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Sacroiliac Joint Syndrome – Causes & Treatment

Sacroiliac joint syndrome refers to pain originating from the sacroiliac joint, which connects the spine to the pelvis. It is a common cause of lower back and buttock pain.

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Things worth knowing about "Sacroiliac joint syndrome"

Sacroiliac joint syndrome refers to pain originating from the sacroiliac joint, which connects the spine to the pelvis. It is a common cause of lower back and buttock pain.

What is Sacroiliac Joint Syndrome?

Sacroiliac joint syndrome (also known as SI joint syndrome or SI joint dysfunction) is a condition affecting the sacroiliac joint – the joint that connects the ilium (hip bone) to the sacrum at the base of the spine. This joint plays a key role in transferring forces between the upper body and the legs. When the joint becomes dysfunctional, it can cause significant pain and restricted movement.

Causes

Sacroiliac joint syndrome can result from a variety of causes:

Overuse or abnormal loading of the joint, such as from repetitive physical activity or heavy lifting
Trauma, including falls on the buttocks or motor vehicle accidents
Pregnancy: hormonal changes cause ligament laxity, which can destabilize the joint
Leg length discrepancy or spinal misalignment
Inflammatory conditions such as ankylosing spondylitis
Degenerative changes (osteoarthritis) of the SI joint
Muscular imbalances in the surrounding musculature

Symptoms

Common symptoms of sacroiliac joint syndrome include:

Pain in the lower back, typically on one side
Pain radiating to the buttocks, groin, or leg
Increased pain when standing up, climbing stairs, or sitting for prolonged periods
Morning stiffness in the pelvic region
Worsening pain during single-leg activities (e.g., walking or standing on one leg)
Occasional numbness or tingling in the leg (if nerves are irritated)

Diagnosis

Diagnosing sacroiliac joint syndrome typically involves:

Medical history and physical examination: specific provocation tests such as the FABER test or compression test
Imaging: X-ray, MRI (Magnetic Resonance Imaging), or CT scan to rule out structural damage or inflammation
Diagnostic nerve block: injection of a local anesthetic into the SI joint to confirm the source of pain

Because the symptoms of SI joint syndrome overlap with other spinal conditions, careful differential diagnosis is essential.

Treatment

Conservative Treatment

Most cases of sacroiliac joint syndrome respond well to conservative measures:

Physical therapy: targeted exercises to strengthen core and pelvic floor muscles
Manual therapy or osteopathy: mobilization and manipulation of the SI joint
Heat therapy or cold therapy to relieve acute pain
Pain medication: non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac
Orthopedic support: pelvic belts to stabilize the joint

Minimally Invasive and Surgical Treatment

For persistent or treatment-resistant cases, additional options may be considered:

Corticosteroid injections into the SI joint to reduce inflammation
Radiofrequency ablation: targeted nerve denervation to interrupt pain signals
SI joint fusion (arthrodesis): surgical stabilization in severe, chronic cases

Prognosis

The prognosis for sacroiliac joint syndrome is generally favorable. With consistent physical therapy and lifestyle adjustments, most patients experience significant improvement. Chronic cases may occur, particularly if underlying causes remain untreated.

References

Maugars Y. et al. – Assessment of the efficacy of sacroiliac corticosteroid injections in spondylarthropathies. British Journal of Rheumatology, 1996.
Szadek K.M. et al. – Diagnostic validity of criteria for sacroiliac joint pain. Journal of Pain, 2009.
Cohen S.P. – Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment. Anesthesia & Analgesia, 2005.

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