The sacroiliac joints are located where the lower end of the spine joins the pelvis. These bones and joints are covered with cartilage that allows for some movement in the area and acts as a cushion between the bones. Certain conditions can cause this cartilage to degenerates such as ankylosing spondylitis, rheumatoid arthritis, psoriasis, previous trauma, and age-related degeneration. When this cartilage is worn down, the bones are exposed and rub against each other resulting in sacroiliac joint inflammation (sacroiliitis) and eventual dysfunction.
Patients with sacroiliitis complain of pain that occurs in the lower back and buttocks, and the pain can also refer to the groin, legs, and the feet. The condition is aggravated by activities such as bearing more weight on one leg than the other, prolonged standing, running, climbing stairs, and taking large strides when walking.
Conservative Management of Sacroiliitis
The rationale behind sacroiliac joint dysfunction treatment is to reduce the symptoms associated with the inflammation and disability caused by the condition to improve the patient’s quality of life.
Conservative treatment of sacroiliitis includes using oral pain-relieving medications such as paracetamol, anti-inflammatories such as ibuprofen and naproxen, muscle relaxants such as cyclobenzaprine which helps to reduce muscle spasms around the inflamed sacroiliac joints, and tumor necrosis factor (TNF) inhibitors which help to reduce joint inflammation associated with ankylosing spondylitis.
Physical therapy can also be initiated where the physiotherapist can teach the affected person stretching and range-of-motion exercises and techniques to help improve joint flexibility, as well as strength-training exercises to help improve the stability of the muscles around the sacroiliac joints.
Sacroiliac Joint Injections
Sacroiliac (SI) joint injections can be performed if oral and topical medications are ineffective. This procedure involves injecting a combination of a steroid with or without local anesthetic medications directly into the sacroiliac joints. This is performed in a clinical environment using X-ray imaging to guide the needle to the correct position.
Some patients do complain of pain after SI joint injection because the medications can burn and sting after they are administered, but for the most part, the procedure isn’t uncomfortable and the pain resolves within a few hours. After the injection is administered, the patient will be taken to the ward or recovery area and given pain medication for this pain if needed and until it resolves.
The patient won’t stay for too long in the day clinic or hospital and once they are awake and alert will be allowed to go home. Some patients will return to work or their normal daily activities within a couple of days after the procedure is performed.
The patients feel immediate pain relief from the injection, but as the local anesthetic begins to wear off, the pain begins to come back. Fortunately, the steroidal medication that was administered gets to work around two to three days after being administered and this helps to reduce the inflammatory response in the SI joints.
SI joint injections are safe and effective. In one clinical study, it was demonstrated that the success rate of the injections, 6 months after being administered, was 89 percent in the participant group.