Driving. Walking up stairs. Pregnancy.
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They’re normal parts of life but ones that can bring terrible pain in your sacroiliac joint (SI joint), where your back and hip meet. The joint tissue becomes inflamed, putting pressure on nerves and causing pain.
Zeeshan Ahmad, MD, a spine physiatrist at OSF HealthCare, says the SI joint stabilizes the back, helping with standing, walking and balance. He says SI joint pain, like all back pain, is common but hard to diagnose.
“Your posture is chronically bent forward. You’re not doing any stretching or changing posture. Then there’s a lot of stress on the sacroiliac joint,” Dr. Ahmad points out as one cause for the pain.
Sports injuries, falls or being bed-bound can also play a role. When driving, a sudden pound on the brake can shift your pelvis and cause stress on the SI joint. For pregnant woman, Dr. Ahmad says certain hormones can make the SI joint more mobile to accommodate the growing baby, and this can cause pain.
People with SI joint pain typically have lower back pain. It may extend to the rear end but usually does not extend down the legs, Dr. Ahmad says.
Diagnosis involves checking nerve function and reflexes, doing physical tests while the person is on an exam table and an X-ray to rule out bone issues.
Treatment could start with medication and physical therapy. If that’s not helpful, a provider may use an injection to reduce inflammation in the joint and take pressure off the nerve. Providers typically use lidocaine and/or a steroid for these injections.
“If a combination of lidocaine and a steroid is injected under camera guidance and the person gets better, it’s diagnostic. But it also becomes therapeutic. And it can last a long time,” Dr. Ahmad explains.
From there, it’s a matter of if or how long the person has pain relief. A provider could try an injection higher up the back than the first. Injections could become a once or twice-a-year thing. In cases where injections don’t help, a provider will consider more imaging to see if the problem is actually a herniated disc or spinal stenosis, where the spinal canal is narrowed. Surgery is possible in serious cases.
Prevention
Some tips to prevent SI joint pain and back pain in general:
- Practice good posture. Sit up straight. Bend at your knees, not your hips.
- Practice good nutrition.
- Manage conditions like hypertension and diabetes.
- Exercise and stretch regularly.
“Exercise will lead to strengthening of muscles,” Dr. Ahmad says. “Many people gradually will develop degeneration of discs and joints [in the spine.] These are painless changes. But they become less capable of withstanding stresses.”
- If stairs cause pain, take an elevator or escalator when you can.
- If you drive for a living, avoid sudden braking. Use cushions to support your back and rear end. Take breaks to get out, walk and stretch.
- Bring up health issues with your primary care provider right away. For example, Dr. Ahmad says at age 40, you should talk to your provider about when to get a bone density test.
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