What Is the Treatment for Sacroiliitis?

Sacroiliitis occurs when the sacroiliac joints become inflamed. These joints are located at the lower part of your spine where it connects to your pelvic area, close to your hips. This condition is also known as sacroiliac joint dysfunction. Either term can be used to describe pain stemming from the sacroiliac joint.

Sacroiliitis is one of many inflammatory conditions of the spinal column. These diseases and conditions are grouped together as “spondyloarthropathy.” This group includes ankylosing spondylitis, Crohn’s disease, osteoarthritis, and other forms of arthritis.

The symptoms of sacroiliitis are similar to other lower back, or lumbar, issues. This makes diagnosing this condition difficult. You might have sacroiliitis if you feel moderate to severe pain in your lower back, hips, buttocks, and, though rare, down your legs as well.

This type of pain is usually caused by standing for a long time, going up and down stairs, or walking with long strides. You might feel stiffness in your lumbar region after getting out of bed in the morning, or after sitting still for a long period of time. People who have sacroiliitis may also experience fevers.

Other causes of sacroiliitis can include:

• Altered gait or readjustment of joints during and after pregnancy
• Damage to the sacroiliac joints from falling or after a car accident
• Difference in leg lengths
• Existing back or spine issues
• Gout
• Infection of the sacroiliac joint

To diagnose sacroiliitis, your doctor will ask questions about your medical history, recent physical activity, and/or potential accidents. Next, they will perform a physical exam that can include the pressing and stretching of your lower back, hips, and legs. Additional measures to identify sacroiliitis may include an X-ray, computerized tomography (CT) scan, magnetic resonance imaging (MRI) scan, or Ultrasound Doppler Imaging.

The treatment that will be recommended for sacroiliitis will depend on the type and extent of the diagnosis. Your treatment options may include a combination of rest, medication, physical therapy, exercise, injections, and/or surgery.

Medications

In most cases, over-the-counter pain medications, such as acetaminophen, and anti-inflammatory medications, such as ibuprofen, will be recommended. These medicines should provide sufficient pain relief. If the pain is moderate to severe, your doctor might recommend prescription medication such as tramadol, opioids, or muscle relaxants. These will help reduce painful muscle spasms.

Home care

Rest and limiting any physical activities that put pressure on the lower back area can help alleviate the symptoms related to sacroiliitis. The pain should be reduced, and may even go away after a few days.

Your doctor might recommend a physical therapy program that can include stretching, strengthening, and low-impact aerobics. Some of these can include:

• Extension: Lie on your stomach and press your body up onto your elbows, making sure your pelvis remains on the floor. Gently push your upper body towards the ceiling, feeling for the stretch in your abdomen, lower back, and buttocks. Hold this position for five seconds and gradually build up to 30 seconds, if possible. Aim for five to ten sets.
• Lumbar rotation: Lie on your back with both knees bent and your feet flat on the floor. Pull both knees to one side, where your thighs should rub together and your knees will not move very far. Keep your lower back and shoulders touching the floor. Hold this position for five to ten seconds, and then complete the same stretch towards the other side.
• Knee-to-chest stretch: Lie on your back with your legs straight. Pull one knee up to your chest and hold with both hands for ten seconds. Alternate the stretch with each leg five to ten times.

Alternative therapies

For moderate to severe pain, a sacroiliac joint injection might be needed to insert anti-inflammatory medication directly into the joint. This will also confirm the sacroiliac joint as the source of your pain. This injection is completed with a type of live X-ray known as fluoroscopic guidance. This ensures the correct placement of the needle into the joint. The injection includes local anesthesia in the injection area.

If you require injections, the process will typically require a couple of rounds over the course of a year. These should be accompanied by physical therapy and visits to a chiropractor to ensure the back maintains a proper range of motion and is rehabilitated correctly.

If your pain reaches a point where it is unbearable and your lower back hasn’t responded positively to nonsurgical options, surgery may be needed. The procedure is called sacroiliac joint fusion. It fuses the sacroiliac joint so that it can’t move anymore.

As with all surgeries, sacroiliac joint fusion has potential complications and unintended consequences. Excessive blood loss, for example, or a negative reaction to the anesthesia can occur. Adjacent Segment Disease is another possible complication.

Adjacent Segment Disease happens when the fused joint is no longer able to absorb shock. As a result, it transfers the responsibility to another part of the spine that might not be able to withstand it. Adjacent Segment Disease, however, is rather rare. It is experienced by around 5 percent of patients who receive the surgery.