The joints at which your lower spine and pelvis connect are known as the sacroiliac joints. Pain and inflammation in these joints is known as sacroiliitis, which is associated with a group of conditions causing inflammatory arthritis of the spine. Patients with the condition experience pain in their lower back and buttocks that may extend down their legs. However, there are various causes of lower back pain, which makes it tricky to diagnose. Patients with the condition are typically treated with a variety of methods involving a mixture of rest, drug treatment and physiotherapy.

Symptoms

The condition is characterized by pain in the lower back and buttocks, which may extend into the legs, hips, groin and foot. The pain may be exacerbated by prolonged sitting or standing, rolling over in bed, climbing stairs, taking long strides, running, or putting your weight onto one leg. You may also experience stiffness in the back and hips, particularly after sleeping or long periods of sitting. In addition, the condition may cause fevers.

Causes of Sacroiliitis

Various factors and events predispose patients to sacroiliac joint dysfunction, including:

• Arthritis. For example, ankylosing spondylitis is a form of inflammatory arthritis involving the spine. Osteoarthritis (wear-and-tear of the joint cartilage) can also affect the sacroiliac joints.
• Pregnancy. In pregnancy and childbirth, the sacroiliac joints tend to slacken and stretch. Extra stress may be placed on the joint through weight gain and changes in gait during pregnancy, leading to possible joint deterioration.
• Traumatic injury. The sacroiliac joint may be damaged by a sudden impact, such as those experienced in car crashes and falls.
• Infections. Osteomyelitis, infection of the vertebral common, is a rare cause of back pain. Endocarditis, inflammation of the inner layer of the heart, and urinary tract infections can also result in sacroiliac pain. Finally, the sacroiliac joint may become directly infected.
• IV drug use/drug addiction. The condition is commonly observed in IV drug users.
• Rheumatological diseases, such as lupus
• Psoriasis

Diagnosis

Your doctor will perform physical tests on the leg, hip and buttock area to determine the source of the pain. Injections of an anesthetic into the sacroiliac joint may also help to pin down the source of pain – if this anesthetic provides relief, the problem is likely to be located within this joint. In addition, X-rays and MRI may be used to visualize the pelvis. 

Treatment for Sacroiliitis

The specific treatment regime for each patient will depend on the underlying cause of the condition, and the type and severity of their symptoms. Using a mixture of non-surgical methods works for many patients in alleviating their symptoms, although surgical options are available for severe cases.

1. Rest

Sacroiliac joint inflammation may be reduced by avoiding or at least modifying any activity that exacerbates the pain. It is also important to develop and maintain proper posture.

2. Apply a Heat or Cold Pack

The use of heat and coldness may give some local relief from the pain. An ice pack applied to the area helps to reduce inflammation. Holding a warm press to the joint may soothe any discomfort, stimulate blood flow and attract restorative nutrients to the joint.

3. Change Sleep Position

Night-time and morning pain may be reduced by modifying your sleep posture. Many sacroiliitis patients find that sleeping on their side, with a pillow placed between the knees to correctly align the hips, is most comfortable.

4. Medications

• Pain relievers. Over-the-counter medications, such as ibuprofen (sold as Advil or Motrin IB) and acetaminophen (often marketed as Tylenol), can provide sufficient temporary relief. However, some side-effects from these drugs, including stomach upsets, and kidney and liver issues, have been noted. Stronger versions of these medicines may be available on prescription if the over-the-counter pills don’t provide enough relief.
• Muscle relaxants. The muscle spasms often experienced by patients may be reduced using muscle relaxant drugs, such as cyclobenzaprine (Flexeril, Amrix).

5. Exercises

The majority of treatment plans for sacroiliac joint disorders include a specific set of exercises consisting of stretching, strengthening and low-impact aerobic conditioning. These exercises will usually be assisted by a physiotherapist, chiropractor, or other trained healthcare professional.

• The Prone Leg Lift. This exercise stretches the hip muscles and may provide short-term pain relief. Lie on your stomach. Raise your leg from the hip, using your gluteal and hamstring muscles, only going as far as is comfortable. Gently lower the leg back to the ground; then repeat with the other leg.

• Hip Stretch. This exercise may bring some temporary relief from the pain. Lie on your back. Slide one of your feet up the opposite leg as far as you can. This will naturally turn out the hip, as you make a "figure 4" shape with your legs. Hold this position for a few seconds, then slide the foot back down the leg. Repeat this on the other side.

Watch the following to learn more exercises:

6. Joint Injections

The injection of corticosteroids directly into the joint can alleviate pain and inflammation. However, these corticosteroid injections should only be administered a few times a year, as the drugs can weaken the sacroiliac bones and tendons.

7. Surgery

In severe cases where the pain is not relieved by non-surgical methods and the condition is affecting everyday life, surgery may be required. Sacroiliac joint fusion uses metal implants to fuse the sacrum and ileum together in order to alleviate the pain.