Sacroiliac joint pain is one of the most overlooked causes of low back pain. The SI joint, as it is abbreviated, is one of the joints in the pelvis, formed by two bones, the sacrum and the ilium. It is believed that there is normally a small amount of interplay, or movement, at this joint. Falling or an activity that stresses the joint can cause pain to originate at this joint.
Causes of pain
- Standing for extended periods. Most people find it tiring to remain standing for any length of time. Waiting in lines, shopping or many work situations can require standing in place. When this happens, the muscles that hold us erect soon tire and we slump into poor posture positions. Now our entire weight is pulling against ligaments, especially those in the pelvis and lower back. After years, the ligaments become stretched and weakened so that they cannot properly control our joints.
- Work and sports strain. There are many occupations, work situations and sports requiring lifting, bending or twisting, which keep the back under constant or repeated strain. Anyone from a farmer to a ballet dancer can develop overstretched ligaments from these occupational hazards. When overstretched ligaments no longer hold the back joints in proper position, a serious back sprain condition results.
- Obesity and pregnancy. Every extra pound we carry puts added strain on our backs. This is especially true of the large stomach. This weight tips the pelvis forward and strains the back by forcing the lower vertebrae into an unnatural position.
Stretched pelvic ligaments
Once ligaments stretch, pelvic tilting results. The spine loses normal support, and various curvatures can develop over a period of time.
Disc problems result from unequal pressure on the disc caused by spinal curvature or injury. This can cause a herniated disc, which presses into the sciatic nerve, creating pain that may be felt in the buttocks and legs. The symptoms of SI joint pain usually begin in the hip, although pain can also be felt in the thigh, groin, buttocks or down the leg. Masquerading as low back and sciatic pain, the SI joint is often overlooked.
What to do
Treatment of the sacroiliac joint is usually non-surgical.
- Stop all strenuous activities. Lying down produces the best results for relieving pressure.
- Take an anti-inflammatory medication if you can tolerate it. Ibuprofen works very well. Follow the container's directions.
- Apply cold to the painful area. Put crushed ice (or ice cubes) into a double plastic bag, hot water bottle or wet towel. Apply one layer of a wet cloth over the injury, place the ice pack on the cloth, and then use an elastic bandage to hold the ice pack in place.
An ice pack should be applied to the area for 20 to 30 minutes every 2 or 3 hours during the first 24 to 48 hours. Skin being treated with cold passes through four stages: cold, burning, aching and numbness. When the skin becomes numb, usually in 20 to 30 minutes, remove the ice pack.
Cold constricts the blood vessels to and in the injured area, which helps reduce the swelling and inflammation and at the same time dulls the pain and relieves muscle spasms.
- See your physician if the pain persists or goes into the leg.
Exercises
Unless your physician instructs you otherwise, exercises performed twice each day can help prevent and rehabilitate many painful backs. Use slow, smooth actions as you exercise. If you feel any discomfort while doing the exercises, stop immediately and contact your physician. Stop any exercise that increases back pain or causes tingling, numbness or weakness in your legs.
Some examples of back exercises include:
- Double knee-to-chest stretch. Lie down on back, pull both knees into chest until comfortable stretch is felt and hold for 45 to 60 seconds.
- Pelvic tilt. Lie on back with knees bent, feet flat on floor, and arms at sides. Flatten small of back against the floor. Hold for 10-15 seconds and release.
- Curl-up exercise. Lie on floor on back. Keep arms folded across chest; tilt pelvis to flatten back; tuck chin into chest. Tighten abdominal muscles while raising head and shoulders from floor. Hold for 10 seconds and release.
- Prone lumbar extension. Lie on your stomach and place your hands on the floor near the sides of your head. Slowly push your upper body off the floor by straightening your arms, but keep your hips on the floor. Hold for 10 seconds, then relax and move back to the floor.
- Alternate arm extension. Face floor on hands and knees. Raise left arms and right leg. Do not arch neck. Hold for 10 seconds and release.
- Trunk flexion stretch. On hands and knees, tuck in chin and arch back. Slowly sit back on heels, letting shoulders drop toward floor. Hold for 45 to 60 seconds.
Over-the-counter pain medications (e.g., ibuprofen) and exercises designed to restore normal mobility and strength across the joint should be tried first. If they fail, sometimes injections of cortisone into the SI joint are also necessary. If pain still continues, occasionally surgery may be considered. Fortunately, this is the exception rather than the rule.
Alton Thygerson, professor of health sciences at Brigham Young University, is the National Safety Council's first aid and CPR author and technical consultant. For more information, the new National Safety Council First Aid Handbook by Alton Thygerson is available in local bookstores.