Got a Pain in the Butt? Sacroiliac Joint Dysfunction May Be the Cause

Lady Holding Her Lower Back in PainHave you suffered severe pain in your low back and buttocks? Have you been to several doctors, chiropractors, and therapists all to no avail?

It may be possible that your doctor has completely missed the real cause of your problem: the sacroiliac joint.

The sacroiliac joint may be the culprit in in as many as 30 percent of the cases of low back pain. In spite of the fact that problems with the sacroiliac joint are common, sacroiliac joint dysfunction is a diagnosis that is often missed. In fact, many patients eventually found to have SIJ dysfunction have seen a string of doctors and therapists without ever being properly diagnosed.

The sacroiliac joint connects the sacrum at the bottom of the spine with the pelvis. Its function is to transfer the upper body weight to the pelvis and legs.

Causes of Sacroiliac Joint Dysfunction

The two most common causes of sacroiliac joint injury are falls and car accidents, especially rear-end collisions. When a patient reports a history of either of these accident types, the doctor should consider the possibility of an injury to the SI joint.

Symptoms of SIJ Dysfunction

SIJ pain always includes the buttocks, and may also cause pain in the low back, groin, thigh, and foot, as well as sciatica. Pain usually worsens when walking, sitting, turning over in bed, climbing stairs, and when under emotional stress. The patient will often sit with weight on the opposite buttock, may have difficulty standing on one leg on the affected side, and may shift weight when standing on two legs to avoid the side with the problem.

Diagnosis of Sacroiliac Joint Dysfunction

Because X-rays, CT scans and MRIs don’t show SI joint dysfunction, the diagnosis is usually made using an arthrogram and block. Imaging will, however, rule out other problems that could be causing the pain. The definitive test is the sacroiliac iliac intra articular injection in which a contrast dye is injected into the joint. The dye spreads through the joint space, producing an arthrogram, and a local anesthetic and steroid are injected.

A CT scan is then done to track the dye. Then the patient is asked to stand up and perform a series of movements that typically cause pain. If the pain disappears, this is an indication that the problem is coming from the SI joint. In some patients only buttock pain disappears, which would indicate that there may be another source in addition to the SI joint.

The injection may give the patient several days or even several weeks of relief, but the relief is only temporary. Learn about how sacroiliac joint dysfunction is treated.