What is SI Joint Dysfunction?

(SI) joint dysfunction describes pain due to abnormal movement (too much or too little) or misalignment of the SI joint. It can cause sharp, stabbing pain that starts in the hips and pelvis and radiates into the lower back and down the thighs.

Pain is the main symptom of SI joint dysfunction. It can be felt on one side of the body in the lower back and the hip, buttock, and leg on the same side. While rare, SI joint dysfunction can also affect both sides of the lower body.

SI joint dysfunction can be caused by various conditions, including osteoarthritis (OA), ankylosing spondylitis (AS), trauma, repetitive stress to the joints, older age, pregnancy, abnormal walking patterns, leg length differences, and scoliosis (abnormal curvature of the spine).

SI joint dysfunction is a treatable and manageable condition. It is treated with both nonsurgical and surgical therapies. This article will cover SI joint dysfunction causes, symptoms, treatment options, and more.

What Causes SI Joint Dysfunction?

Causes and risk factors for SI joint dysfunction include:

• Osteoarthritis: Because OA is associated with aging, it can affect the SI joints and spine. Years of wear and tear on these joints can lead to cartilage damage. Cartilage is the covering of a bone's surface at a joint.

  
  

• Ankylosing spondylitis and other types of inflammatory arthritis: AS is a type of arthritis that mainly affects the spine but might also affect the hips and the SI joints. SI joint inflammation is a hallmark symptom of AS. Additional types of inflammatory arthritis that might lead to SI joint problems are psoriatic arthritis. inflammatory bowel disease-associated arthritis, and reactive arthritis.

  
  

• Injuries, including trauma and spinal injuries: Various injuries can lead to SI joint dysfunction, such as sports injuries, automobile accidents, or spinal injuries.

  
  

• Repetitive stress: Some sports and work activities put repeated stress on the SI joint, including contact sports and heavy lifting. Jobs that require prolonged sitting or standing might also contribute to SI joint problems. 

  
  

• Older age: Degeneration of the SI joints can be seen on imaging, even in adults with few or no symptoms. Degeneration refers to a breakdown or loss of body parts due to aging.

  
  

• Pregnancy and childbirth: Pregnancy weight gain, hormonal changes that cause the ligaments of the SI joints to relax, and pelvic changes from childbirth might contribute to SI joint pain.¹ For some people, ligaments may remain loose after giving birth and lead to instability of the SI joints.

  
  

• Abnormal walking patterns or leg length differences: Gait problems and leg discrepancy can put pressure on one side of the pelvis, causing wear and tear and misalignment of the SI joints.

  
  

• Scoliosis: Scoliosis is a condition that causes a sideways curvature of the spine. It can affect the alignment of the pelvis and SI joints.

  
  

• Prior back surgery: A 2017 study found that SI joint was a common finding after spinal fusion surgery, especially multiple-level surgery. Other types of lower back surgery that may lead to SI joint dysfunction include hip replacement surgery and discectomy. erapy, consider scheduling your first session today. Your body and mind will thank you for it!

Physical Therapy 

Physical therapy can help manage SI joint pain with exercises that improve the strength and flexibility of the spine, hips, and pelvis. A physical therapist can help you find safe and practical exercises to best manage symptoms and pain.9 Continuing with a home exercise program might prevent symptom recurrences.  

Chiropractic Care

A chiropractor can diagnose and treat SI joint dysfunction. They use spinal manipulation techniques to help relieve pain and improve mobility and function.

Manual manipulation therapies used by chiropractors have been reported to reduce pain and disability as soon as one month after treatment.9 This includes both hand and instrument techniques used by chiropractors to treat lumbar spine problems.

Spinal manipulation has risks, including fracture, disk herniation, and blood vessel dissection. Chiropractors are not physicians.

Specialists Who Understand SI Joint Dysfunction 

Your primary healthcare provider is the first person you might see if you are experiencing low-back, hip, groin, and buttock pain. After getting a complete medical history, including symptoms experienced, a physical exam, and imaging, your provider may refer you to another specialist to confirm and adequately treat you.

Depending on the results of such testing, you may be referred to a rheumatologist, orthopedist, physical therapist, or pain management doctor, whose specialties include:

• Rheumatologist: A rheumatologist is a healthcare provider who specializes in diagnosing and treating inflammatory diseases like AS and RA that cause systemic inflammation. If your SI joint pain is caused by inflammatory arthritis, your rheumatologist will prescribe treatments to reduce inflammation and manage underlying causes of sacroiliitis and SI joint pain.17

• Orthopedist: An orthopedist specializes in diagnosing and treating musculoskeletal system conditions. This provider can diagnose and treat SI joint dysfunction and might be your best option for managing SI joint pain not related to inflammatory arthritis.1

• Physical therapist: A physical therapist can offer various nonsurgical therapies to help you manage pain and build strength in the pelvis, spine, and hips. 18 You can also work with a physical therapist to rebuild your strength after surgery. 

• Pain management doctor: A pain management professional can offer advanced treatment techniques to help you avoid surgery.18 Treatments include steroid injections, pain medicines, behavioral therapies, and alternative therapies like acupuncture and spinal manipulation. Some of these therapies might also help you recover quicker after surgery. 

A diagnostic method that can help confirm SI joint dysfunction involves the injecting a numbing medicine into the affected SI joint. If the injection brings relief, the SI joint is likely the source of pain.19

Weill Cornell Medicine Brain and Spine Center. Diagnosing and treating sacroiliac joint dysfunction.

If it does not, other tests will be done to ascertain the cause of your symptoms.

A second helpful test is an arthrogram, a type of joint X-ray that uses a contrast dye injected into a joint to take detailed images of the SI joint.19 It is sometimes used with an SI joint injection.