SI Joint Disruption / Degenerative Sacroiliitis
Low back pain is a common complaint of millions of people and the pain may linger for months or even years. For decades, the sacroiliac joint (or SI Joint) was suspected to be a common cause of low back or leg pain however the standard diagnostic tests of the time left doctors skeptical. Over the last twenty to thirty years, much of the medical profession has focused on discogenic pain caused from herniated discs and degenerative disc disease as the common cause for low back or leg pain. Still to this day SI Joint conditions may still be overlooked as very few healthcare professionals are trained to identify the specific symptoms that indicate SI Joint Disruption / Degenerative Sacroiliitis.
The SI joints are formed by the connection of the sacrum and the right and left iliac bones (the two large bones that make up the pelvis). The SI joints connect the spine to the pelvis. While most of the bones of the spine are mobile, the sacrum is made up of five vertebrae that are fused together and do not move. The sacrum and the iliac bones are held together by a collection of strong ligaments. There is very little motion at the SI joints.
One of the most common causes of SI joint conditions is degenerative arthritis. Like other joints in the body, the SI joints have a layer of cartilage covering the bone. This allows for some movements and acts as a shock absorber between bones. Then the cartilage becomes damages or worn away the bones begin to rub against each other. When bones rub against each other, degenerative arthritis occurs.
Another common cause of SI Joint Degeneration is pregnancy. This is believed to be because of the possible changes in posture, weight and walking pattern as well as the relaxation of ligaments holding the SI joints together in preparation for childbirth.
Any condition that may alter a normal walking pattern may cause SI Joint dysfunction (such as having uneven leg length, injuries to the legs or feet that may cause a permanent limp or altered gait).
The most common symptom of SI joint Degeneration or Degenerative Sacroiliitis is pain. Most people experience lower back pain or pain in the back of the hips. However pain may also be present in the groin or the thighs. Most patients say that pain is typically worse when standing or walking and improves when they lie down. Patients may also experience stiffness and a burning sensation in the pelvis due to inflammation and arthritis in the SI joint.
Because SI Joint conditions can be difficult to diagnose as the symptoms may mimic other common conditions and does not usually show up on X-rays, MRIs, or CT scans, a specially trained expert in the field such as our experts at SCCNS must perform a physical examination to evaluate the SI Joints and how they are functioning in relation to the rest of the body.
The initial treatment of SI Joint Disruption / Degenerative Sacroiliitis usually includes the use of ice (cold packs) to reduce inflammation. This treatment may be used from two days to two weeks. Treatment may also include over the counter pain medications as well as anti-inflammatory medications to reduce the swelling in the area that usually contributes to the pain. Occasionally, depending on the severity of the condition, manual manipulation by a chiropractor may be helpful if the joint is fixated or stuck but may be more irritating if the joint is hypermobile (too loose). Other treatments may include supports and braces if the joint is hypermobile as this can help stabilize the joint if it is inflamed or painful.
Before surgery is considered, physical therapy will be attempted in order to strengthen the muscles around the SI Joint and increase the range of motion. Low impact aerobic exercise may also increase the blood flow to the area which will stimulate healing. Because of our multidisciplinary approach, along with physical therapy, one of our pain management experts may also suggest an SI Joint injection in order to determine whether the sacroiliac joint is the actual cause of the patient's pain. These injections are the gold standard in diagnosing SI Joint Conditions and are useful in providing immediate relief of pain.
If all conservative methods fail to reduce the pain and symptoms of SI Joint pain, surgery may be a beneficial option. At SCCNS, we use the most minimally invasive SI Joint surgery currently available. The FDA approved iFuse System® used by SCCNS is designed to provide fusion for the sacroiliac joint. This is accomplished by inserting small titanium implants across the sacroiliac joint to maximize post-surgical stability and weight bearing capacity. Our partnership with SI Bone allows us to be at the forefront of this minimally invasive surgery. This highly advanced technique allows for fewer complications, smaller incision than traditional SI Joint fusion surgeries, minimal blood loss, decreased operation time and reduced risk of infection. The SCCNS is one of the very few places in Southern California trained and approved to perform this procedure.
**SCCNS in conjunction with SI Bone is now conducting a study to be able to help publish research data and success rates of patients. Please contact Nichole Martinez at SCCNS to see if you may qualify. You can read more about this study at www.si-bone.com or at www.clinicaltrials.gov
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