Video presented by Zinovy Meyler, DO
This video accompanies the article: Treatment Options for Sacroiliac Joint Dysfunction.
Non-surgical treatment options for sacroiliac joint pain really have to be addressed in sort of a two-fold or two-pronged approach. On one hand, the underlying source of the pain has to be addressed; on the other hand, the pain itself has to be addressed. So, what I mean by that is that the sacroiliac joint pain usually stems from sacroiliac joint dysfunction and there are a variety of reasons for that to happen. What's important is that we treat the underlying causes. That can be addressed in a certain — in a variety of ways.
So for one, ice, ice packs, compression, support braces can be immediate support - can provide immediate support for the pelvis and for the sacroiliac joint whenever is necessary. It is also important to remember not to start depending on the brace too much because it becomes a crutch and most certainly not the goal of the treatment - it is only used for the time being and then is discarded as something that is no longer necessary. Our goal is to really restore function of the pelvis and normal movement. That can be done through chiropractic care and manipulations, it can be done through osteopathic manipulations and what they do is with the manipulations is that they change the mechanics of the sacroiliac joint by affecting the muscles and the ligaments and through affecting them, they’ll normalize the alignment and the movement of the sacroiliac joint. At the same time, it’s also very important to strengthen the core and provide good support for almost a muscular corset, if you will, for the whole motion and also loosen up the hips, strengthen the hips. Our goal is to have limber and strong muscles supporting the overall structure.
Besides that, at the same time, we need to worry and treat the pain itself because if the pain exists and the inflammation that usually exists and causes the pain, you won't be able to really do the manipulations or do the exercises that are really necessary in order to restore the function. So, that being said, there are many ways that we can do that. As I mentioned, ice packs can certainly reduce the inflammatory component of this. Heat can relax the muscles. Physical therapy becomes a very important component, even in the pain reduction aspect of it.
Medications - we have a variety of different medications. So some classes of these medications are muscle relaxants. The sacroiliac joint dysfunction’s because of the mechanical changes as well as the pain will cause tightening of the muscle - the muscle spasms. It is important to relax those muscles to allow normal physiological movement. Pain medications that are specific to the pain, such as Tylenol or even a Tylenol with opioid additives can control the more acute and stronger pain. Medications that fall into the category of non-steroidal anti-inflammatory medications can serve two functions at once - they can reduce the pain and at the same time control the inflammation that usually comes with the dysfunction, although the limitation of that is that the only way to get this anti-inflammatory medication to the joint is through the blood flow and unfortunately the blood flow is comparatively insufficient around that joint to get the proper amount of medication there. It can, however, reduce the inflammation in the surrounding tissues.
If that is not sufficient, diagnostically and therapeutically under controlled conditions, under the guidance of the x-ray or fluoroscopy, we can perform an injection into the joint which contains both the diagnostic aspect - which is the anesthetic controlling the pain and reducing the pain - and a corticosteroid, which is a very strong anti-inflammatory agent and that reduces the pain. The benefit of that is that it reduces the pain at its source. It is almost like taking a fire extinguisher and putting it at the source of the fire.