Sacroiliac Joint Dysfunction: Causes, Symptoms & Treatment

You have the MRI. You have the official diagnosis of sacroiliac joint dysfunction. And you definitely have the low back pain to prove it. You’ve likely tried everything: anti-inflammatory medications, physical therapy, and maybe even painful cortisone injections, all with disappointing results. Now, surgery might be on the table. It’s a frustrating and all-too-common story. But what if those treatments failed because they were targeting the wrong problem? What if the real source of your pain isn’t the joint at all, but something else entirely?

All of these treatments did not help them. Why? A recent study in the Clinical Spine Journal (1) offers the suggestion that sacroiliac joint dysfunction patients do not get treatment relief because they do not have sacroiliac joint dysfunction. This may be somewhat difficult for you to believe because all along you have been told you have SI joint pain.

Look at what the doctors of this study reported: Confusion and a lot of it.

A person goes to the doctor for pain in the pelvic / hip / groin lower back region.

The currently reported incidence of primary sacroiliac joint ranges from 15% to 30%. (In other words 15% to 30% of these people will get a diagnosis of sacroiliac joint dysfunction.)
When they do not get a diagnosis of sacroiliac joint dysfunction, they may get a diagnosis of:

• pain generated from the lumbar spine, (degenerative disc disease),
• sacroiliac joint dysfunction, (but not as the primary cause of their pain and therefore not the primary target)
• and the hip joint.

When these researchers re-examined these patients, with the goal of proving or disproving sacroiliac joint as the primary cause, what they found after a complete diagnostic workup was:

• 112 (90%) had lumbar spine pain,
• 5 (4%) had hip pain,
• 4 (3%) had primary sacroiliac joint dysfunction pain, and
• 3 (3%) had an undetermined source of pain upon initial diagnosis.

Patients did not have sacroiliac joint dysfunction as the primary source of their pain. In fact the sacroiliac joint was found to be a rare pain generator (3%-6%) in patients complaining of more than 50% sacroiliac joint region related pain. Pain in the sacroiliac joint area is commonly a referral pain from the lumbar spine (88%-90%).

This is why treatments including the use of cortisone will not work in patients with sacroiliac joint dysfunction. The wrong area is getting treated OR the right areas are not getting treated. The right areas may include:

• The axial low back,
• buttock/leg region
• groin/anterior thigh region

Understanding Sacroiliac (SI) Joint Dysfunction

If you’re dealing with persistent low back pain, you might have heard the term “SI joint dysfunction,” but what does it actually mean? This condition is a common source of discomfort, yet it’s frequently misunderstood and misdiagnosed. Getting to the root of the problem starts with understanding the joint itself. The sacroiliac joints are a critical link between your upper and lower body, and when they aren’t functioning correctly, the pain can significantly impact your daily life. Let’s break down the anatomy, how common this issue is, and the different ways it can present itself.

What is the SI Joint?

The sacroiliac (SI) joint is the connection point between the sacrum—the triangular bone at the base of your spine—and the ilium, which is the top part of your pelvis. You have two of these joints, one on each side of your spine. Their main job is to act as a shock absorber, transferring weight and forces between your upper body and your legs. They are incredibly strong, supported by a dense network of ligaments, and designed for minimal movement. When this stability is compromised, either through too much or too little motion, it can lead to pain and dysfunction.

Anatomy and Function

Think of your SI joints as the foundation that connects your spine to your pelvis. They are essential for stability when you walk, stand, and lift. Unlike more mobile joints like your knee or shoulder, the SI joints are meant to be relatively rigid, with only a few degrees of rotation and movement. This limited motion is crucial for maintaining proper posture and absorbing impact from activities like running or jumping. When the supporting ligaments become damaged or loose, or if the joint becomes inflamed, this delicate balance is disrupted, leading to the pain characteristic of SI joint dysfunction.

How Common is SI Joint Pain?

You’re not alone if you suspect your SI joint is the source of your pain. Research suggests that SI joint dysfunction is responsible for anywhere from 15% to 30% of chronic low back pain cases. However, because its symptoms can mimic other conditions like a herniated disc or hip problems, it’s often overlooked or misdiagnosed. This overlap in symptoms is why getting an accurate diagnosis from a specialist is so important. Understanding the prevalence highlights the need for a thorough evaluation to ensure you’re treating the right problem and not just chasing symptoms with ineffective therapies.

SI Joint Pain vs. Sacroiliitis: What’s the Difference?

While people often use the terms “SI joint pain” and “sacroiliitis” interchangeably, they aren’t exactly the same thing. SI joint pain, or dysfunction, is a general term for pain originating from the joint due to mechanical issues—either too much or too little movement. Sacroiliitis, on the other hand, specifically refers to inflammation within one or both of your sacroiliac joints. This inflammation can be a symptom of SI joint dysfunction but is also commonly associated with types of inflammatory arthritis, such as ankylosing spondylitis. Distinguishing between the two is key for determining the right treatment path.

The Two Types of Dysfunction: Hypermobility and Hypomobility

SI joint dysfunction typically falls into one of two categories: hypermobility or hypomobility. Hypermobility, or instability, occurs when the joint moves too much. This is often due to loose or injured ligaments that can no longer hold the joint securely, causing the pelvis to feel unstable and leading to pain in the lower back, hip, or groin. Conversely, hypomobility, or stiffness, happens when there is too little movement in the joint. This can be caused by conditions like osteoarthritis or scar tissue, resulting in pain, muscle tension, and reduced mobility, often felt on one side of the low back or buttocks.

Causes and Symptoms of SI Joint Dysfunction

Understanding what causes SI joint pain is the first step toward finding relief. The issue can stem from a sudden injury, a chronic condition, or even the natural changes your body goes through during life events like pregnancy. The symptoms can be just as varied, ranging from a dull ache in your lower back to sharp, radiating pain that travels down your leg. Because these symptoms can easily be mistaken for other back problems, it’s helpful to know the specific patterns and risk factors associated with SI joint dysfunction. This knowledge can help you have a more productive conversation with your doctor about what you’re experiencing.

Common Causes and Risk Factors

Several factors can contribute to the development of SI joint dysfunction. It’s rarely caused by a single event but rather a combination of influences that stress the joint over time. Activities that involve repetitive twisting or impact, underlying medical conditions, and even the way you walk can all play a role. Identifying your personal risk factors is an important part of the diagnostic process, as it helps your healthcare provider pinpoint the source of your pain and develop a targeted treatment plan that addresses the root cause, not just the symptoms you’re feeling day to day.

Trauma, Arthritis, and Repetitive Stress

A sudden impact, such as from a car accident or a fall, can directly injure the ligaments that support the SI joint, leading to instability and pain. Over time, wear-and-tear arthritis (osteoarthritis) can also cause the cartilage in the joint to break down, resulting in stiffness and discomfort. Repetitive stress is another common culprit. Activities like jogging on hard surfaces, frequent heavy lifting, or sports that involve twisting motions can repeatedly strain the SI joint. These factors can lead to chronic inflammation and pain, which may benefit from treatments that focus on tissue repair, such as PRP Therapy.

Pregnancy and Gait Issues

During pregnancy, the body releases hormones that cause ligaments to relax in preparation for childbirth. This can make the SI joints more mobile and susceptible to stress, leading to pain. Additionally, the added weight and changes in posture put extra strain on the joint. An altered walking pattern, or gait, can also be a factor. If you have a leg length discrepancy or favor one leg due to pain from another injury (like a knee or ankle problem), it can create an imbalance that puts uneven pressure on one of the SI joints, eventually leading to dysfunction and chronic pain.

Key Symptoms to Watch For

The primary symptom of SI joint dysfunction is pain, but where and how you feel it can vary. Unlike some other back issues, the pain is often one-sided and located very low in the back, typically below the beltline. It can feel like a dull ache or a sharp, stabbing sensation. Many people also report that the pain worsens with specific activities, such as standing up from a seated position, climbing stairs, or rolling over in bed. Paying close attention to these patterns can provide valuable clues for you and your doctor when trying to identify the source of your discomfort.

Pain Patterns and Locations

The most common symptom is pain in the lower back and buttocks. According to the Cleveland Clinic, this pain can often radiate, spreading to the groin, hips, or down the back of the thigh. It’s typically felt on one side but can occur on both. Many people find the pain gets worse after sitting or standing for a long time or with transitional movements like getting out of a car. The pain is often described as deep and achy, but it can also be sharp and shooting, sometimes mimicking the symptoms of sciatica, which is why a precise diagnosis is so critical for effective treatment.

Stiffness, Numbness, and Instability

Beyond pain, you might experience other sensations. Stiffness in the lower back and hips, especially in the morning or after being in one position for too long, is common. Some people also report a feeling of instability in the pelvis, as if their leg might “give way” when walking or standing. While less common, numbness or tingling in the leg can also occur if the inflammation around the SI joint irritates nearby nerves. These symptoms can be unsettling, but they are important pieces of the puzzle that can help your doctor understand the full picture of your condition.

The Importance of an Accurate Diagnosis

Getting the right diagnosis for low back pain can be tricky, and SI joint dysfunction is a perfect example of why. As we’ve seen, its symptoms often overlap with other conditions like herniated discs, hip arthritis, or sciatica. This is why so many people go through rounds of treatments that don’t work—they’re targeting the wrong problem. An accurate diagnosis is the most critical step toward finding lasting relief. It ensures that your treatment plan is aimed directly at the true source of your pain, saving you time, frustration, and discomfort from ineffective therapies.

How Doctors Diagnose SI Joint Pain

Diagnosing SI joint pain isn’t as simple as looking at an X-ray or MRI. While imaging can help rule out other issues, it often doesn’t show definitive signs of SI joint dysfunction. Instead, a diagnosis is typically made through a combination of a detailed medical history and a hands-on physical examination. A skilled physician will use specific tests and maneuvers to isolate the SI joint and determine if it’s the pain generator. This careful, methodical approach is essential for distinguishing SI joint pain from other potential causes and setting you on the right path to recovery.

Physical Exams and Movement Tests

A thorough physical exam is the cornerstone of an SI joint diagnosis. Your doctor will likely ask you to stand, sit, and walk to observe your posture and gait. They will also perform a series of provocative tests, which involve applying pressure or moving your hips and legs in specific ways to see if the movements reproduce your pain. For example, they might press directly on your SI joints or have you perform a thigh thrust test. If these specific maneuvers trigger your familiar pain, it strongly suggests the SI joint is the culprit. This hands-on evaluation is a crucial step in getting an expert evaluation of your condition.

Imaging and Diagnostic Injections

While standard imaging like X-rays and MRIs can’t definitively diagnose SI joint dysfunction, they are useful for ruling out other problems like fractures or tumors. The gold standard for confirming an SI joint diagnosis is a diagnostic injection. During this procedure, a local anesthetic is injected directly into the SI joint under fluoroscopic (X-ray) guidance. If you experience significant pain relief after the injection, it confirms that the SI joint is the source of your pain. This procedure provides a clear answer and allows your doctor to proceed with a confident and targeted treatment plan.

Nerve Block Didn’t Work? It Might Not Be Your SI Joint

I will often receive an email that will describe to me cortisone injections or nerve blocks that did not help the e-mailer with their low back pain. As we have seen in many patients, the hip-spine-sacroiliac joint complex is a challenging one to differentiate where the pain is coming from. Injections into the hip may not provide relief if the pain is in the sacroiliac joint region. Injections into the sacroiliac joint region may not work if the pain is from the hip or groin.

A study in the medical journal Pain Physician looked at various treatment recommendations for patients suffering from sacroiliac joint pain. These treatments incldued burning the nrves, freezing the nerves, applying cortisone and Botox.

The researchers found the following:

• “The evidence for cooled radiofrequency neurotomy (freezing the nerve) in managing sacroiliac joint pain is fair.
• The evidence for effectiveness of intraarticular steroid injections is poor.
• The evidence for periarticular injections of local anesthetic and steroid or botulinum (Botox) toxin is poor.
• The evidence for effectiveness of conventional radiofrequency neurotomy (burning the nerves) is poor.
• The evidence for pulsed radiofrequency is poor.” (2)

Why did they find so many poor results? The chances are the patient did not have sacroiliac joint dysfunction.

Let’s look at another study. This time from June 2017 in the journal Medicine.(3) In this research, doctors from Korea investigated the degree of pain reduction following intra-articular pulsed radiofrequency stimulation of the sacroiliac joint in patients with chronic sacroiliac joint pain that had not responded to corticosteroid injection.

These research too found disappointing results:

• Intra-articular pulsed radiofrequency stimulation of the sacroiliac joint was not successful in most patients (80% of all patients). Based on our results, we cannot recommend this procedure to patients with chronic sacroiliac joint pain that was unresponsive to corticosteroid injection. 

Here is where treatments that are not helping the sacroiliac joint can become dangerous. How so? Because they will lead to a surgery that will not work either.

This was also suggested by a late 2019 study.(4)

• “The rationale for SI joint fusion is to relieve pain created by the movement of a joint through the removal of movement by arthrodesis (fusion) of the joint space. Only few comparative studies of percutaneous SI joint fusion and denervation have been reported, and they had limited clinical evidence.

Why Neurosurgeons Advise Against Spinal Fusion for SI Joint Pain

This is the title of a paper published in the journal Neurosurgery clinics of North America : “Sacroiliac Fusion: Another “Magic Bullet” Destined for Disrepute.”(5)

This is what the paper says:

“Pain related to joint dysfunction can be treated with joint fusion; this is a long-standing principle of musculoskeletal surgery. However, pain arising from the sacroiliac  joint is difficult to diagnose. . . Evidence establishing (successful) outcomes (of spinal fusion) is misleading because of vague diagnostic criteria, flawed methodology, bias, and limited follow-up. Because of nonstandardized indications and historically inferior reconstruction techniques, SI joint fusion should be considered unproven. The indications and procedure in their present form are unlikely to stand up to close scrutiny or weather the test of time.”

Is a Ligament Problem the Real Cause of Your SI Joint Pain?

Doctors at the Mayo Clinic have published a paper entitled: Comparative role of disc degeneration and ligament failure on functional mechanics of the lumbar spine. In this paper the Mayo Clinic researchers wanted to make a clear definition between two problems affecting low back pain patients.

• First, that pain could be coming from the discs.
• Second that pain could be coming from the spinal ligaments.

The Mayo researchers suggest that recognizing how the spine moves is essential for distinguishing between the many different types of spinal disorders, and a diagnosis which may ultimately, and erroneously lead to back surgery.

• If a patient has instability, excessive movement, and decreased stiffness, doctors should examine for ligament damage.
• If the opposite, less movement, more stiffness, the doctor should look for disc disease.(6)

This information can help determine the true cause of a patient’s sacroiliac joint dysfunction. When nothing is working, look at the ligaments. How do you look at the ligaments? Through physical examination.

How a Misdiagnosis Can Lead to Unnecessary Surgery

In our own published peer-review research appearing in the July 2018 in the Biomedical Journal of Scientific & Technical Research (BJSTR), July 2018, (6) we examined treating spinal ligaments with low back pain. Below is an explanatory adaption of the introductory paragraph of that study. It gives a good understanding of the importance of understanding that we should be looking at the ligament problems in back pain.

• • An Orthopaedic Knowledge Update from the American Academy of Orthopedic Surgeons tells its surgeon members that muscle strains, ligament sprains, and muscle contusions account for up to 97% of low back pain  in the adult population (7)
  • Additionally, researchers wrote in the Spine Journal that spinal ligaments are often neglected compared to other pathology that account for LBP (8). This could be due to the over-reliance of MRIs to guide physicians to correct diagnoses. They write: The influence of the posterior pelvic ring ligaments on pelvic stability is poorly understood. Low back pain and sacroiliac joint pain are described being related to these ligaments.When these ligaments are damaged or weakened, they serve as generators of low back pain.

How We Treat Sacroiliac Joint Dysfunction

 

We offer stem cell therapy and Platelet Rich Plasma Therapy 

PRP treatments involve collecting a small amount of your blood and spinning it in a centrifuge in order to separate the platelets from the red cells. The platelets are the key to the treatment. The collected platelets are then injected back into the injured area of the spine to stimulate healing and regeneration of soft connective tissue, specifically the ligaments that hold the vertebrae in place and the tendons that attach the muscles to the spine.

PRP concentrates specific healing factors in an attempt to accelerate healing. Blood is made up of four main components; plasma, red blood cells, white blood cells, and platelets. Each part plays a role in keeping your body functioning properly. Platelets act as wound and injury healers. They are first on the scene at an injury, clotting to stop any bleeding and immediately helping to regenerate new tissue in the wounded area.

A Soldier’s Story: Finding Relief from SI Joint Pain with PRP

A case report in the August 2020 edition of the journal Military medicine (9) offers an insight into how PRP therapy can help a patient with SI Joint pain. The patient in this case history is an military members. Here is what the researchers reported in their observations of how PRP treatment to the low back could help reduce the need for opioid medications.

Darrow Stem Cell Institute research article published in the Biomedical Journal of Scientific & Technical Research (BJSTR), July 2018. This article presents highlighted portions of that research.

You can read about 4 patient’s cases studies here:

Study’s findings: This is the first reported study treating low back with bone marrow aspirate (BMC) stem cell injections to the ligaments, fascia, and muscles surrounding the lumbar spine. It is promising that at one-year follow-up, 100% of patients in this study experienced a decrease in resting and active pain in addition to performing daily activities with less difficulty.

• All four patients experienced sustained or increased improvement at annual follow-up compared to short-term follow-up.
• On average, patients reported:
  • 80% decrease in resting pain,
  • 78% decrease in active pain,
  • and a 41% increase in functionality score.
• Additionally, patients reported a mean 80% total overall improvement following
  treatment.
• The two patients who considered surgery prior to BMC treatment no longer felt the need for it.
• These results provide evidence that appropriately chosen patients with low back pain may find relief with BMC injections.

 

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References:

1 DePhillipo NN, Corenman DS, Strauch EL, Zalepa LK. Sacroiliac Pain: Structural Causes of Pain Referring to the SI Joint Region. Clinical spine surgery. 2018 Oct.
2 Hansen H, Manchikanti L, Simopoulos TT, et al. A systematic evaluation of the therapeutic effectiveness of sacroiliac joint interventions. Pain Physician. 2012 May;15(3):E247-78.
3 Chang MC, Ahn SH. The effect of intra-articular stimulation by pulsed radiofrequency on chronic sacroiliac joint pain refractory to intra-articular corticosteroid injection: A retrospective study. Medicine. 2017 Jun;96(26).
4 Chuang CW, Hung SK, Pan PT, Kao MC. Diagnosis and interventional pain management options for sacroiliac joint pain. Ci Ji Yi Xue Za Zhi. 2019 Sep 16;31(4):207-210. doi: 10.4103/tcmj.tcmj_54_19. PMID: 31867247; PMCID: PMC6905244.
5 Bina RW, Hurlbert RJ. Sacroiliac Fusion: Another “Magic Bullet” Destined for Disrepute. Neurosurgery Clinics of North America. 2017 Jul 31;28(3):313-20.
6 Ellingson AM, Shaw MN, Giambini H, An KN. Comparative role of disc degeneration and ligament failure on functional mechanics of the lumbar spine. Comput Methods Biomech Biomed Engin. 2016;19(9):1009-18. doi: 10.1080/10255842.2015.1088524. Epub 2015 Sep 24. PMID: 26404463; PMCID: PMC4808500.
7 Marc Darrow, Brent Shaw BS. Treatment of Lower Back Pain with Bone Marrow Concentrate. Biomed J Sci&Tech Res 7(2)-2018. BJSTR. MS.ID.001461. DOI: 10.26717/ BJSTR.2018.07.001461. 5/
8 An HS, Jenis LG, Vaccaro AR (1999) Adult spine trauma. In Beaty JH (Eds.). Orthopaedic Knowledge Update 6. Rosemont, IL: American Academy of Orthopedic Surgeons pp. 653-671
9 Broadhead DY, Douglas HE, Bezjian Wallace LM, et al. Use of Ultrasound-Guided Platelet-Rich Plasma Injection of the Sacroiliac Joint as a Treatment for Chronic Low Back Pain. Mil Med. 2020;185(7-8):e1312-e1317. doi:10.1093/milmed/usz398

### Regenerative Medicine for Joint Stability When the ligaments supporting the SI joint are loose or damaged, the joint becomes unstable, leading to chronic pain. Regenerative medicine focuses on repairing this underlying issue rather than just masking the symptoms. These treatments use your body’s own healing components to rebuild and strengthen weakened connective tissues, offering a path toward long-term stability and pain relief. By addressing the root cause of the instability, you can restore proper joint function and get back to your life without the constant discomfort that has been holding you back. This approach is fundamentally different from temporary fixes like cortisone shots or nerve blocks. #### PRP Therapy Platelet-Rich Plasma, or PRP Therapy, is a treatment that uses a concentration of your own blood platelets to accelerate healing in injured tissues. We start by drawing a small amount of your blood, which is then spun in a centrifuge to separate the platelets. This platelet-rich plasma, full of powerful growth factors, is then injected directly into the damaged ligaments around the SI joint. A compelling case study in *Military Medicine* highlighted a patient with chronic SI joint pain who had failed traditional treatments and was reliant on opioids. After a single PRP injection, she experienced a drastic decrease in pain and was eventually able to stop taking opioids completely, with relief lasting over a year. #### Prolotherapy Prolotherapy is another regenerative injection technique designed to strengthen weak or damaged ligaments. The treatment involves injecting a natural solution (often a dextrose-based solution) into the affected ligaments and tendons. This creates a mild, localized inflammation that triggers the body’s natural healing cascade. As the body responds, it stimulates the growth of new, stronger ligament and tendon tissue. Over a series of treatments, this process helps tighten and stabilize the SI joint, reducing the painful micro-movements that were causing your symptoms. It’s a great option for addressing the ligament laxity that is so often the real culprit behind SI joint dysfunction.

Conventional Treatments and Self-Care

Before exploring regenerative options, most people try a range of conventional treatments aimed at managing SI joint pain. These methods can be effective for some, particularly when the pain is acute or caused by minor inflammation. They typically focus on reducing symptoms and improving function through a combination of medical interventions and at-home care. While these approaches may not always address the underlying ligament instability, they are an important part of the treatment landscape and can provide temporary relief. Understanding these options can help you have a more informed conversation with your doctor about what has and hasn’t worked for you. ### Standard Non-Surgical Options The first line of defense against SI joint pain usually involves non-surgical methods that are easy to access and relatively low-risk. These treatments are designed to reduce inflammation, alleviate pain, and restore normal joint mechanics without invasive procedures. They often form the foundation of a pain management plan and can be combined to create a comprehensive approach. For many, a mix of physical therapy, medication, and supportive devices is the starting point. The goal is to calm the irritated joint and surrounding muscles so you can begin to move more comfortably and work on strengthening the area to prevent future flare-ups. #### Physical Therapy and Manual Manipulation Physical therapy is one of the most common treatments for SI joint dysfunction. A physical therapist can guide you through specific exercises and stretches designed to strengthen the muscles around your hips and lower back, which helps support and stabilize the SI joint. They can also teach you proper body mechanics to reduce strain during daily activities. In addition, manual manipulation from a chiropractor or osteopathic doctor can be beneficial if the joint is “stuck” or misaligned. These practitioners use hands-on techniques to gently mobilize the joint, which can help restore normal movement and provide significant pain relief for some individuals. #### Medications, Braces, and Radiofrequency Ablation Over-the-counter pain relievers like acetaminophen and anti-inflammatory drugs like ibuprofen are often recommended to manage pain and reduce swelling. For more severe pain, a doctor might suggest prescription medications or steroid injections directly into the joint, though as we’ve discussed, their effectiveness can be limited. Some people find relief by wearing a sacroiliac belt, a brace that wraps around the hips to provide compression and support to the unstable joint. If these methods fail, a procedure called radiofrequency ablation may be considered, which uses heat to destroy the nerve fibers carrying pain signals from the joint. ### Lifestyle Adjustments for Pain Management Simple changes to your daily habits can make a big difference in managing SI joint pain. How you sit, sleep, and move all impact the amount of stress placed on your lower back and pelvis. Becoming more mindful of your posture and activities can help prevent flare-ups and reduce your overall pain levels. These adjustments empower you to take an active role in your own care and can complement any medical treatments you are receiving. The key is consistency—making these small changes a regular part of your routine can lead to significant long-term benefits for your joint health. #### Sleeping and Sitting Posture Your posture doesn’t just matter when you’re standing. If you sleep on your back, try placing a pillow under your knees to maintain the natural curve of your lower back. For side sleepers, a pillow between the knees can keep your hips aligned and reduce stress on the SI joint. When sitting, aim to keep your back straight but relaxed, with your feet flat on the floor and your knees apart. Avoid crossing your legs, as this can put uneven pressure on your pelvis. It’s also a good idea to get up and move around frequently rather than sitting in one position for too long. #### Recommended Exercises and Activities to Avoid Gentle, low-impact exercise is crucial for strengthening the muscles that support your SI joint. Walking is an excellent choice, as it improves blood flow and builds strength without jarring the joint. Pay attention to your posture as you walk to ensure you aren’t putting uneven stress on one side. On the other hand, you should avoid high-impact activities like running or jumping, which can aggravate the joint. It’s also wise to steer clear of repetitive twisting motions and activities that involve prolonged standing or sitting, as these can contribute to pain and instability.

Managing SI Joint Pain Long-Term

Successfully managing SI joint pain over the long term requires a proactive and informed approach. For many, it’s not about finding a single “cure” but about developing a sustainable strategy that combines effective treatments with smart lifestyle choices. The prognosis is generally positive, and most people are able to control their symptoms and maintain a good quality of life. However, understanding the potential complications and knowing when to seek professional help are key to preventing chronic issues. Staying engaged with your healthcare provider and being adaptable with your management plan will help you stay active and comfortable for years to come. ### Prognosis and Potential Complications For most people, the outlook for SI joint pain is good. With the right combination of treatment and self-care, symptoms can often be managed effectively. However, if the pain is caused by an underlying condition like inflammatory arthritis, there is a risk of permanent joint damage over time. In these cases, managing the underlying disease is just as important as treating the SI joint pain itself. If left unaddressed, chronic SI joint instability can sometimes lead to compensatory issues in other areas, such as the hips or lumbar spine, as your body tries to adapt to the dysfunction. ### Prevention and When to Seek Medical Care While not all cases of SI joint pain are preventable, you can reduce your risk by maintaining good posture, using proper lifting techniques, and staying active to keep your core and hip muscles strong. It’s important to listen to your body and not push through pain. If you experience new or worsening lower back, hip, or buttock pain that doesn’t improve with rest after about a week, it’s time to see a doctor. Getting an accurate diagnosis is the most critical step toward finding effective relief. If you’re struggling with persistent pain and aren’t getting answers, we encourage you to contact our team for a comprehensive evaluation.

Frequently Asked Questions

My doctor said I have SI joint dysfunction, but my cortisone shot didn’t help. Why not? This is a really common and frustrating experience. Often, a cortisone shot doesn’t work because it’s targeting the wrong problem. As the research shows, pain felt in the SI joint area is frequently referred pain coming from another source, most commonly the lumbar spine. The injection might reduce inflammation right where it’s administered, but if the root cause is instability from weak ligaments in your lower back, you won’t get lasting relief. It’s like silencing a fire alarm without putting out the fire.

My MRI didn’t show anything wrong, so why am I still in so much pain? An MRI is excellent at showing issues with bones and discs, but it’s not designed to show damage to ligaments. Ligaments are the tough, fibrous bands that hold your joints together, and when they become stretched or injured, they can cause significant instability and pain. Your MRI can look perfectly normal while these crucial supportive tissues are the real source of your problem. This is why a hands-on physical examination by a specialist is so important for getting to the bottom of your pain.

How can I tell if my pain is truly from my SI joint or from my lower back? Distinguishing between the two can be tricky because the symptoms overlap so much. The most reliable way to get a clear answer is through a thorough diagnostic process with a physician who specializes in these conditions. This involves specific physical movement tests that stress the joint to see if they reproduce your pain. The definitive test is often a diagnostic injection of a local anesthetic into the SI joint. If your pain disappears temporarily, it confirms the joint is the source. If it doesn’t, it’s a strong indicator that the pain is originating elsewhere, like the lumbar spine.

What makes regenerative treatments like PRP different from the steroid injections I’ve already tried? The fundamental difference is their goal. A steroid injection is an anti-inflammatory treatment designed to temporarily reduce swelling and mask pain signals. It doesn’t do anything to repair the underlying injury. Regenerative treatments like Platelet-Rich Plasma (PRP) therapy work completely differently. They use your body’s own growth factors to initiate a healing response in the damaged tissue, helping to strengthen the weak ligaments that are causing the instability and pain in the first place. The goal is to fix the root problem for more durable relief.

If my problem is weak ligaments, can’t I just fix it with physical therapy and exercise? Physical therapy is an incredibly valuable tool for strengthening the muscles that support your spine and pelvis, and it’s an important part of recovery. However, if the ligaments themselves are significantly stretched or damaged, exercise alone often isn’t enough. Muscles can compensate for some instability, but they can’t tighten a loose ligament. Regenerative treatments are designed to address the ligament tissue directly, creating a more stable foundation that allows your muscles to do their job effectively.

Key Takeaways

• Re-evaluate Your Diagnosis: If treatments like cortisone shots or nerve blocks have failed, it’s a strong sign your pain may not be coming from the SI joint itself. Research shows that the vast majority of SI joint region pain is actually referred from the lumbar spine, meaning many people are treating the wrong area.
• Look Beyond the Joint to the Ligaments: The true culprit behind chronic SI joint pain is often weakened or damaged ligaments that create instability. This underlying issue is the reason the joint feels painful and unstable, but it’s a problem that standard MRIs and X-rays frequently miss.
• Focus on Repair, Not Just Symptom Relief: Regenerative treatments like PRP Therapy and Prolotherapy address the root cause of the instability. By using your body’s own healing mechanisms to strengthen damaged ligaments, these therapies can restore proper joint function and provide a long-term solution.

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