Sacroiliitis: Pain in the You-Know-What

The COVID-19 pandemic has forced us all to change the way we live and work. And for many of those working from home, the changes have been literally painful.

That’s because as much as we love working in our pj’s on our laptops in bed or on the sofa, this is the worse thing for the back and neck. And that favorite recliner, while OK for watching a few shows in the evening, can wreak havoc on your back—especially the lower portions of the spine and pelvis—if you spend all day in it.

Since the onset of the pandemic, there has been a spike in the number of people complaining of lower back pain, but for many of those patients, the source of their pain is not their back, but the sacroiliac joints.

What is Sacroiliitis?

Sacroiliitis is an inflammation of one or both of the sacroiliac joints — situated where the lower spine and pelvis connect. Sacroiliitis can cause pain in the buttocks or lower back that can extend down one or both legs. Prolonged standing or stair climbing can worsen the pain. Some people report even rolling over in bed can be excruciating.

Sacroiliitis can be caused by a number of factors, including:

• Inflammation of the sacroiliac joints. 
• Osteoarthritis that causes the cushioning cartilage in the sacroiliac joints to break down.
• Pregnancy, and the added weight and pressure it brings, can put additional stress on the sacroiliac joints, which naturally begin to stretch to prepare for childbirth.
• Poor posture, including sitting or standing for extended periods of time that results in pressure on the sacroiliac joints. Many people report pain when they rise after long periods of sitting, including after long car rides.
• Trauma from an accident or fall.

Pinpointing and Treating the Source of the Pain

Sacroiliitis can be difficult to diagnose because the symptoms often mimic those of lower back pain. A thorough physical exam, including physical manipulation of the legs and hips, will help determine if the SI joints are the source of the pain. In addition, the physician may inject a local analgesic specifically into the SI joint region to see if it relieves the pain. If it does, he or she may recommend other treatment options to treat the sacroiliitis, beginning with the most conservative options first.

• Over-the-counter anti-inflammatories can help address inflammation in the SI joints in milder cases of sacroiliitis.
• Physical therapy that includes strength and stretching exercises can help improve SI joint flexibility and stability to reduce discomfort.
• Lifestyle changes, including proper support for the SI joints while seated for extended periods of time, can significantly reduce the pain caused by sacroiliitis.

If the pain persists even after implementing these treatments, a qualified pain management specialist can offer long-term relief of sacroiliitis through:

• Prescription medication management that includes stronger oral anti-inflammatories or muscle relaxants to reduce muscle spasms associated with sacroiliitis.
• Targeted injections of corticosteroids to the SI joint to reduce inflammation and pain. Because these powerful anti-inflammatories may weaken bones and tendons, patients are limited to the number of injections they can receive.
• LinQ™ is a minimally invasive therapy for patients with chronic sacroiliitis where more conservative measures have failed to bring pain relief. This unique procedure involves implanting a small bone graft into the SI joint to stabilize and fuse the joint through one small incision on the patient’s back. It is performed on an out-patient basis at a hospital or surgery center. Patients can go home the same day and are generally able to resume their normal daily routines within a couple of weeks.

Anyone experiencing pain in their lower back, hips, buttocks and legs should not suffer needlessly. An experienced pain medicine specialist can accurately determine if sacroiliitis is the cause of the pain and offer the most appropriate therapies to provide much-needed pain relief.

Dr. Ioannis Skaribas is fellowship-trained and double board certified in Pain Medicine and Anesthesiology. He has been performing minimally invasive treatments to address chronic pain for more than 25 years. Dr. Skaribas is nationally recognized for his expertise and training on the latest advanced treatments such as LinQ™ to help his patients with complex chronic pain.