Sacroiliitis is an inflammation of one, or both, of the sacroiliac joints located where the lower spine connects with the pelvis. Though it rarely requires surgery, sacroiliitis can cause pain in the buttocks or lower back that can extend down into the legs. Oftentimes, patients suffering from this type of condition will later experience pain after extended periods of standing, walking, or climbing. Your sacroiliac joints are located where the sacrum and ilium meet. The sacrum is the triangle-shaped bone near the bottom of your spine, just above your tailbone. The ilium, one of the three bones that make up your hip bones, is the uppermost point of your pelvis.
The sacroiliac joints support the weight of your body, distributing it across the pelvis. This acts as a shock absorber and reduces the pressure on your spine. The bones of the sacroiliac joints are then jagged. These jagged edges help them stay in alignment. Spaces in between the bones of the sacroiliac joints are filled with fluid, which provides lubrication. These spaces are also filled with free nerve endings, which send pain signals to the brain. When the bones in the sacroiliac joint become out of alignment, it can be very painful.
Causes & Symptoms
Inflammation of the sacroiliac joint causes most of the symptoms of sacroiliitis. Many medical conditions cause inflammation in the sacroiliac joint, inducing the following:
- Osteoarthritis – Also known as ‘wear and tear’ arthritis, is the most common arthritis diagnosed by doctors. As you go about your life and wear out your body, your joints and skeleton tend to wear down. The more active you are, the faster your joints wear out. Osteoarthritis normally affects the hips, which can cause you to move and walk differently. As with a spinal degenerative condition, your sacroiliac joint becomes inflamed and starts hurting.
- Ankylosing spondylitis – This is a type of inflammatory arthritis of the joints of the spine. Sacroiliitis is often an early symptom of ankylosing spondylitis.
- Psoriatic arthritis – This inflammatory condition causes joint pain and swelling as well as psoriasis. Psoriatic arthritis can cause inflammation of the spinal joints, including the sacroiliac joints.
- Trauma – A fall, a motor vehicle accident, or other similar injuries to the sacroiliac joints (or the ligaments supporting or surrounding the sacroiliac joint) can cause symptoms linked to sacroiliitis.
- Pyogenic sacroiliitis – This is a rare infection of the sacroiliac joint caused by the bacteria known as staphylococcus aureus.
- Infection – Although this is quite rare, an infection may occur in the sacroiliac joints or an infection in a separate part of the body can cause inflammation in the joints.
Other common symptoms of sacroiliitis include pain in the buttocks, lower back, and back of one or both legs. Slight fever can also be a symptom showing signs of sacroiliitis, as well as stiffness in the hips and lower back.
Certain activities that can aggravate sacroiliitis pain include:
- Standing with the weight on one leg
- Climbing up stairs
- Running for a long period of time
- Turning over in bed
- Standing for a long period of time
- Walking long distances
Who Gets Sacroiliitis?
Anyone can develop sacroiliitis, although, certain factors can raise the risk of developing this condition, including:
- Gait issues – Such as leg length discrepancy or scoliosis, which can place uneven pressure on one side of the pelvis, causing wear and tear on the sacroiliac joint and an increased risk of pain.
- Pregnancy or recent childbirth – Can commonly cause sacroiliac joint pain in women due to weight gain, hormonal changes causing ligaments in the sacroiliac joint to relax, and pelvic changes associated with childbirth.
- Lower back surgery – Which can displace pressure to the sacroiliac joint. One study found that sacroiliac joint pain tends to be much more common following a fusion surgery than a discectomy. The same study found that multi-level surgery was more likely to cause sacroiliitis than a single-level procedure. Sacroiliitis has also been reported following hip joint replacement surgery and bone grafts taken from the iliac bone.
- Activities that place stress on the joint – Such as sports, regular heavy lifting, or labor-intensive jobs. If pelvic and / or low back muscles are unconditioned, stress from prolonged sitting or standing may also contribute to sacroiliitis.
How Does It Affect You? How Serious Is It?
Sacroiliitis is not uncommon in women who are pregnant. That is because during pregnancy your hip and sacroiliac joints will begin to naturally loosen. This is your body preparing to give birth. Additionally, a change in the way some women walk as a result of pregnancy can cause the sacroiliac joints to become inflamed; this becomes sacroiliitis. Therefore, during pregnancy and breastfeeding, a woman’s hormones change, which can affect the laxity of the joints, including the sacroiliac joints. A patient can sprain the sacroiliac joints fairly easily – for example, excessive walking, exercising incorrectly, bending and lifting with poor form, or taking a weird step off a curb. It can start anywhere from weeks 12-39, but it will typically arise in the middle to the late second trimester. You may also experience sacroiliac joint dysfunction after delivery. It will typically arise 6-12 weeks after delivery, during which time your uterus has returned to its former size, you return to other activities and continue to bend and lift a growing baby. It is more common in breastfeeding mothers as breastfeeding continues to affect the hormones.
Recommended Treatment & Rehabilitation
Your doctor will ask you about your medical history, including any previous inflammatory disorders or conditions. Other diagnostic tests include:
- Physical exam / movement tests – During the physical examination, the spine is examined for proper alignment and rotation. During various physical movement tests, you are positioned or asked to move in specific directions. In some of these tests, the doctor applies pressure to your sacroiliac joint, spine, hip, or leg. The greater the number of tests that are positive, the higher the likelihood that you have sacroiliitis.
- Blood work – Blood work looks for signs of inflammation.
- Imaging tests – X-rays, CT scans, and / or MRI scans may be ordered if the doctor suspects an injury as the source of pain or to look for changes in the sacroiliac joint.
- Steroid injection – An injection of steroids into the sacroiliac joint is both a diagnostic test if it relieves the pain, and a treatment. This procedure is performed using an X-ray to guide the spinal needle to the appropriate location for the injection.
Treatment for sacroiliitis is determined by the underlying causes of the condition, as well as the severity of the patient’s symptoms. Fortunately, there are many non-surgical treatments that can provide relief for sacroiliitis symptoms. Pain relievers, like over-the-counter pain medications such as NSAIDs (non-steroidal anti-inflammatory drugs) or acetaminophen, can provide pain relief for mild to moderate sacroiliitis pain. For moderate to severe sacroiliitis pain, prescription pain relievers and muscle relaxers can help provide relief and reduce muscle spasms associated with sacroiliitis. For patients with a diagnosis of ankylosing spondylitis, tumor necrosis factor inhibitors (TNFis) can help slow the progression of sacroiliac joint damage and provide pain relief.
Physiotherapy can also help individuals with sacroiliitis maintain range of motion in their sacroiliac joints and provide strengthening exercises for surrounding muscles.
Sacroiliac joint injections are a minimally invasive treatment method for sacroiliitis pain. These injections are performed by a pain doctor in a clinical setting and use a combination of steroids and local anesthetics to target one or both of the sacroiliac injections. The procedure typically takes only 30 minutes to complete and begins to take effect in 3-5 days. Electrical stimulation can help with sacroiliitis pain by blocking the electrical signals involved in sacroiliac joint pain.
Surgery is very often the last line of defense when it comes to sacroiliitis and is rarely required. However, for patients who are suffering from severe pain that is unresponsive to non-surgical options and is inhibiting their everyday lives, sacroiliac joint fusion is a recommended option. This surgery effectively stabilizes the joint and increases load-bearing capacity by fusing the joint together through a brief and minimally invasive procedure.
The symptoms of sacroiliitis may be felt in the low back, buttocks, hips, and legs. Some of these symptoms are similar to sciatica and may mimic other lumbar spinal disorders. Therefore, you may find some of the stretches and exercises included here may also be part of a treatment plan for other low back diagnoses. Here are a few exercises that can help reduce symptoms linked to sacroiliitis:
Hip abduction strengthening
The hip abductor muscles on the outside of the thighs connect to the thighs from the hip bones. Firstly, lie on the back with the knees slightly bent and a resistance band around the knees. Keeping the back arched, gently push the knees apart to strengthen the outer thigh and buttock. Lastly, hold for 5 seconds, and repeat this exercise 10 times.
Hip abduction strengthening
The hip adductors in the groin / inside of the thighs connect to the thighs from a ligament in the pelvis. Lie down on the back with both knees bent and place a medium rubber exercise ball between the knees. Keeping the back slightly arched, squeeze the ball with both knees for 5 seconds, and repeat 10 times to strengthen the hip adductor muscles.
Lie on your back with knees bent and your palms flat on the floor. Keeping your palms on the floor, lift the hips into the air and hold for 5 seconds to help strengthen muscles in the lower abdomen, lower back, and hips. Repeat this stretch between 8-10 times.
This is a more advanced exercise method that involves twisting the lower spine which is called the triangle yoga pose. Begin with the feet a little more than shoulder-width apart, and point the right foot outwards. Extend both arms straight to the sides so they are parallel to the floor. Then, slowly bend to the side so the right hand touches the right shin or the floor, and the left arm is over the head. Hold this stretch for 10-20 seconds, then repeat on the left side.
Bird dog poses
Another more advanced yoga pose, the bird dog pose can help strengthen the lower back and core muscles that support the pelvis. Starting on the hands and knees, position your shoulders square and faces toward the floor. Lift one leg and the opposite arm straight into the air and hold for 5 seconds. Make sure to keep the back and pelvis level while doing the exercise.
Alternative & Homeopathic Treatment
There is a wide range of home remedy options available. Most patients find that a combination of two or more of the following at-home treatments can be effective in managing their symptoms:
Rest – A short period of rest may help calm the inflamed sacroiliac joints.
Ice and/or heat – Warmth or cold applied to the area will provide local pain relief. Application of a cold pack will help reduce the inflammation in the area, while the application of warmth, such as a heating pad or hot tub, will help stimulate blood flow and bring healing nutrients to the area.
Sleep position – Changing one’s sleep position can help alleviate pain while sleeping and at waking. Most patients find it best to sleep on the side, with a pillow placed between the knees to keep the hips in alignment.