How Pain Management Doctors Diagnose and Treat SI Joint Dysfunction

Sacroiliac (SI) joint dysfunction is one of the leading causes of chronic lower back pain. For many, this condition disrupts daily living with discomfort that may radiate to the hips or thighs.

Pain management doctors play a crucial role in accurately diagnosing and treating SI joint dysfunction. Let us explore their structured approach and highlight treatment for SI joint dysfunction available today.

KEY TAKEAWAYS

• The sacroiliac joints is located where the bottom of the spine meets the pelvis. Inflammation, abnormal movement, or degeneration can cause chronic pain, also known as sacroiliac (SI) joint dysfunction.
• SI joint dysfunction can easily be mistaken for symptoms of other pain conditions, which is why a careful process is required to diagnose it. The diagnostic process may include several steps, such as a review of medical history, a physical examination, imaging, and diagnostic injections.
• There are a wide variety of treatment options for managing SI joint dysfunction pain, including physical therapy, pain medications, injections, radiofrequency ablations, and minimally invasive SI joint fusion procedures.

Table of Contents

• What is SI joint dysfunction?
• Diagnosing SI joint dysfunction
  • Detailed medical history
  • Physical examination
  • Diagnostic imaging
  • Diagnostic SI joint injection
• Treating SI joint dysfunction
  • Physical therapy
  • Medications
  • Sacroiliac joint injection
  • Radiofrequency ablation
  • iFuse INTRA X fusion
  • iFuse TORQ fusion
  • Lifestyle modifications

What is SI joint dysfunction?

The sacroiliac joints sit on both sides of the lower spine, where the sacrum meets the ilium bones of the pelvis. These joints are responsible for absorbing shock and transferring weight between the upper body and legs. SI joint dysfunction occurs when the joint becomes inflamed, moves abnormally, or degenerates over time.

Symptoms may include:

• Lower back pain that worsens when sitting, standing, or walking for long periods.
• Pain radiating to the hips, thighs, or groin.
• Stiffness or feelings of instability in the pelvis.

If left untreated, SI joint dysfunction can severely limit mobility and quality of life.

Diagnosing SI joint dysfunction

Diagnosing SI joint dysfunction requires a careful and thorough process, as its symptoms often overlap with conditions like herniated discs or sciatica. Pain management doctors use several methods to pinpoint the root cause of your pain.

1. Detailed medical history

Your doctor will take time to review your medical history. They will ask about:

• The location, duration, and intensity of your pain.
• Any recent injuries or accidents.
• Lifestyle factors (e.g., exercise habits or work-related strain).
• Past medical conditions like arthritis or previous surgeries.

This information helps your doctor develop an initial understanding of your pain.

2. Physical examination

A physical exam will involve specific tests to determine if the SI joint is the source of your pain. Commonly used maneuvers include:

FABER test (Flexion, Abduction, External Rotation)

While lying on your back, one leg is kept straight while the other foot is placed against the inside of the straight knee. Pressure is applied by gently pushing the bent knee down and out to target the SI joint.

Modifications may include pulling the bent knee toward the chest, moving it side-to-side, or applying downward pressure to the opposite hip.

The test is considered positive if it reproduces pain or reveals a limited range of motion. This test may also reproduce pain in the hip or lumbar region, so pinpointing the exact location of pain is essential to confirm SI joint involvement.

Sacral thrust test

While lying face down (prone) on an examination table, pressure is applied to the back of the hips. This test is considered positive when the pressure reproduces pain in the SI joint area.

Palpation tests

Deep thumb pressure is applied directly over the SI joint on each side to locate tender spots. A positive test is tenderness over the affected sacroiliac joint.

When combined with other tests, such as motion palpation and provocative maneuvers, palpation increases diagnostic accuracy ¹

Distraction test

While lying face up (supine), pressure is applied to the front of the hips. A positive test occurs if this pressure reproduces pain, indicating potential SI joint involvement.

These detailed tests are critical for guiding the diagnosis and identifying SI joint dysfunction.

3. Diagnostic imaging

Your pain management doctor may recommend imaging studies, such as:

• X-rays: To rule out fractures or arthritis.
• CT Scans or MRI: To provide detailed images of the SI joint and surrounding structures.

These tests can uncover joint irregularities or damage that cannot be detected through a physical exam alone.

4. Diagnostic SI joint injection

If imaging and physical exams suggest SI joint dysfunction, a diagnostic injection may be performed. During this procedure:

• A small amount of anesthetic and steroid medication is injected into the SI joint using X-ray guidance.
• If the injection provides temporary pain relief, it confirms that the SI joint is the source of discomfort.

This step is considered the “gold standard” for confirming a diagnosis of SI joint dysfunction.

Exploring treatment options for SI joint dysfunction

Once diagnosed, pain management doctors create a personalized treatment plan. They often combine conservative measures with advanced medical procedures to relieve pain and restore function.

1. Physical therapy

Physical therapy is often the first line of treatment for sacroiliac (SI) joint dysfunction, aimed at addressing both pain and underlying biomechanical issues. A licensed physical therapist tailors exercise to:

• Strengthen the muscles supporting the SI joint, such as the gluteus medius, piriformis, and core muscles, reducing strain on the joint.
• Improve joint mobility through manual therapy and targeted stretches to correct alignment issues.
• Enhance core stability, which helps to balance and stabilize the pelvis and lumbar spine.

Consistent physical therapy not only alleviates symptoms but also promotes long-term joint health by restoring optimal movement patterns and preventing future dysfunction.

2. Medications

Medications can play a role in managing the pain and inflammation associated with SI joint dysfunction. Common options include:

• Over-the-Counter NSAIDs: Ibuprofen (Advil) or naproxen (Aleve) help reduce inflammation and provide temporary pain relief.
• Topical Anti-Inflammatory Agents: Prescription creams or gels containing diclofenac may be applied directly to the affected area to minimize systemic side effects.
• Muscle Relaxants: In cases of muscle spasms contributing to SI joint pain, drugs like cyclobenzaprine or tizanidine may be used.
• Oral Corticosteroids: For short-term flare-ups, systemic corticosteroids like prednisone may help reduce severe inflammation. These are generally reserved for acute cases.

3. Sacroiliac joint injection

A sacroiliac joint injection is both a diagnostic and therapeutic procedure. It involves injecting a corticosteroid (to reduce inflammation) and a local anesthetic (to block pain) directly into the SI joint under fluoroscopic or ultrasound guidance².

• Diagnostic purposes: If pain relief is significant post-injection, it confirms the SI joint as the source of discomfort.
• Therapeutic benefits: Many patients experience significant short-term relief, which improves mobility and allows for better participation in physical therapy.

This procedure is minimally invasive and typically performed on an outpatient basis.

4. Radiofrequency ablation

Radiofrequency ablation (RFA) is an advanced, minimally invasive treatment for chronic SI joint pain, particularly in cases resistant to other therapies.

• The procedure involves using heat generated by radio waves to target the lateral branches of sacral nerves responsible for transmitting pain signals from the SI joint.
• RFA is guided by fluoroscopy to ensure precise nerve ablation ³.
• Pain relief typically lasts from 6 months to a year, making it an effective option for long-term symptom management.

RFA is particularly beneficial for patients unresponsive to corticosteroid injections or physical therapy.

5. iFuse INTRA X fusion procedure

The iFuse INTRA X fusion procedure is a cutting-edge surgical intervention for severe, refractory SI joint dysfunction. Pain doctors typically recommend this procedure for patients who do not respond to extensive non-surgical treatments.

• This procedure involves implanting small triangular titanium devices across the SI joint, stabilizing it by preventing excessive or abnormal movement.
• The minimally invasive technique uses only small incisions, reducing surgical risks and recovery times⁴.
• The procedure stimulates bone growth around the implants to permanently fuse the joint, providing long-term pain relief.

Clinical studies show high success rates, with most patients experiencing significant improvements in mobility and quality of life⁵.

6. iFuse TORQ® procedure

The iFuse TORQ® procedure is another advanced surgical option for addressing SI joint dysfunction. It aims to provide stabilization and long-term relief for patients with chronic joint pain.

• iFuse TORQ® utilizes threaded implants that are inserted across the SI joint, offering mechanical stability while promoting fusion.
• Like the iFuse INTRA X, this procedure is minimally invasive, requiring only small incisions to reduce recovery time and surgical risks.
• The unique threaded design of the implants ensures optimal fixation and encourages bone integration for durable results.

Both fusion procedures are backed by clinical research and tailored to improve mobility, reduce pain, and enhance the overall quality of life for patients suffering from SI joint dysfunction.

7. Lifestyle modifications

Lifestyle changes are essential for both managing SI joint dysfunction and preventing future flare-ups. Key recommendations include:

• Maintaining a Healthy Weight: Excess body weight places additional strain on the SI joint, exacerbating symptoms.
• Practicing Good Posture: Proper posture reduces stress on the pelvis and spine, improving joint alignment and function.
• Regular Exercise: Low-impact activities like swimming, walking, or yoga strengthen surrounding muscles, enhance flexibility, and support overall joint health.
• Ergonomic Adaptations: Using supportive seating or adjusting workstations can minimize repetitive strain on the SI joint during daily activities.

These modifications, combined with other treatment options, contribute to long-term symptom relief and improved joint function.

Pain management in Burnsville, Chaska, Edina, Maple Grove, Maplewood, and Woodbury, MN

If you are struggling with chronic pain from SI joint dysfunction, you do not need to face it alone. Pain management doctors are here to help you return to a life filled with comfort and mobility.

At Twin Cities Pain Clinic, we specialize in advanced treatment for SI joint dysfunction. Our compassionate team of pain management experts, certified nurse practitioners, and physical therapists works with you to design a care plan tailored to your needs. Whether it is physical therapy, joint injections, or advanced procedures like iFuse INTRA-X Fusion, we are with you every step of the way.

Begin your journey to relief by scheduling a consultation with one of our pain management experts. For more information or to schedule a consultation, call us today at 952-841-2345 or use our appointment request form. We look forward to serving you!

DISCLAIMER:

The contents of this article are intended for informational and educational purposes only and are not intended as a substitute for professional medical advice, diagnosis or treatment. Always consult with a physician or other qualified healthcare provider before engaging in any action or decision-making based on the content of this article. Never disregard or delay seeking professional medical advice or treatment because of the content of this article or any other content on the Twin Cities Pain Clinic website. Reliance on any information conveyed on the Twin Cities Pain Clinic website without direct consultation with a healthcare professional is solely at your own risk.

REFERENCES

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2. Soneji N, Bhatia A, Seib R, Tumber P, Dissanayake M, Peng PWH. Comparison of Fluoroscopy and Ultrasound Guidance for Sacroiliac Joint Injection in Patients with Chronic Low Back Pain. Pain Practice. 2015;16(5):537-544. doi:10.1111/papr.12304
3. Lowe M, Okunlola O, Raza S, et al. Radiofrequency Ablation as an Effective Long-Term Treatment for Chronic Sacroiliac Joint Pain: A Systematic Review of Randomized Controlled Trials. Cureus. June 25, 2022. doi:10.7759/cureus.26327
4. Martin CT, Haase L, Lender PA, Polly DW. Minimally invasive sacroiliac joint Fusion: the current evidence. The International Journal of Spine Surgery. 2020;14(s1):S20-S29. doi:10.14444/6072
5. Lorio MP, Polly DW Jr, Ninkovic I, Ledonio CGT, Hallas K, Andersson G. Utilization of minimally invasive surgical approach for sacroiliac joint fusion in surgeon population of ISASS and SMISS membership. The Open Orthopaedics Journal. 2014;8(1):1-6. doi:10.2174/1874325001408010001