Sacroiliitis: Causes, symptoms, and treatment

Sacroiliitis is a condition that causes pain in the lower back and buttocks. The part connecting the lower spine and pelvis is known as the sacroiliac joint, and the inflammation of this joint is known as sacroiliitis. Sacroiliitis is associated with other inflammatory arthritis conditions. The pain caused by sacroiliitis can travel through the lower back and buttocks, and sometimes even down into the legs and feet.

Here you will learn about the causes, symptoms, and treatment of sacroiliitis, as it can be a difficult condition to diagnose. By understanding the signs and symptoms, you’ll be able to relay how you feel to your doctor, who can give you the appropriate treatment.

Sacroiliitis causes, risk factors, and complications

There are a variety of causes of sacroiliitis, including arthritis, pregnancy, traumatic injury, infections, IV drug use or drug addiction, rheumatological diseases such as lupus, and psoriasis. Below are some of the main causes of sacroiliitis.

Degenerative arthritis: This often results in cartilage break down due to wear and tear or injury of a joint. This process may be accelerated by aging, obesity, traumatic injury, repeated stress on joints, and joint misalignment or malformation.

Ankylosing spondylitis: Commonly known for being a familial condition passed down through recessive genes, this condition originates in the sacroiliac joints before progressing further up the spine, causing inflammation, erosion, and calcification.

Psoriatic arthritis: An inflammatory joint condition that presents scaly skin patches called psoriasis. This condition causes inflammation of the spinal joints, including those found in the sacroiliac region. It is estimated that about 10 percent of people with psoriasis develop psoriatic arthritis.

Gout: Gout is an inflammatory arthritis caused by the accumulation of uric acid crystals in various joints around the body, but most commonly in the big toe. These crystals are created by the body as they break down purine: substances found in some foods and drinks, such as beers, beans, and organ meats. Gout patients may experience pain and inflammation of the sacroiliac joints.

Non-arthritic causes:

Trauma: Injury to the sacroiliac joint or the ligaments supporting or surrounding it can be a source of pain. Trauma may occur due to something as minor as stepping on a stair in the wrong way or something more serious, such as being in a motor vehicle accident.

Mechanical stress: Some individuals have severe spine stiffness due to a condition such as long-term severe arthritis or surgical spinal fusion. Additional stress on these compromised joints can lead to degenerative changes and pain.

Lax ligaments during pregnancy: During pregnancy, hormones that relax the muscles and ligaments of the pelvis are released. Sometimes, this can make the ligaments get so lax that the sacroiliac joint slips out of place, becoming painful. However, after pregnancy, this ligament tends to regain its strength and stability.

If you have a history of bone, joint, or skin infections, experience a repeated injury to specific joints, have a urinary tract infection, or are an illicit drug user, then you may be at a higher risk of developing sacroiliitis.

If left untreated, sacroiliitis can lead to further chronic pain experienced elsewhere in the body—along with depression and insomnia—as living in pain can keep you up at night and negatively affect your mood.

Sacroiliitis symptoms

The primary symptom of sacroiliitis is pain experienced in the pelvic and buttock area. This pain may also travel down the legs into the ankle and foot. Pain experienced from sacroiliitis can be worsened by standing, bearing more weight on one leg than the other, stair climbing, running, and taking large strides.

Diagnosing sacroiliitis

There are numerous causes of lower back pain, so diagnosing sacroiliitis can be a bit of a challenge. To properly diagnose sacroiliitis, your doctor will review your symptoms and perform a physical examination. As for imaging tests, your doctor may recommend an X-ray or MRI to differentiate between sacroiliitis and another similar condition, ankylosing spondylitis.

To further aid with diagnosis, your doctor may recommend the use of a numbing agent injection. For example, if you get an injection in your sacroiliac joint and the pain goes away, then that can narrow in on where the pain stems from. On the other hand, the injection may travel, which makes this test at times unreliable.

Sacroiliitis Treatment

• Rest: Taking the time to rest will help calm inflamed sacroiliac joints.
• Heat and ice: The application of heat and ice in tandem can provide local pain relief. The ice will help to reduce inflammation, and warmth with help stimulate blood flow to the area, helping promote the healing process.
• Sleep position: Changes in sleep position can help alleviate pain. Most individuals find that sleeping on their side with a pillow between their knees is a great method.
• Medications: Commonly used non-steroidal anti-inflammatory medication such as ibuprofen and acetaminophen can provide pain sufferers sufficient relief. Sometimes prescription grade pain relievers may be required to better reduce pain and will be at the discretion of your doctor. Specific medication targeting the immune system may also be used.
• Sacroiliac joint injections: Often reserved for severe cases of sacroiliac joint pain. The injection typically includes a numbing agent and a steroid to help reduce inflammation. These injections would have to be done about four times a year to maintain effectiveness.
• Radiofrequency: The use of high radiofrequency to damage or destroy pain-causing nerve tissue
• Joint fusion: A rarely used treatment that involves fusing two bones together with metal hardware.

Exercises for sacroiliitis

Quadriceps stretch: While standing, bend your knee at a 90-degree angle so your heel is towards your lower back. Use your hand to grab onto your foot ankle and gently pull. You should feel the stretch in the front of your thigh. Hold this position for a few seconds and release gently.

Prone leg lifts: This exercise helps stretch your hip muscles. Begin by laying on your stomach. Raise your leg by using your gluteal and hamstring muscles. Go as far as possible, hold, and lower the leg back down. Repeat this exercise a few times.

Hip stretch: Lay on your back and slide one foot as far as you can up the opposite leg. This motion will naturally turn out your hip, and your legs should be in a “figure four” position. Hold this position for a few seconds before sliding your foot back down. Repeat this exercise on each leg a few times a day.

Knee rotation: Start by laying on your back with knees bent and both feet flat on the floor. While keeping your lower back stationary on the ground, allow your knees to gently sway to the left, hold for a few seconds, and then return the knees to the center. Do this exercise for about eight to ten repetitions.

Bridge: To perform this exercise, start by lying on your back with knees bent and both feet flat on the ground. While keeping your palms flat on the ground, squeeze your buttocks and raise your hips off the ground, thrusting into the air. Hold this position for five seconds then slowly bring yourself down. Repeat this exercise eight to ten times.

Child’s pose stretch: A common yoga pose, this exercise helps you stretch your thighs and relax your muscles. Start on your hands and knees, making sure your knees are spread apart with buttocks resting on your heels. Now extend your arms with your palms facing down reaching as far forward as you can.

Bird dog: Another yoga-inspired exercise that helps work out the lower back and abdominal muscles. Start on all fours, making sure your spine and neck are in neutral position and looking down at the ground. Now slowly extend your right leg behind you while simultaneously extending your left arm forward. While keeping your back straight, hold this position for five seconds. Repeat this exercise for six to ten repetitions per side.

If you’re uncomfortable with these exercises, you can work alongside a physiotherapist to ensure you have the technique down.

Related: Sacrum pain: Causes, symptoms, and treatment tips