• Pregnancy: During pregnancy, hormonal changes, particularly increased levels of relaxin, can cause the ligaments around the SI joints to loosen. This is necessary to facilitate childbirth by allowing the pelvis to widen. However, this increased laxity can also lead to instability in the SI joints, resulting in pain and discomfort, especially in the later stages of pregnancy.
• Arthritis: Various forms of arthritis, such as osteoarthritis or ankylosing spondylitis, can affect the SI joints. In osteoarthritis, the cartilage in the SI joints may deteriorate, leading to inflammation and pain. Ankylosing spondylitis, a type of inflammatory arthritis, can cause inflammation in the SI joints and lead to stiffness and discomfort.
• Leg Length Discrepancy: A difference in leg length, whether congenital or acquired, can alter the mechanics of the pelvis and SI joints. This imbalance can lead to asymmetrical loading of the SI joints, causing pain and dysfunction over time. Individuals with leg length discrepancies may experience symptoms such as hip pain, lower back pain, or SI joint pain.

Symptoms

SI joint pain typically presents as:

• Low Back Pain: Pain in the lower back, buttocks, or hips, often on one side of the body.
• Pain with Movement: Discomfort aggravated by activities such as standing up from a seated position, walking, or climbing stairs.
• Stiffness: Difficulty in bending or rotating the spine, especially in the morning or after prolonged periods of inactivity.
• Radiating Pain: Pain that may radiate into the groin, thighs, or down the legs, mimicking symptoms of sciatica.

Diagnosis

Diagnosing SI joint pain requires a comprehensive approach due to its similarity to other spinal conditions. Here’s a detailed explanation of the diagnostic process:

1. Medical History: The first step in diagnosing SI joint pain involves gathering information about the patient’s medical history, including any previous injuries, surgeries, or underlying conditions. Understanding the onset, duration, and characteristics of the symptoms is crucial for identifying potential triggers and contributing factors.
2. Physical Examination: A thorough physical examination is conducted to assess the range of motion, tenderness, and stability of the SI joints. The healthcare provider may perform specific maneuvers, such as the FABER test (flexion, abduction, and external rotation), to provoke pain and identify areas of discomfort indicative of SI joint dysfunction.
3. Diagnostic Injections: Diagnostic injections, such as SI joint injections, are commonly used to confirm the source of pain and pinpoint the exact location of dysfunction. During this procedure, a local anesthetic or corticosteroid is injected directly into the SI joint under fluoroscopic guidance. If the injection provides temporary relief of symptoms, it suggests that the SI joint is the source of pain.
4. Imaging Tests: While physical examination and diagnostic injections are valuable diagnostic tools, imaging tests such as X-rays, MRI (magnetic resonance imaging), or CT (computed tomography) scans may be ordered to further evaluate the structure and integrity of the SI joints. These imaging modalities can help rule out other potential causes of pain, such as fractures, tumors, or degenerative changes in the spine.

Treatment

Treatment for SI joint pain may include:

• Physical Therapy: Strengthening exercises, stretches, and manual therapy techniques to improve joint stability, mobility, and muscle balance.
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, or corticosteroid injections may be prescribed to alleviate pain and inflammation.
• SI Joint Injections: Therapeutic injections of corticosteroids or local anesthetics into the SI joint to reduce pain and inflammation.
• Radiofrequency Ablation: A minimally invasive procedure that uses heat to disrupt the nerves transmitting pain signals from the SI joint.
• Sacroiliac Joint Fusion: In severe cases of SI joint dysfunction, surgical fusion of the joint may be considered to stabilize and alleviate pain.