Sacroiliitis and SI joint painBy Nigel Chua
Painful inflammation of our sacro-iliac joint can be a symptom of a range of inflammatory conditions, including:
Also known as osteoarthritis of the sacroiliac joint, degenerative arthritis is primarily caused by wear and tear and breakdown of the joint cartilage. It can also be caused by diseases, injuries and direct impacts.
The wearing and breakdown of our sacroiliac joint cartilage can be caused and/or aggravated by:
- age (the older, generally the more wear and tear)
- obesity (the heavier, the more load is put through the joints)
- direct trauma
- repeated stress on the sacroiliac joints from repetitive movements and strains
- malformed/misaligned joints.
ANKYLOSING SPONDYLITIS (AS)
Ankylosing spondylitis (AS) usually begins as sacroiliitis. Ankylosing spondylitis begins in our sacroiliac joints, before it progresses by traveling upwards along the spine through a vicious cycle of inflammation, erosion and calcification.
To be able to accurately diagnose ankylosing spondylitis, our sacroiliac joints need to be clearly seen to be affected by the inflammation cycle. This detection of AS-related sacroiliitis can be done via
- X-ray imaging
- MRI scans
- CT scans
- Blood tests to detect elevated C-reactive protein (CRP) and/or erythrocyte sedimentation rate (ESR).
PSORIATIC ARTHRITIS (PSA)
Psoriatic arthritis is an auto-inflammatory disease that causes
- pain and swelling in our joints
- scaly skin patches (commonly known as psoriasis).
Psoariatic arthritis can be hard to distinguish from rheumatoid arthritis because their symptoms overlap. That being said, psoriatic arthritis is much more likely to cause spondylitis which is the inflammation of the joints in our spine, which also includes the sacroiliac joints.
If sacroiliitis is amongst the symptoms experienced by a patient, then the patient is more likely to have psoriatic arthritis. Research shows that 10% of patients with psoriasis develop psoriatic arthritis, and 90% of them do not experience any forms of joint pain and swelling.
Gout is a painful condition that is caused when the build up of uric acid forms uric acid crystals that can travel. These uric acid crystals insert painfully into the joints, causing swelling and pain.
Gout is a common form of inflammatory arthritis, and it generally and typically affects one joint at a time (usually the big toe). But unfortunately in some cases, some gout patients may experience pain and inflammation in the sacroiliac joints too.
If the usual and typical gout treatments aren't working for your sacroiliac joint symptoms, and there are no inflammatory conditions identified by a doctor, it is possible that you may receive direct treatment to the sacroiliac joint, such as
- a diagnostic anesthetic injection to confirm the pain
- steroid compound to treat the gouty pain
There are many different causes of sacroiliac joint pain and inflammation, and treating them effectively lies in identifying the main cause of the problem and treating the cause.
NON-ARTHRITIC CAUSES OF SI JOINT PAIN
Not all types of sacroiliac joint pains are caused by or related to arthritis. There are other causes such as direct trauma, pregnancy and even mechanical loads:
- Trauma. The SI joint, which is comprised of the ligaments that surround and support the SI joint, can be injured by direct trauma. Our sacroiliac joint can be easily damaged even with mild or light force trauma. You can damage your sacroiliac joint by something as simple as stepping onto higher ground the wrong way or accidentally "jamming" the joint in a fall.
- Lax ligaments during pregnancy. Pregnant bodies secrete the special hormones relaxin and progesterone to loosen the joints to prepare the body for childbirth. Sometimes, these ligaments get too lax and unfortunately in some cases, the sacroiliac joint can dislodge or slip out of place. Symptoms often decrease after pregnancy and childbirth, as the ligament automatically becomes stronger once the relaxin hormone is no longer secreted, and as patients increase activity levels.
- Mechanical stress. Some people develop very stiff spines because of conditions like severe arthritis or surgical spinal fusion, which can increase the stress experienced at the SI joint due to overload/overcompensatory functions. Over a period of time, this can lead to degenerative changes and pain.
A trained and experienced specialist physiotherapist can assess, diagnose and treat the root cause of your sacroiliac joint pain and customize a specific treatment plan for you.
PHYSIOTHERAPY TREATMENT OF SACROILIAC DYSFUNCTION
Most of the causes of back pain linked to SI dysfunction can be treated with rest, anti-inflammatory medications and spinal physiotherapy.
When sacroiliac joint pain and sacroiliitis are caused by a specific type of arthritis, we always need to diagnose and treat the main cause underneath - there is no point just treating the symptoms only.
Sometimes the inflamed SI joint can be slightly misaligned and our specialist spinal/sacroiliac physiotherapist can help to realign the joint with a combination of
- gentle, graded and guided exercise
- joint manipulation
- manual therapy.
At other times, injections are helpful to decrease the inflammation, and in some cases, surgical intervention is required for SI dysfunction that doesn't respond to non-surgical interventions.