment with more localized injection of local anesthetic and methylprednisolone acetate.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue .Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age –related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.