Tell-tale Back Pain

Specific symptoms can indicate problems with the sacroiliac joint Back pain will strike about 80 percent of people in their lifetime, but when one cause mimics many others, the diagnosis can prove frustratingly elusive.

But then, the sacroiliac joint does have its giveaways.

There’s the sufferer who has trouble standing or walking for very long, or—as Dr. Arthur Arand notices when he walks into an exam room—who can’t sit on the painful side so they lean to the other.

Of course, Arand, a neurosurgeon with Mayfield Brain & Spine, applies more tests to determine whether the SI joint is the culprit, perhaps starting with an X-ray, CT scan or MRI to rule out a fracture or tumor.

SI joint pain accounts for 15 to 25 percent of all back pain, says Dr. Jonathan Grainger, anesthesiology and pain management specialist at the St Elizabeth Spine Center.

The symptoms of SI pain start in the lower back and bottom, where patients often point when asked where it hurts, Arand notes. The very broad SI joints, which connect the spine to the hips and are key in providing support and stability, are marked on the surface by the dimpled spots on the lower back.

The SI joints are supported themselves by strong ligaments, which cause SI joint pain when they become too tight or too loose, such as in pregnancy, Arand says. Age-related degeneration, falls or injuries, disparate leg length or past surgery also can cause the SI joint trouble.

Often, patients who have had lumbar fusion, total hip or knee replacement surgeries will show up two or three years later with SI joint pain because of their slightly altered gait, he adds.

The pain sometimes radiates to the lower hip, groin or upper thigh and can cause a numbness, tingling or weak feeling in the leg.

Treatment for SI joint pain varies, according to the severity of the condition, with surgery always a last resort.

“Probably 80 percent [of SI joint afflictions] can be fixed without an operation,” Arand says, adding non-surgical options for treatment include chiropractic manipulation, stretching, oral anti-inflammatory medications or topical patches, creams, salves or mechanical bracing.

Non-chronic SI joint flare-ups, which can occur suddenly, may be treated by rest, physical therapy, nsaids, ice and heat and perhaps steroid injections, which reduce the swelling and inflammation of nerves, says Grainger. He adds that maintaining a healthy weight, regular exercise and avoidance of trauma or repetitive activities are recommended for pre-empting SI point problems.

Treatment of chronic issues with the SI joint, lasting 10 weeks or more, may involve procedures like nerve ablations, which uses an electrical current to destroy the nerve fibers that send pain signals in the joint. The downside is that the nerves can grow back, making the procedure necessary in another five years or so.

When all else has lost effectiveness and the pain level has become intolerable, corrective action may be recommended through a minimally invasive SI joint fusion surgery, Arand says.

Through a small incision, titanium implants are inserted to stabilize the joint and promote bone growth. The surgery takes about 45 minutes to an hour, but the results are dramatic in post-operative visits three or so weeks later, Arand says.

Following some post-operative soreness at the site, “the patient literally wakes up” without the once-nagging pain, he says.

But patients can spend time researching the cause of their pain.

Other back or spine maladies that can be mistaken for SI joint pain include spondyloarthropathies, facet joint disease, hip dysfunction, lumbar disc herniation, spinal stenosis and piriformis syndrome.

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