By Jenny L. F. Andrus, MD
Many women suffer from low back pain at some point in their lives. Common medical issues can cause that nagging ache. When I see ladies in the office for this complaint, I frequently diagnose them with Sacroiliac (SI) Joint Dysfunction. Why are women patients more likely to have this condition?
As healthcare providers, we know that the pelvic region is a complex structure of muscles, bones and soft tissue. We also know that a woman’s pelvis is specifically made to expand for childbearing and her sacroiliac joints can bear the brunt of years of overuse, obesity, lack of exercise, and aging.
Women who have had lumbar joint fusions can also report more pain and dysfunction in the SI joints because the fused vertebrae cannot move, so the body transfers increased motion to the SI joints. As this area becomes more painful, tight muscles tend to put increased stress on the SI joints. Daily activities, such as sitting at work, walking and standing may even cause pain. When medical attention is sought, symptoms may easily be mistaken for other conditions, such as facet syndrome, disc herniation or radiculopathy.
When a female patient comes to see me, I start with a physical exam using specific movement tests which help to pinpoint if the SI joint is causing the pain. I ask lots of questions to rule out other possible causes. If I can reproduce pain specifically at the SI joint, the likely culprit is SI Joint Dysfunction.
An SI joint injection can be used as a diagnostic tool. With fluoroscopic guidance, I inject anti-inflammatory and numbing medications into the SI joint to see if the pain is relieved.
A treatment plan is tailored specifically to meet the patient’s needs and activity level. Obviously, we can start with conservative treatments first, such as the use of non-steroidal anti-inflammatory medications; the use of ice or heat; massage therapy; relative rest from activities that aggravate pain; and a specific regimen of physical therapy and exercise to increase range of motion and strength in the muscles of the lower back.
SI joint injections are recommended next. Thankfully, most patients find that these steroid injections decrease pain and inflammation. Some require them every 3 months; others may only need them once a year or even less often.
Another treatment option that has shown results is prolotherapy, in which an irritant (aqueous sugar) solution is injected into and around the SI joints. The inflammatory response that occurs typically will strengthen and tighten loose ligaments, providing more stability and improved function with less pain.
For those patients who fail other methods of treatment, SI Joint Radio Frequency Ablation is recommended to provide more lasting pain relief. During this in-office procedure, the myelin sheath around the injured nerve(s) of the SI joint is heated and temporarily destroyed, causing a disruption in the transmission of pain signals to the brain.
Dr. Jenny Andrus is a fellowship-trained interventional pain management physician who joined OSC in 2009. osc-ortho.com