Treatment Options For Sacroiliac Joint Pain (SI Joint Pain)

The sacroiliac joints are located in the lower back on both sides of the pelvis. They can be a source of pain for patients who are experiencing chronic low back pain. It may be difficult to establish definitively the diagnosis of sacroiliac joint generated pain. Studies have shown the joint can be a source of pain in 10 to 30% of patients with chronic low back pain.

There is no universally accepted standard for diagnosing sacroiliac joint pain. It’s not exactly a linear joint, it’s a bit irregular and can be tough to properly evaluate x-rays, so making a definitive diagnosis from imaging studies in fairly inaccurate.

There are provocative tests on exam that can help make the diagnosis of SI generated pain. The compression test, thigh thrust test, FABER test, etc. FABER stands for flexion, abduction, and external rotation. Multiple of the exam tests have shown accuracy in making the diagnosis of SI pain.

Bone scans have been proposed for making the diagnosis of SI pain, but research has not panned out for its use.

Therapeutic options for SI pain include acetaminophen, NSAIDS,narcotics, PT, chiropractic treatment, pain injections, or radiofrequency neurotomy.

For acute pain, non surgical treatments like medication, therapy, or chiropractic should be tried first. The medications should be taken according to the maker’s recommendations. In physical therapy, strengthening up the muscles around the SI joint may decrease joint pressure and decrease pain.

Diagnostic SI injections may give pain relief for months but also help diagnose the pain generator as the SI joint. Some debate exists about whether injections are best in the joint or also around the joint for pain relief to cover the small nerve endings supplying the area.

In individuals who have received pain relief with diagnostic SI injections, small studies have displayed satisfactory results with radiofrequency ablation for the SI joint. This treatment can give pain reduction for over a year by eliminating the small nerve endings that were causing pain.

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