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SI Joint Syndrome: Causes, Symptoms & Treatment

SI joint syndrome refers to pain and dysfunction of the sacroiliac joint. It is one of the most common causes of lower back and buttock pain.

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Things worth knowing about "SI joint syndrome"

SI joint syndrome refers to pain and dysfunction of the sacroiliac joint. It is one of the most common causes of lower back and buttock pain.

What is SI Joint Syndrome?

SI joint syndrome (also called sacroiliac joint syndrome or sacroiliac joint dysfunction) is a painful condition affecting the sacroiliac joint (SIJ). This joint connects the sacrum (the triangular bone at the base of the spine) to the iliac bones of the pelvis. The sacroiliac joint plays a crucial role in transmitting forces between the upper body and the legs and in stabilizing the pelvis during movement.

SI joint syndrome is one of the most frequently overlooked causes of lower back pain and is often misdiagnosed as a herniated disc or hip osteoarthritis.

Causes

SI joint syndrome can be triggered by a variety of factors:

Hypomobility (joint blockage): Restricted movement of the SI joint, often caused by sudden movements or poor posture.
Hypermobility (instability): Excessive joint movement, which commonly occurs during pregnancy due to hormonal loosening of the ligaments.
Degenerative changes (osteoarthritis): Wear and tear of the joint cartilage, particularly in older adults.
Inflammatory conditions: Diseases such as ankylosing spondylitis (Morbus Bechterew) or other forms of sacroiliitis can cause inflammation in the SI joint.
Trauma: Falls, accidents, or sports injuries affecting the pelvis.
Leg length discrepancy: Unequal leg lengths leading to asymmetric loading of the pelvis.
Muscular imbalances: Weakness or tightness of the muscles surrounding the pelvis and hip.

Symptoms

The symptoms of SI joint syndrome are varied and can mimic other spinal conditions:

Deep, one-sided or bilateral low back pain, often located over the sacrum or buttocks
Pain that may radiate into the groin, thigh, or calf
Pain triggered by standing up, climbing stairs, prolonged sitting, or one-sided loading
Morning stiffness in the pelvic region
Pain when turning over in bed or lying on one side
A feeling of instability in the pelvis

Diagnosis

The diagnosis of SI joint syndrome is based on a combination of:

Medical history: A detailed assessment of the nature, location, and triggers of the pain
Physical examination: Targeted provocation tests such as the FABER test, compression test, or distraction test, which reproduce the characteristic pain
Imaging: X-ray, MRI, or CT of the pelvis to rule out structural causes such as fractures, osteoarthritis, or inflammatory changes
Diagnostic injection: A targeted injection of local anesthetic into the SI joint can confirm the diagnosis if it significantly reduces the pain

Treatment

Conservative Treatment

The majority of SI joint syndrome cases can be managed without surgery:

Physical therapy: Targeted exercises to strengthen the pelvic and core muscles, along with manual techniques to mobilize the SI joint
Manual therapy / Osteopathy: Hands-on treatment techniques to correct blockages or misalignment of the SI joint
Pain management: Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac for pain relief and reduction of inflammation
Heat or cold therapy: Depending on the type of complaint, to relieve pain and muscle tension
SI joint injections: Injection of corticosteroids and/or local anesthetics directly into the joint for persistent symptoms
Bracing and support belts: To stabilize the pelvis, especially during pregnancy

Surgical Treatment

In rare cases of treatment-resistant, chronic SI joint pain, a surgical fusion (arthrodesis) of the joint may be considered. This procedure can be performed minimally invasively or as an open surgery, aiming for long-term pain reduction.

References

Szadek KM et al. - Diagnostic validity of criteria for sacroiliac joint pain: a systematic review. In: Journal of Pain, 2009.
Simopoulos TT et al. - A Systematic Evaluation of Prevalence and Diagnostic Accuracy of Sacroiliac Joint Interventions. In: Pain Physician, 2012.
Airaksinen O et al. - European guidelines for the management of chronic nonspecific low back pain. In: European Spine Journal, 2006.

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