A big problem for many people is back pain that has been going on for a long time. Sometimes, no matter how much medicine they take and physiotherapy they do, it seems like there is no relief. But did you know, not all back pain has to be caused by a problem in the spine. Maybe the cause of your pain is a little lower in the back, in the joint where your spine connects to your hip bone. We call this the Sacroiliac Joint or SI Joint.
Why is SI joint pain so difficult to diagnose?
Simply put, the SI joints are two very strong joints that connect the lower part of our spine (which we call the sacrum) and the hip bone (the ilium). In between 15% and 30% of people who suffer from chronic back pain, the primary cause of pain is a problem with one or both of these SI joints.
But diagnosing this can be a bit of a challenge for you and sometimes even for doctors. The reason is that although this joint is one of the largest in our body, it is located very deep in the hip area. Therefore, a doctor may not be able to detect a problem in this joint when he or she physically examines you. Also, even tests like X-rays can sometimes be difficult to get a clear picture of.
Another thing is that the symptoms of SI joint pain are very similar to other conditions, such as sciatica or hip arthritis, so it can be a bit complicated to pinpoint the exact cause.
A doctor will usually combine the results of several tests to confirm the presence of SI joint dysfunction. Most of these tests can be done in the doctor's office.
Physical Tests Performed by the Doctor
First, your doctor will ask you about your medical history and give you a complete examination. Your posture and the way you walk are also taken into account during this time. Then, several special tests are performed to see where the pain is coming from and how well the SI joint is moving. One or two of these tests alone will not lead to a diagnosis. A problem with the SI joint is suspected only if at least three of the tests are positive.
The table below lists some common tests performed for this purpose.
| Test Name | Simply put, what you do |
|---|---|
| Gaenslen's Test | You are made to lie faceup on the table, one knee bent towards your chest and pressed down, while the other leg is stretched straight out and pressed down against the table. |
| Patrick's Test or FABER Test | While lying on your back, you are asked to place the ankle of the painful leg on top of the knee of the other side. Then, the doctor simultaneously presses the bent knee and the opposite hip. |
| Pelvic Compression Test | You are turned on your side and placed on your back, applying downward pressure to the upper hip bone. This puts pressure on the SI joint. |
| Thigh Thrust Test | While you are lying on your back, the doctor will bend your knees and hips to 90 degrees and apply downward pressure along your thigh. |
| Flamingo Test | They ask you to stand on only the painful leg and jump a little on that leg. They see if the pain increases. |
Don't be afraid when doing these tests.
During these tests, you may feel some discomfort or pain as the doctor bends and squeezes your legs and hips in different directions. This is normal. These tests are done to deliberately apply a little pressure to the SI joint to confirm that your pain is coming from that joint. So tell your doctor exactly what you are feeling.
The role of imaging tests
In addition to physical examinations, your doctor may recommend a scan to get a clear picture of the inside of your back and hip area.
- X-ray: An X-ray can help to see if there are any changes, fractures, or arthritic conditions in the SI joint.
- CT Scan (Computed Tomography): This is a more powerful test than an X-ray. A CT scan can look at the joint and surrounding bones in much more detail than an X-ray can.
- MRI Scan (Magnetic Resonance Imaging): An MRI is usually used to rule out other causes of SI joint pain, rather than to diagnose it. Imagine, your pain could be caused by a disc prolapse or other soft tissue problem. An MRI can help you be 100% sure that you don't have other conditions that cause symptoms similar to SI joint pain.
Diagnostic Injection
If, after all other tests, it's still not clear whether the SI joint is the cause of the pain, there is a very accurate test that doctors will eventually turn to. That is, injecting a numbing medicine directly into the SI joint.
This is not done lightly. The doctor uses an X-ray or ultrasound scan to ensure that the needle goes exactly into the joint.
Imagine if your long-standing pain disappeared instantly after getting this injection? What does that prove? The cause of the pain is 100% a problem with the SI joint.
This is a diagnostic test, and sometimes used as a temporary treatment when given with a steroid medication. Because it carries fewer risks (such as infection) than other tests, doctors only recommend it in extreme cases.
So, if you too are experiencing unexplained pain in your lower back or hip area, don't ignore it. By seeing a qualified doctor and getting a proper examination, you can find the exact cause and get the right treatment for it.
Take-Home Message
- The cause of chronic pain in your lower back and buttocks may not be a problem with your spine itself, but rather a problem with your sacroiliac (SI) joint.
- Because diagnosing this condition is quite complex, your doctor will perform several different physical tests that will help determine the cause of the pain.
- Scans, such as X-rays, CT scans, or MRIs, can help diagnose the condition and rule out other conditions.
- The best test to definitively confirm the disease is a diagnostic injection of a numbing drug into the joint.
- If you have these symptoms, do not self-treat, but definitely see your doctor for an accurate diagnosis and treatment plan.
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