HEALTH & MEDICINE :: APRIL/MAY 2007
Treatment for Sacroiliac Joint Pain
The Sacroiliac Joint is the cause of about 10% of lower back pain. Its presence used to be controversial, but multiple studies have validated its existence.
The sacroiliac joints (SIJs) form the base for which the spine axis rests, transferring loads from the upper trunk of the body to the legs. It acts as a shock absorber in many planes of body motion. The back parts of the joints receive nerve branches, which transmit pain signals to the brain. Although pain from the SIJs may arise from various metabolic diseases i.e. osteoporosis as well as from tumors, fractures or inflammatory conditions from arthritis, it may also be seen in conditions when strength and flexibility problems of the hip and thigh muscle cause abnormal sacroiliac joint movement.
Other mechanical abnormalities potentially leading to sacroiliac joint pain occur in various instances of trauma. Examples of this include falling on the buttocks, automobile accidents where the knee hits the dashboard, a rear end collision when the foot is on the brake or where one is broadsided resulting in a blow to the outer portion of the pelvis. Further traumatic causes include missing a step when walking down the stairs or even from bending, lifting or twisting. The site of pain can vary, but it is usually associated with buttock pain that refers to the groin, thigh (front or back) and less commonly it can mimic sciatica.
Needle in sacroiliac joint before contrast.
Needle in sacroiliac joint with perfect contrast flow within the joint.
SIJ pain, if not caused by inflammatory conditions, cannot be diagnosed by X-ray, CT or and MRI. There are no scientifically validated physical exam findings that diagnose SIJ pain. Diagnosis is made when an image guided sacroiliac joint injection eliminates the pain. Because this joint has a complex course, the procedure can only be employed using a fluoroscope or CAT scan. Under-going this procedure should not be expected to cure this condition. As is always recommended, patients must participate in their own rehabilitative care in order for them to be successful. This procedure is thus primarily utilized as a tool to help patients move forward in correcting any imbalances of muscle strength and flexibility around these joints in a fashion that is much more painful otherwise. Recent evidence suggests that because the pain sensing nerves on the backside of the sacrum allow the sacroiliac joint to feel pain they can be targeted for coagulation by a treatment using actual radio waves (Radiofrequency Neurotomy). Another sacroiliac joint radiofrequency technique involves cauterizing the small pain sensing fibers that lie along the substance of the back of the joint itself.
Dr. Lieberman is Board Certified in Pain Management, Physical Medicine and Rehabilitation. Dr. Lieberman is an attending Physician at Kent General Hospital and serves on the hospital’s Trauma Committee. Please call the office at 302.674.8444 for more information and to make an appointment. Delaware Spine Institute is located at 1673 South State Street, Suite B, Dover DE 19901.
Other Services offered by Dr. Lieberman are:
- Spinal Injection Procedures (cervical, thoracic, and lumbar)
- Epidural Blocks
- Discography
- Selective Epidurals
- Facet Blocks
- Costovertebral Blocks
- Sacroiliac Joint Block
- Radiofrequency Ablative Procedures
- Plasma Discectomy (lumbar)
- Electromyography (EMG’s)
- Trigger Point Injections
- Prolotherapy
Selective Spinal Injection procedures are conveniently performed in the Delaware Spine Institute.
Testimonials (Letters sent to Dr. Lieberman):
“Dr Lieberman, I have had problems with pain in my lower back, thighs, and both legs for several years. I have been to several doctors because of this pain with no relief in sight. I had little relief from therapy, but nothing compared to the relief that I got from you. Since I have come to you, my pain is 90% better. I think you are an excellent spine Doctor and I would recommend you to anyone that has this problem. Thank God for giving people like you the knowledge to help people like me.” ~Virginia Coston….patient
“Dr Lieberman, Thank you so much for fixing my back. The treatment you performed has already made my life enjoyable. May God Bless you always,” ~Wayne Morse……..patient
“Honored, humbled and proud to be part of a community that is so rich in history and so steeped in traditional values.”…says Dr. Lieberman.
