Treatment Options for Sacroiliac Joint Dysfunction

By: Steven G. Yeomans, DC

Treatments for sacroiliac joint dysfunction (SI joint pain) are usually conservative (meaning non-surgical) and focus on trying to restore normal motion in the joint.

Typical treatments for sacroiliac joint dysfunction include:

Ice, heat and rest
Initial treatment recommendations will typically include use of ice or cold packs, applied in 15 to 20 minute intervals as needed to reduce inflammation in the area, along with rest to reduce irritation. Depending on the duration of sharp, intense pain, ice can be continued anywhere between 2 days to 2 weeks. Once the inflammation is less, gradual return to normal activities may be advisable. Application of heat (such as a heat wrap or hot bath) may help the healing process, but not during the acute, high intense pain time frame.

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Medications
First line of treatment often may include pain medications (such as acetaminophen), as well as anti-inflammatory medications (such as ibuprofen or naproxen) to reduce the swelling that is usually contributing to the patient's pain.
Chiropractic manipulations
Manual manipulation provided by a chiropractor, osteopath, or other qualified health practitioner may help. This can be highly effective when the SI joint is fixated or “stuck.” It may be irritating if the SI joint is hypermobile (see previous definitions). This is accomplished by a number of methods including (but not limited to): side-posture manipulation, drop technique, blocking techniques, and instrument guided methods. Your health care provider will choose a method they feel is most appropriate for your specific case. Read more with Chiropractic Procedures for the Sacroiliac Joint.

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Supports or braces
When the SI joint is "hypermobile" or too loose, an "orthotic" or brace about the size of a rather wide belt can be wrapped around the waist and pulled snuggly to stabilize the area. This can sometimes be very helpful at times when the joint is inflamed or painful. When it calms down, the orthotic can be weaned away.
Physical therapy and exercise
Controlled, gradual physical therapy may be helpful to strengthen the muscles around the sacroiliac joint and appropriately increase range of motion. In addition, any type of gentle, low impact aerobic exercise will help increase the flow of blood to the area, which in turn stimulates a healing response. For severe pain, water therapy may be a reasonable option, as the water provides buoyancy for the body and reduces stress on the painful joint. Read more with Sacroiliac (SI) Joint Exercises for Sciatic Pain

Sacroiliac Joint Injection Video

Sacroiliac joint injections
While the primary reason for sacroiliac joint injections is to determine whether or not the sacroiliac joint is the cause of the patient’s pain, it is also useful in providing immediate pain relief. As part of the injection, an anesthetic (such as lidocaine or bipuvicaine, or novacaine) is typically injected along with an anti-inflammatory medication (such as a corticosteroid) to help reduce inflammation around the joint, which in turn will help alleviate the pain. The immediate pain relief can help the patient start with a physical therapy program and return to normal activity levels.

Sacroiliac Joint Fusion

For severe cases of pain that are not addressed by several weeks or months of one or a combination of the above treatments, surgery may be a possible option. In surgery, one or both of the sacroiliac joints may be fused with the goal of eliminating any abnormal motion.