What is sacroiliitis?

Sacroiliitis is an inflammation of the sacroiliac joint. It can include both joints or just one. These joints are found at the lower part of your spine where it connects to your pelvic area, near the hips. The pain of sacroiliitis can affect the:

  • buttocks
  • lower back
  • legs (one or both)
  • hips (one or both)
  • feet (not as common)

Sacroiliitis is a main component in ankylosing spondylitis. Ankylosing spondylitis is a rheumatic disease that causes joint inflammation and stiffness in the spine and hips. It is a type of arthritis that is progressive.

Anyone can get sacroiliitis. However, ankylosing spondylitis, which has sacroiliitis as a major component, is less common and is seen more often in Caucasians.

Treating sacroiliitis

Treatment depends on the type of sacroiliitis. Taking over-the-counter pain medications and resting the joint can often help alleviate many symptoms. However, if you are pregnant you should check with your doctor before taking any medication. Treatment options for sacroiliitis include:

  • alternating ice and heat to relieve pain and inflammation
  • physical therapy and exercise
  • injections of corticosteroids directly into the joint (these can only be done periodically due to side effects from regular use)
  • electrical stimulation of the joint using a TENS unit (aka, transcutaneous nerve stimulation) and spinal cord stimulation
  • surgery, which is only performed in extreme cases and is done to fuse together the bones

Medication options

If the pain is severe, your doctor may prescribe a pain medication or a muscle relaxer to help, since muscle spasms are common. You may also be given a prescription for a medication called a TNF inhibitor if your sacroiliitis is related to ankylosing spondylitis.

Sacroiliitis exercises

Receiving physical therapy and learning strengthening and flexibility exercises can be helpful for those with sacroiliitis.

Here are a couple exercises that can help with sacroiliitis:

Hip flexion exercise

  1. Lay on your back with the lower part of legs on a box or several pillows.
  2. Cross one foot over the other.
  3. Squeeze your legs together, hold, and release.
  4. Repeat this several times or as directed by your doctor or therapist.
  5. Switch legs.
  6. Lie on your back with your knees bent and your feet flat on floor.
  7. Put a pillow between your knees, squeeze, and hold briefly.
  8. Repeat several times or as directed by your doctor or therapist.

Hip adduction isometric hold

During physical therapy you will learn range of motion exercises and strengthening exercises. Many of these exercises you’ll eventually be able to do yourself at home. Treatment will also focus on stretching and keeping or increasing your joint flexibility. You should always check with your doctor or physical therapist before trying any exercises so you don’t make your symptoms worse or cause additional injury.

What are the symptoms?

The symptoms of sacroiliitis can look similar to other lower back issues. However, it is specifically an inflammation in the joint. The more common symptom is pain in the lower back, hip, buttocks, and down the legs. This is sometimes accompanied by a low-grade fever.

The pain will usually be worse after standing for a long time, going up or down stairs, or running or walking with long strides.

What are the causes?

The causes of sacroiliitis can include:

  • damage to the sacroiliac joints from falling or after a car accident
  • joints becoming loose during pregnancy to prepare for birth
  • an altered gait during pregnancy
  • osteoarthritis and ankylosing spondylitis (an inflammatory arthritis)
  • an infected sacroiliac joint (not as common)
  • gout
  • existing back or spine issues

Sacroiliitis in pregnant women

Sacroiliitis is not uncommon in women who are pregnant. That is because during pregnancy your hip and sacroiliac joints will begin to naturally loosen. This is your body preparing to give birth. Add to that a change in the way some women walk as a result of pregnancy and that can cause your sacroiliac joints to become inflamed. This becomes sacroiliitis.

How is it diagnosed?

Diagnosis comes through several options which are usually done in combination for a more accurate diagnosis. Your doctor will start with a physical exam which may include pressing in the area of your hip or your buttocks and moving your legs.

In order to identify that the pain in in your sacroiliac joint and not somewhere else in your lower back, your doctor may decide inject a numbing medication directly into the joint. However, this is not always an accurate test since the medication can spread to other areas.

You doctor might also send you for an X-ray to confirm. An MRI might be used if your doctor thinks you might have ankylosing spondylitis.

Outlook and prognosis

The outlook for sacroiliitis may vary based on the cause. Some injuries will be improved by medications, therapy or an exercise program. However, if it is caused by joint damage that cannot be corrected by surgery or medication, or in relation to ankylosing spondylitis, then treatment will be based on managing symptoms long term.

It is important that you see your doctor for any pain in your joints. This is especially true if it interferes with your normal life functions. The earlier you receive treatment the better the outcome will be.