Sacroiliitis: Causes, Symptoms, and Effective Pain Management

Sacroiliitis is a painful condition caused by inflammation in one or both of the sacroiliac (SI) joints, where the lower spine connects to the pelvis. This often-overlooked source of lower back and buttock pain can significantly affect daily activities, leading to discomfort, stiffness, and limited mobility.

Understanding the causes, recognising the symptoms, and exploring effective treatment options are key to managing sacroiliitis and improving quality of life. In this guide, we’ll delve into what sacroiliitis is, its common triggers, and the best strategies for pain relief and long-term management.

What Is Sacroiliitis?

The sacroiliac joints are strong, weight-bearing joints located at the junction of the spine and pelvis. They help absorb impact and transfer forces between the upper body and legs during activities like walking and running. When these joints become inflamed, it leads to sacroiliitis, characterised by pain and stiffness in the lower back, buttocks, and sometimes the legs.

Sacroiliitis is often mistaken for other causes of lower back pain, such as herniated discs or sciatica, making accurate diagnosis crucial for effective treatment.

What Causes Sacroiliitis?

Sacroiliitis can result from a variety of factors, including injury, overuse, or underlying medical conditions. Understanding these causes can help in both prevention and management.

Common Causes of Sacroiliitis:

• Trauma or Injury:

  • A fall, car accident, or direct impact to the lower back can inflame the SI joints.

• Repetitive Stress or Overuse:

  • Activities involving repetitive bending, lifting, or prolonged standing can strain the SI joints.

• Arthritis:

  • Ankylosing spondylitis and other inflammatory arthritic conditions often affect the SI joints.
  • Osteoarthritis can lead to joint degeneration and inflammation.

• Pregnancy:

  • Hormonal changes loosen ligaments around the pelvis, increasing SI joint mobility and strain.

• Infection:

  • Though rare, bacterial infections can invade the SI joint, leading to inflammation.

• Leg Length Discrepancy or Gait Abnormalities:

  • Uneven leg length or altered walking patterns can place excess stress on one SI joint.

• Post-Surgical Changes:

  • Surgeries involving the lower spine or pelvis may alter biomechanics, leading to sacroiliitis.

Recognising the Symptoms of Sacroiliitis

Sacroiliitis can present with a variety of symptoms, often overlapping with other back-related conditions. Knowing the key indicators can help differentiate it and seek appropriate treatment.

Common Symptoms Include:

• Lower Back Pain:

  • A deep, aching pain on one or both sides of the lower back, near the SI joints.

• Buttock and Hip Pain:

  • Discomfort often radiates to the buttocks, hips, or even the back of the thighs.

• Pain Worsened by Activity:

  • Movements like climbing stairs, standing for long periods, running, or bearing weight unevenly can exacerbate symptoms.

• Stiffness and Reduced Mobility:

  • Morning stiffness or difficulty bending and twisting due to joint inflammation.

• Pain While Sitting or Lying:

  • Prolonged sitting or lying on the affected side can increase pressure on the SI joint, worsening pain.

• Leg Pain or Numbness (Occasionally):

  • If inflammation irritates nearby nerves, symptoms similar to sciatica can occur.

Diagnosing Sacroiliitis: What to Expect

Accurate diagnosis is essential to distinguish sacroiliitis from other causes of lower back pain. Healthcare providers use a combination of physical exams, imaging, and sometimes diagnostic injections.

Evaluation Process:

• Medical History & Physical Exam:

  • The clinician will ask about the onset, nature, and location of pain.
  • Special tests like the FABER test (Flexion, Abduction, External Rotation) and Gaenslen’s test help provoke SI joint pain to aid diagnosis.

• Imaging Studies:

  • X-rays: Can reveal joint space narrowing or signs of arthritis.
  • MRI: Useful for detecting early-stage inflammation and soft tissue involvement.
  • CT Scans: Offer detailed images of bone structures to identify joint irregularities.

• Diagnostic Injections:

  • An anaesthetic injection into the SI joint can confirm the diagnosis if pain significantly decreases post-injection.

Effective Pain Management and Treatment Options

The goal of sacroiliitis treatment is to reduce inflammation, relieve pain, restore mobility, and prevent future flare-ups. Most cases respond well to conservative, non-surgical management, though severe cases may require advanced interventions.

1. Non-Surgical Management

Rest and Activity Modification:

• Temporarily reducing or modifying activities that trigger pain, such as heavy lifting or high-impact sports.

Physical Therapy:

• A tailored program focusing on:
  • Strengthening core muscles for better spinal support.
  • Improving hip and pelvic stability.
  • Enhancing flexibility in the lower back, hips, and hamstrings.

Pain Management:

• NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): Help reduce pain and inflammation.
• Muscle Relaxants: May be prescribed if muscle spasms contribute to discomfort.
• Heat and Ice Therapy:
  • Ice reduces inflammation in acute flare-ups.
  • Heat helps relax tight muscles and improve circulation.

Bracing (Temporary):

• An SI joint belt can provide additional support during activities, but prolonged use is discouraged to avoid muscle weakening.

2. Injection-Based Treatments

If conservative treatments don’t provide adequate relief, injections may help reduce inflammation and alleviate pain.

• Corticosteroid Injections:

  • Directly injected into the SI joint to reduce inflammation and provide temporary pain relief (often lasting weeks to months).

• Prolotherapy:

  • Involves injecting a dextrose solution to stimulate the body’s natural healing response, strengthening the surrounding ligaments.

• Platelet-Rich Plasma (PRP) Injections:

  • Concentrated platelets from the patient’s blood are injected into the SI joint to promote tissue healing and reduce inflammation.

3. Advanced and Surgical Options

For persistent or severe cases of sacroiliitis that don’t respond to conservative measures, more invasive treatments may be considered.

• Radiofrequency Ablation (RFA):

  • Uses heat generated by radio waves to disrupt the nerves transmitting pain signals from the SI joint.

• SI Joint Fusion:

  • A surgical procedure where the SI joint is fused to prevent movement and reduce pain. It’s typically reserved for cases involving significant instability or chronic pain unresponsive to other treatments.

Home Remedies and Lifestyle Modifications

In addition to medical treatments, several home-based strategies can help manage sacroiliitis symptoms and support long-term recovery.

• Gentle Stretching:

  • Regular stretching of the hips, lower back, and hamstrings can reduce tension and improve mobility.
  • Examples: Knee-to-chest stretches, piriformis stretches, and cat-cow stretches.

• Low-Impact Exercises:

  • Activities like swimming, walking, or cycling help maintain fitness without placing excessive strain on the SI joints.

• Posture Correction:

  • Improving sitting and standing posture can reduce pressure on the SI joints.
  • Using lumbar support pillows and maintaining a neutral spine can help.

• Weight Management:

  • Maintaining a healthy weight reduces stress on the lower back and SI joints.

• Mind-Body Practices:

  • Yoga, Pilates, and mindfulness techniques can improve flexibility, reduce muscle tension, and promote relaxation.

Preventing Sacroiliitis Flare-Ups

Prevention focuses on maintaining strong and flexible muscles around the SI joint and avoiding repetitive strain.

• Strengthen Core Muscles:

  • Strong abdominal and back muscles support the pelvis and reduce SI joint strain.

• Balance Training Loads:

  • Gradually increase exercise intensity and avoid sudden changes in activity levels.

• Avoid Prolonged Sitting:

  • Take regular breaks to stand, stretch, and move during long periods of sitting.

• Use Proper Lifting Techniques:

  • Bend at the knees, keep the load close to your body, and avoid twisting while lifting heavy objects.

FAQs: Sacroiliitis and Pain Management

1. How do I know if my lower back pain is from sacroiliitis?

Sacroiliitis often causes pain in the lower back and buttocks, sometimes radiating to the thighs. Pain typically worsens with prolonged standing, climbing stairs, or taking long strides. A healthcare provider can perform specific tests and imaging to confirm the diagnosis.

2. Can sacroiliitis heal on its own?

Mild cases of sacroiliitis may resolve with rest, activity modification, and anti-inflammatory treatments. However, chronic or severe cases often require structured rehabilitation and sometimes injection-based therapies.

3. Is exercise safe with sacroiliitis?

Yes, but it’s important to choose low-impact exercises and avoid activities that exacerbate pain. A physiotherapist can guide you through safe exercises that strengthen and stabilise the pelvis and core.

4. How long does it take to recover from sacroiliitis?

Recovery time varies based on the cause and severity. Acute cases may resolve within a few weeks, while chronic sacroiliitis may require several months of consistent treatment and rehabilitation.

5. Are corticosteroid injections safe for sacroiliitis?

Corticosteroid injections are generally safe and can provide significant pain relief. However, they are typically limited to 2–3 injections per year to avoid potential side effects, such as weakening of nearby tissues.

6. When should I consider surgery for sacroiliitis?

Surgery, such as SI joint fusion, is considered a last resort and is typically only recommended if conservative treatments and injections fail to provide relief over an extended period.

Final Thoughts: Managing Sacroiliitis for Long-Term Relief

Sacroiliitis can be a challenging and painful condition, but with proper diagnosis, targeted treatments, and lifestyle modifications, most people can manage their symptoms effectively and return to an active life. Early intervention, combined with a holistic approach to treatment, is key to preventing chronic pain and maintaining long-term SI joint health.

If you’re experiencing persistent lower back or buttock pain, consult a healthcare provider to explore your options and develop a personalised treatment plan.