Do you suffer ongoing “nagging” lower back pain that radiates into you buttock? Do you have difficulty sitting in one position for any length of time? Have you considered the possibility of sacroiliac joint (SIJ) pain as the cause of your symptoms?
Probably not! In the 1930’s SIJ pain was such a popular diagnosis there was a period actually referred to as the “Era of the SI joint”. Nowadays many doctors are reluctant to believe that a joint with so little movement can cause so much pain.
Dr. Dominic Hegarty (Clinical Director, Pain Relief Ireland) is a big advocate of the SIJ syndrome as a cause of lower back pain and he is a specialist in the management of Sacroiliac joint syndrome. He has published the largest follow up study on the advanced interventional management of this syndrome. (Hegarty. Pain Physician 2016)
In fact, Dr. Hegarty recently introduced the state-of-the-art bipolar radiofrequency denervation technique, the Sacroiliac Joint Palisade Device, in conjunction with Cosman Medical Inc., and PEI healthcare in Ireland.
In 9 minutes this technique, which was developed by Dr. Jianguo Cheng of the Cleveland Clinic, can generate an elongated ablation that conforms to the individual’s sacral curvature, and interrupts the nerve fibers form the L5-S3 dorsal innervation to the painful joint. The advantage of this bipolar radiofrequency (RF) technology is that it creates larger ablations, using smaller, RF cannulae and electrodes and improves patient experience compared to previous equipment on the market.
The technique predicts a more complete SI Joint lesion zone that conforms to patient anatomy and is less likely to leave gaps between adjacent lesions that could allow painful nerves to remain.
Treatment options for SIJ syndrome
A clinical assessment & examination vital to make the accurate diagnosis as there are no investigations to confirm the syndrome
a) Conservative Treatment
- Patients commonly start using physical therapy treatment for SI joint problems. A well-rounded rehabilitation program assists in calming pain and inflammation, improving mobility and strength, and helping you do your daily activities with greater ease and ability.
- Stabilization exercises involve posture and muscle training. Therapy sessions may be scheduled two to three times each week for up to six weeks.
- Anti-inflammatory maybe indicated to help the rehabilitation
b) Pain intervention
- Failure to response within 12 weeks would suggest that injection to the region might be warranted. Your pain physician can help make this decision with you
- This can be under X-ray or ultra sound guidance with the use of steroid and local anesthesia
- Failure to completely respond may indicate the need to repeat steroid injection or perhaps consider the bipolar radiofrequency denervation technique to offer long-term significant pain relief Figure 1.
SIJ syndrome is a real cause of lower back pain that is often under appreciated and may only take 9 minutes to sort out!