The specific sacroiliitis treatments will be determined primarily by the type and severity of the patient’s symptoms, and the underlying cause of the sacroiliitis.
Non-Surgical Treatments for Sacroiliitis
There is a wide range of nonsurgical options available. Most patients find that a combination of two or more of the following nonsurgical treatments can be effective in managing their symptoms:
A short period of rest may help calm the inflamed sacroiliac joints.
Heat and/or ice
Warmth or cold applied to the area will provide local pain relief. Application of a cold pack will help reduce the inflammation in the area. Application of warmth, such as a heating pad or hot tub, will help stimulate blood flow and bring healing nutrients to the area.
See also Heat and Cold Therapy
Changing one's sleep position can help alleviate pain while sleeping and at waking. Most patients find it best to sleep on the side, with a pillow placed between the knees to keep the hips in alignment.
For many, over-the-counter pain medications, such as acetaminophen, and/or anti-inflammatory medications, such as ibuprofen, provide sufficient pain relief. Prescription medications may be recommended, such as tramadol (brand name Ultram), or a short course of narcotic pain medications, or muscle relaxants, such as cyclobenzaprine (brand name Flexeril) to help reduce painful muscle spasms.
Sacroiliac joint injections
For severe pain, a sacroiliac joint injection may be recommended both to confirm the sacroiliac joint as the source of the pain and to introduce the anti-inflammatory medication directly into the joint. The injection is done with fluoroscopic guidance, which is a type of live x-ray, to ensure correct placement of the needle in the joint. The injection typically includes both a numbing agent, such as lidocaine, and a steroid, which is a strong anti-inflammatory medication.
Injections can typically be done up to three to four times in one year, and should be accompanied by physical therapy and/or chiropractic or osteopathic manual manipulation to restore proper range of motion and rehabilitation.
A prescribed physical therapy program of stretching, strengthening and low impact aerobic conditioning is usually a part of most sacroiliitis or sacroiliac joint dysfunction treatment regimens. The therapy may be done by a physical therapist, chiropractor or other appropriately trained health specialist.
Other Sacroiliitis Treatments
As part of treatment for another condition
If sacroiliac joint mediated pain is a result of another condition, (such as ankylosing spondylitis, osteomyletis, etc.), then additional treatments will focus on treating the underlying cause of the SI joint symptoms as well.
Sacroiliac joint surgery
The vast majority of cases of sacroiliac joint mediated pain are treated with nonsurgical options. For severe, intractable pain that is unresponsive to nonsurgical options and interferes with the patient's everyday life, surgery may be considered an option. The surgery is a sacroiliac joint fusion, which is designed to fuse the SI joint to stop the motion in the joint.
For related information, see also Sacroiliac Joint Dysfunction (SI Joint Pain).