To help you sort out your options for SI joint dysfunction, let’s review the common treatments offered by healthcare providers and therapists.
In the end, though, the choice of treatment may not matter. In 2012, Spiker, et. al., conducted a review of studies that was published in Evidence-Based Spine Care Journal. The review compared surgery to injections and fusion of the SI joint to denervation. Spiker’s team concluded that most of the studies reported 40% pain relief regardless of the treatment tried. In other words, SI derangement improved independently of the exact therapies patients underwent.
Antiflammatories such as ibuprofen come in lower doses in the over-the-counter form, and higher doses should your healthcare provider prescribe them for you.
The exercises in your home program may also help you develop muscle balance. Because the SI joints are located on either side of your spine, (at the sacrum and hip bones) attaining equal strength and flexibility between the muscles on each side of your body may be one of the keys to regain symmetry and alignment.
Researchers measured the change in muscle and other activity related to the sacroiliac joint when patients wore a pelvic belt. They concluded that pelvic belts improve health-related quality of life, and may be responsible for decreased SI joint pain. Some of the improvements noted include decreased quadriceps activity (in particular, the rectus femoris) as well as better postural steadiness while walking.
The researchers suggest that pelvic belts may be considered as a low risk, cost-effective treatment for SI joint pain. But weaning out of the brace once symptoms have resolved is important to limit weakness or stiffness in the hips.
When you get manual therapy from a physical therapist or osteopath, the practitioner may manipulate your joints. Studies have shown that no change in the alignment of the SI joint occurs after manipulation, but that patients may report improvement in their symptoms.
Massage therapy is another form of manual therapy. Its role in treating sacroiliac joint dysfunction revolves around releasing chronic muscle tension that may reduce pain in the joint. Massage can also increase the range of motion in general, which may make exercising easier, more fun and more productive.
The value of an SI injection as a treatment is not as clear. Spiker, et. al., in their 2012 review “Surgical versus injection treatment for injection-confirmed chronic sacroiliac joint pain,” published in the November 2012 issue of Evidence-Based Spine Care Journal, conclude that although injections and surgeries may help patients reduce their pain, based on the studies done so far, they cannot tell you which of these treatments work better than the others.
A 2012 review of studies done by Hansen, et. al., and published in Pain Physician found that intraarticular (meaning inside the joint) sacroiliac injections with steroids were not effective in relieving pain in the short or long term. However, other studies have shown improvement in patients who undergo injections. Currently no comparative studies exist between treatment methods, and more research is needed in this area.
Citing poor evidence, the review done by Hansen, et. al. in 2012, found that conventional radiofrequency denervation was not effective for relief of sacroiliac pain.
However, the review found a fair degree of effectiveness for a newer type of procedure, cooled radiofrequency, as compared with the poor effectiveness associated with the conventional types, which may warrant further investigation.
But even with minimally invasive spine surgery on the rise, having an SI fusion can be a tricky decision to make. The reason goes back to the diagnosis process.
“The difficulty is identifying that it is the sacroiliac joint,” says Carter Beck, MD. Beck is a Montana surgeon who has developed a minimally invasive procedure for fusing the SI joint that, according to him, is easy on the patient, safe and effective. Dr. Beck cautions both practitioners and patients to be sure the pain is truly coming from the SI, and not from another area of the spine.
While Beck’s new procedure sounds promising, medical research has yet to answer all the questions about safety, effectiveness and the type of patient who would be best suited for minimally invasive sacroiliac surgery.
