Treatment Options For Sacroiliac Joint Pain (SI Joint Pain)
There are two sacroiliac joints in the low back, located on both sides of the pelvis. They can cause lots of pain on both sides or just one in patients with chronic low back pain. It can be tough to establish the diagnosis of SI joint pain. Numerous studies have shown the SI joint can generate pain in ten to thirty percent of individuals with chronic low back pain.
No universal accepted standard exists for the diagnosis of low back pain stemming from the sacroiliac joints. The joint itself is fairly irregular in appearance and difficult to properly evaluate in imaging studies, so trying to “hang one’s hat” on the sacroiliac joint as a source of pain from x-rays, CT scans, or MRI’s is not accurate.
There are provocative tests on exam that can help make the diagnosis of SI generated pain. The compression test, thigh thrust test, FABER test, etc. FABER stands for flexion, abduction, and external rotation. Multiple of the exam tests have shown accuracy in making the diagnosis of SI pain.
Bone scans have been proposed for making the diagnosis of SI pain, but research has not panned out for its use.
Treatment options for sacroiliitis include NSAIDS, acetaminophen, or other pain medications, physical therapy, chiropractic treatment, pain management injections, or radiofrequency neurotomy (radiofrequency ablation).
For acute pain, non surgical treatments like medication, therapy, or chiropractic should be tried first. The medications should be taken according to the maker’s recommendations. In physical therapy, strengthening up the muscles around the SI joint may decrease joint pressure and decrease pain.
Diagnostic injections into the SI joint may give not only confirmation of the joint as the pain generator but also provide substantial pain relief for months. There is some debate about whether injections are better in the joint itself or around the joint to cover the nerve endings that supply the joint (and cause pain).
In those who do well with these diagnostic injections, radiofrequency ablation for the joint has been shown in small studies to work well. The RF treatment may give pain relief for over a year by deadening the small nerve endings that were causing pain.
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