Treatments for Sacroiliac Joint Pain and Dysfunction

Those in the know about sacroiliac joint derangement (SIJD)—in particular, people who work in the conventional medical realm—often regard treatment for this problem as “controversial.”

Sacroiliac Joint Treatments

Sacroiliac joint seen from above.
Sacroiliac joint seen from above. MedicalRF.com/MedicalRF.com/Getty Images

One reason may be that getting an accurate diagnosis can be elusive. In other words, is it a good idea to agree to a treatment—especially one that makes permanent changes—when you’re not guaranteed the pain is actually coming from the SI joint? Another reason may be related to the lack of studies done to date on common therapies and procedures used for treating SIJD.

To help you sort out your options for SI joint dysfunction, let’s review the common treatments offered by doctors and therapists.

In the end, though, the choice of treatment may not matter. In 2012, Spiker, et. al., conducted a review of studies that was published in Evidence-Based Spine Care Journal. The review compared surgery to injections and fusion of the SI joint to denervation. Spiker’s team concluded that most of the studies reported 40% pain relief regardless of the treatment tried. In other words, SI derangement improved independently of the exact therapies patients underwent.

Medication

Pills of different shapes, colors and sizes fill the image.
Pain killer types. ShutterWorx/E+/Getty Images

As with many types of back problems, an anti-inflammatory such as ibuprofen may be recommended to you by your doctor as a place to start. That said, ibuprofen comes with many potential side effects, and some of them can be very serious. Please be sure you know what the side effects are, and that you've discussed these with your doctor before taking this drug.

Antiflammatories such as ibuprofen come in lower doses in the over-the-counter form, and higher doses should your doctor prescribe them for you.

Taking a medication such as an antiinflammatory is usually recommended along with other treatments such as physical therapy, bracing and/or activity modification. It is not a cure—it’s there to help reduce your inflammation and pain levels.

Physical Therapy

Senior woman being examined by physical therapist.
lightwavemedia

Physical therapists are trained to work with patients to optimize motion. To that end, you’ll likely get a home exercise program that will help you develop strength in your pelvis, hips, and core. This, in turn, may help stabilize your SI joint.

The exercises in your home program may also help you develop muscle balance. Because the SI joints are located on either side of your spine, (at the sacrum and hip bones) attaining equal strength and flexibility between the muscles on each side of your body may be one of the keys to regain symmetry and alignment.

Sacroiliac Braces

Back brace
Back brace. kamonrat

Many people report good results using a brace to help stabilize a loose sacroiliac joint. In particular, a pelvic belt is often recommended by doctors to their patients.

Researchers measured the change in muscle and other activity related to the sacroiliac joint when patients wore a pelvic belt. They concluded that pelvic belts improve health-related quality of life, and may be responsible for decreased SI joint pain. Some of the improvements noted include decreased quadriceps activity (in particular, the rectus femoris) as well as better postural steadiness while walking.

The researchers suggest that pelvic belts may be considered as a low risk, cost-effective treatment for SI joint pain. But weaning out of the brace once symptoms have resolved is important to limit weakness or stiffness in the hips.

Manual Therapy

Chiropractic adjustment
Chiropractic adjustment. Deeblue

Manual therapy—healing with the hands—is another kind of treatment for sacroiliac joint derangement.

Chiropractic is the most well-known type of manual therapy, but osteopathy, physical therapy, and massage therapy are viable options, as well.

When you get manual therapy from a physical therapist or osteopath, the practitioner may manipulate your joints. Studies have shown that no change in the alignment of the SI joint occurs after manipulation, but that patients may report improvement in their symptoms.

Massage therapy is another form of manual therapy. Its role in treating sacroiliac joint dysfunction revolves around releasing chronic muscle tension that may reduce pain in the joint. Massage can also increase the range of motion in general, which may make exercising easier, more fun and more productive.

Sacroiliac Joint Injections

A nurse holds a needle.
Nerve blocks are spinal injections. H. Armstrong Roberts/ClassicStock Archive Photos/Getty Images

An injection into your painful sacroiliac joint can have a role both as a diagnostic tool and as a pain relief treatment. Injection is about the closest thing medical practitioners and researchers have to definitively identify that the pain is truly coming from the SI joint.

The value of an SI injection as a treatment is not as clear. Spiker, et. al., in their 2012 review “Surgical versus injection treatment for injection-confirmed chronic sacroiliac joint pain,” published in the November 2012 issue of Evidence-Based Spine Care Journal, conclude that although injections and surgeries may help patients reduce their pain, based on the studies done so far, they cannot tell you which of these treatments work better than the others.

A 2012 review of studies done by Hansen, et. al., and published in Pain Physician found that intraarticular (meaning inside the joint) sacroiliac injections with steroids were not effective in relieving pain in the short or long term. However, other studies have shown improvement in patients who undergo injections. Currently no comparative studies exist between treatment methods, and more research is needed in this area.

Radiofrequency Denervation

Back procedure
Back procedure. NunoMt

As the name implies, radiofrequency denervation is a procedure that uses radiofrequency to disable the nerve that causes pain stemming from your sacroiliac joint.

Citing poor evidence, the review done by Hansen, et. al. in 2012, found that conventional radiofrequency denervation was not effective for relief of sacroiliac pain.

However, the review found a fair degree of effectiveness for a newer type of procedure, cooled radiofrequency, as compared with the poor effectiveness associated with the conventional types, which may warrant further investigation.

Sacroiliac Fusion or Arthrodesis

Sacroiliac joint seen from above.
Sacroiliac joint seen from above. MedicalRF.com/MedicalRF.com/Getty Images

The word arthrodesis refers to the immobilizing a joint by means of surgery. In this case, it refers to the fusion of the sacroiliac joint. Historically, surgery on the SI joint has been very complex, with poor results and high complication rates. Many patients required additional surgeries related to their SI fusion.

But even with minimally invasive spine surgery on the rise, having an SI fusion can be a tricky decision to make. The reason goes back to the diagnosis process.

“The difficulty is identifying that it is the sacroiliac joint,” says Carter Beck, MD. Beck is a Montana surgeon who has developed a minimally invasive procedure for fusing the SI joint that, according to him, is easy on the patient, safe and effective. Dr. Beck cautions both practitioners and patients to be sure the pain is truly coming from the SI, and not from another area of the spine.

While Beck’s new procedure sounds promising, medical research has yet to answer all the questions about safety, effectiveness and the type of patient who would be best suited for minimally invasive sacroiliac surgery.

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  1. Spiker WR, Lawrence BD, Raich AL, Skelly AC, Brodke DS. Surgical versus injection treatment for injection-confirmed chronic sacroiliac joint painEvid Based Spine Care J. 2012;3(4):41–53. doi:10.1055/s-0032-1328142

  2. Chuang CW, Hung SK, Pan PT, Kao MC. Diagnosis and interventional pain management options for sacroiliac joint painCi Ji Yi Xue Za Zhi. 2019;31(4):207–210. Published 2019 Sep 16. doi:10.4103/tcmj.tcmj_54_19

  3. Al-Subahi M, Alayat M, Alshehri MA, et al. The effectiveness of physiotherapy interventions for sacroiliac joint dysfunction: a systematic reviewJ Phys Ther Sci. 2017;29(9):1689–1694. doi:10.1589/jpts.29.1689

  4. Soisson O, Lube J, Germano A, et al. Pelvic belt effects on pelvic morphometry, muscle activity and body balance in patients with sacroiliac joint dysfunctionPLoS One. 2015;10(3):e0116739. doi:10.1371/journal.pone.0116739

  5. Nejati P, Safarcherati A, Karimi F. Effectiveness of exercise therapy and manipulation on sacroiliac joint dysfunction: A randomized controlled trial. Pain Physician. 2019;22(1):53-61.

  6. Hansen H, Manchikanti L, Simopoulos TT, Christo PJ, Gupta S, Smith HS, Hameed H, Cohen SP. A systematic evaluation of the therapeutic effectiveness of sacroiliac joint interventions. Pain Physician. 2012;15(3): E247-78.

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