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What is sacroiliac pain?
Sacroiliac (SI) pain stems from a key junction in our body: the sacroiliac joint. This critical point, where the lower spine meets the pelvis, is central to our mobility and stability. It acts as a bridge for weight and movement, transferring forces between the upper body and legs, ensuring our posture and movements are stable and flexible. When this joint functions as it should, it contributes significantly to our ability to move smoothly and without pain.
However, when problems occur due to dysfunction, inflammation, or injury within this joint, the consequences can be more severe than mere back discomfort. Such issues disrupt the delicate balance and function of the sacroiliac joint, leading to significant pain and limiting movement.
What causes sacroiliac pain?
The causes of sacroiliac pain vary and can range from mechanical issues to underlying health conditions:
- Degenerative changes: as the body ages, the sacroiliac joints can undergo wear and tear, leading to osteoarthritis, which contributes significantly to pain.
- Injury or trauma: falls, car accidents, or any direct impact can injure the sacroiliac joints, causing immediate or progressive pain.
- Inflammation: diseases such as ankylosing spondylitis and other forms of arthritis can inflame the sacroiliac joint, leading to chronic pain.
- Pregnancy: during pregnancy, the body releases hormones to loosen the sacroiliac joints for childbirth, which can lead to increased mobility and subsequent pain.
- Improper movement or overuse: activities that place uneven pressure on the pelvis, such as extensive running or bearing heavy loads, can strain the sacroiliac joints.
- Joint mobility issues: hypermobility (excessive movement) and hypomobility (restricted movement) can provoke sacroiliac pain, affecting different areas and manifesting as lower back or hip pain, potentially radiating to the groin or down the leg.
- Leg length discrepancy: a difference in leg lengths can cause abnormal walking patterns, stressing the sacroiliac joint.
What are the symptoms of sacroiliac pain?
Symptoms of sacroiliac joint dysfunction vary widely but typically include:
- Localised pain: the most common symptom of sacroiliac pain is an ache or sharp pain in the lower back, buttocks, hips, or pelvis. It can radiate and extend to the lower limbs, affecting the thighs, groin, or even the feet in some cases.
- Stiffness: individuals with sacroiliac pain may experience noticeable hip or lower back stiffness, particularly in the morning or after prolonged periods of inactivity.
- Pain that worsens with certain activities: sacroiliac pain may intensify with standing, walking, or climbing stairs and may decrease when lying down.
- Difficulty with movements: sacroiliac pain can make it difficult to turn in bed, stand up from a sitting position, or bend over.
Who is at risk of sacroiliac pain in Singapore?
Some individuals are more susceptible to developing sacroiliac pain if they have the following risk factors:
- Age: older adults are at an increased risk of developing sacroiliac pain due to the natural degeneration of the joint with age.
- Gender: women are more likely to develop sacroiliac pain than men. Additionally, pregnant women are also at an increased additional risk due to the body’s production of relaxin, a hormone that loosens joints in preparation for childbirth.
- Athletes and physically active individuals: individuals who engage in activities that put repetitive strain on the sacroiliac joints, such as cycling, running, jumping, tennis, football, and basketball.
- History of previous pelvic or spinal injuries: a history of trauma or injury to the pelvic or spinal region can lead to sacroiliac pain.
How is sacroiliac pain diagnosed?
Diagnosis of sacroiliac pain involves a thorough evaluation, often including:
- Medical history: your pain specialist will discuss your symptoms, lifestyle, and any incidents that might have contributed to the condition.
- Physical examination: the area will be examined physically. Additional tests, such as the sacral thrust test, distraction test, FABER test, and palpation test, will aid in diagnosing sacroiliac pain.
- Imaging tests: imaging tests such as X-rays, magnetic resonance imaging (MRI), or computed tomography (CT) scans are used to visualise joint changes and exclude other potential causes of pain.
- Sacroiliac joint injections: also known as joint block injections, involve injecting a numbing solution into the sacroiliac joint. If this resolves the pain, it helps ascertain that the pain originates from the sacroiliac joint.
What are the treatment options for sacroiliac pain in Singapore?
Treatment for sacroiliac joint dysfunction aims to relieve pain and restore normal motion. Treatment options for sacroiliac pain include:
- Physical therapy: targeted exercises and stretches can help strengthen muscles, improve flexibility, and stabilise the sacroiliac joint.
- Medications: nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, or pain relievers may be prescribed to manage pain and inflammation.
- Injection therapy: corticosteroid injections directly into the sacroiliac joint can temporarily relieve inflammation and alleviate pain.
- Supportive devices: wearing a sacroiliac belt or using orthotic inserts can provide additional support and stability to the pelvis and lower back.
- Radiofrequency ablation: radiofrequency ablation is a minimally invasive procedure that employs heat generated from a radiofrequency device to disable nerve fibres carrying pain signals from the sacroiliac joint.
Frequently asked questions
Sacroiliac pain typically manifests as discomfort in the lower back, buttocks, legs, and feet. The pain might vary from a sharp, stabbing sensation to a more constant dull ache. Activities like standing or sitting for long durations, putting more weight on one leg than the other, stair climbing, running, or taking large steps can exacerbate this pain.
Treatment for sacroiliac pain often begins with physical therapy, focusing on strengthening the muscles around the sacroiliac joints to alleviate pressure and enhance stability. Medications, such as NSAIDs, muscle relaxers, and corticosteroids, may also be prescribed to manage pain and inflammation. Treatments like radiofrequency ablation or surgery might be recommended if conservative options do not work.
Yes, you can sit with sacroiliac joint pain, but staying in one position for too long can worsen the discomfort. To mitigate pain, it is advisable to take regular breaks to move around or change positions.
Total Pain Specialist