Question: I have been diagnosed with a herniated disk as the cause of my lower back pain, and the treatment has been moderately effective…Would pain with inactivity be coming from my herniated disk or my SI joint?

I have been diagnosed with a herniated disk as the cause of my lower back pain and treatment has been moderately effective, but there are frequent flares. It seems the flares happen when I stop my cardio workouts, usually because of a hip or foot injury. My pain consists of dull to sharp hip pain, runs down my glutes, hamstrings, and in my groin area. Lower back is usually stiff. My hamstrings are really tight. Would a problem with the Sacroiliac joint rather than a herniated disk get worse with inactivity? I know I need to see a doctor to get clarity on this, but would appreciate any direction or insight you could give.

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Doctor’s Response: Several lower back conditions can mimic sacroiliac joint pain, and a patient can have pain from both the lumbar spine and sacroiliac joint simultaneously.

In my practice, we believe that all pathology in the lumbar spine must be evaluated and accounted for before considering the sacroiliac joint as a pain generator. The reason for this is that there are several types of pathological conditions in the lumbosacral spine that can mimic exactly sacroiliac joint pain and dysfunction. It is also not unusual to have pain generating from both the lumbar spine and the sacroiliac joint.

For instance, pain running down into the gluteus maximus hamstrings, and also into the groin area, could be coming from the lumbar spine and/or the sacroiliac joint. I believe you do need to get in to see a specialist who understands the sacroiliac joint. Starting off with a good physiatrist, who is a doctor of physical medicine and rehabilitation, can possibly help with an accurate diagnosis, and this professional can also do injections to help verify the diagnosis.

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In Spine-health’s Doctor Advice section, physicians respond to frequently asked questions about back pain issues. These responses represent the opinion of one physician, and do not necessarily reflect the views of the broader medical community. The advice presented has not been peer reviewed by Spine-health’s medical advisory board.