Sacroiliac Joint Pain

Overview

The sacroiliac joints are large, strong fibrous joints between the sacrum and the ilium bones of the pelvis. They are connected by strong ligaments. The sacrum supports the spine and in turn, is supported by an ilium on each side. The inner surfaces of these joints are irregular and incongruous. This, along with the complex arrangement of strong posterior ligaments, and compression of the joint by deep core muscles, aids the stability of the joints.

Pain derived from the sacroiliac joint or adjacent ligaments accounts for around 20% to 40% of low back pain and pelvic girdle pain cases that present to a specialist spinal pain practice.

The Sacroliliac joint is the largest syndesmosis (slightly movable fibrous joint) in the body. It is thought to arise from chronic inflammation or irritation within the joint, capsule and/or deep ligaments that support the joint (the deep interosseous & long dorsal ligaments), which forms the posterior capsule. This irritation may arise from excess movement of the joint, inflammatory arthritis or damage from trauma.

If due to trauma, Sacroiliac joint pain is mostly unilateral, otherwise it maybe bilateral.

Symptoms

Features of sacroiliac joint pain are non-specific. That is, they often mimic symptoms typical of pain caused by lumbar facet joints, hip joints and discs. However, the presence of prominent pain over the sacroiliac joint is present in 80% of people with primary sacroiliac joint pain.

Sacroiliac pain is a classical, deep, and aching in character and may refer with a deep, dull, ache across the buttocks and into the lower legs. Referred pain from the sacroiliac joint and ligaments can reach the foot. A history of a fall onto the buttocks is common.

When studied, sacroiliac joint pain pattern is predominantly in the buttock and present there in 94% of cases. It refers to the thigh in 48%, lower leg 28%, foot and ankle 13%, groin 14% and abdominally in 2% of patients.(1)

Diagnosis

Many physical examination tests are used to diagnose sacroiliac joint pain. However, when tested against the gold-standard of intra-articular injection, they have been shown to be inaccurate.

X-rays and scans of this joint are generally unhelpful in diagnosing it as a source of pain. The only imaging test that has any real validity is a ‘bone scan’. This scan, however, has very low sensitivity in picking up sacroiliac joint pain, and therefore is not generally warranted.

The only method that can be used to diagnose sacroiliac joint pain is an image guided injection into the joint with local anaesthetic, followed by substantial eradication of pain in the immediate post-injection period.

Treatment

At MetroPain, we assess each patient’s condition individually.

As leaders in pain management, we aim to provide advanced, innovative and evidence-based treatments tailored to suit the patient.

Our treatment pathway involves exploring our comprehensive array of available conservative and interventional treatment options. Our goal is to reduce your pain and improve your quality of life, enabling you to Live Better.

Treatment for sacroiliac joint pain typically begins with conservative approaches focused on pain management and joint stabilization.

Rest and activity modification are essential first steps, combined with ice to reduce inflammation during acute phases and heat therapy to relax tight muscles afterward. Over-the-counter anti-inflammatory medications like ibuprofen can help manage pain and swelling in the short term, whilst prescription muscle relaxants may be considered for severe muscle spasms around the joint.

Physical therapy forms the cornerstone of effective SI joint treatment, with specialized exercises targeting core strength, pelvic alignment, and proper movement patterns. Manual therapy techniques performed by physical therapists, chiropractors, or osteopaths can help restore normal joint mobility and reduce pain. Many patients benefit from SI joint belts or braces that provide compression and stabilisation during daily activities, especially during the healing phase.

For those with persistent pain, interventional procedures offer additional relief options. Corticosteroid injections delivered directly into the SI joint can significantly reduce inflammation and provide months of pain relief.

Radiofrequency ablation, which uses heat to disrupt pain signals from the nerves supplying the joint, has shown promising results for longer-term pain management.

Regenerative treatments like prolotherapy or platelet-rich plasma (PRP) injections aim to strengthen ligaments and promote healing in the area.

Surgical intervention is typically reserved for severe cases that haven't responded to conservative treatments.

SI joint fusion, a procedure that permanently connects the sacrum to the ilium, can provide stability and pain relief for appropriate candidates. Complementary approaches like therapeutic massage, acupuncture, and aquatic therapy can work alongside medical treatments to improve outcomes and help patients return to their normal activities with reduced pain and improved function.

References

1. Slipman CW, Lipetz JS, Plastaras CT, Jackson HB, Vresilovic EJ, Lenrow DA. Fluoroscopically guided therapeutic sacroiliac joint injections for sacroiliac joint syndrome. Am J Phys Med Rehabil 2001; A: 425-432.

Disclaimer
Please note the contents contained in this Patient Fact Sheet are not intended as a substitute for your own independent health professional’s advice, diagnosis or treatment. Our specialists assess every patient’s condition individually. As leaders in pain intervention, we aim to provide advanced, innovative, and evidence-based treatments tailored to suit each patient. As such, recommended treatments and their outcomes will vary from patient to patient. If you would like to find out whether our treatments are suitable for your specific condition, please speak to your doctor at the time of your consultation.