Understanding Trauma-induced Sacroiliac Joint Pain

Jordan Lee Tate, M.D., MPH

Trauma-induced sacroiliac joint (SIJ) pain is common in workplace injuries. However, the diagnosis and treatment can be complex.

Understanding the anatomy of the SIJ and the mechanism of injury is imperative. In addition, taking an accurate and comprehensive history of the patient’s musculoskeletal symptoms is crucial for making the correct diagnosis. A fellowship-trained pain management physician is best equipped to provide specialized evaluations and initiate a customized plan of care.

The SIJ is the largest axial joint in the body. It connects the spine to the pelvis, allowing load transfer from the lumbar spine to the lower extremities. In youth, the joint is more mobile and becomes fibrotic with age, which minimizes movement and enhances the stability of the SIJ. Trauma to the joint can cause laxity and hypermobility of the joint due to ligamentous strain and subluxation of the articular surfaces.

SIJ pain can be caused by hypomobility due to degenerative joint disease and may predispose the patient to injury. Studies have shown that the SIJ is a pain generator in up to twenty-five percent (25%) of patients complaining of chronic low back pain. Surprisingly, it is an often-overlooked diagnosis, especially when attention is instead focused on disc or facet joint pathology.

Pain is most common after a fall on the buttock or deceleration injury such as a motor vehicle collision. Postpartum status, prior lumbar fusion surgery, scoliosis, and leg length discrepancy may predispose a patient to SIJ dysfunction. Patients will often complain of pain localized below the waistband, which may radiate to the posterior thigh or anterior groin. The pain is often mechanical in nature and may be intensified by sitting, loadbearing, walking, and hip twisting maneuvers.

Conservative measures—such as physical therapy, chiropractic manipulation, and bracing—should be implemented as first-line treatments. Imaging of the SIJ only serves to rule out fractures and tumors, as normal x-rays, CTs, and MRI scans do not correlate to the absence of SIJ pain. Diagnostic and therapeutic steroid injections performed under fluoroscopy or ultrasound confirm the diagnosis and often provide long-lasting relief, enabling a return to function and work. Contrast enhancement of the fluoroscopic injection can also identify joint disruption which may not be seen on imaging studies.

For refractory patients, denervation of the SIJ with radiofrequency ablation (RFA) may be performed. Regenerative options, such as PRP and prolotherapy are often beneficial. When necessary, SIJ stabilization and fusion procedures can be performed by fellowship-trained interventional pain specialists with minimally invasive techniques.

SIJ pain and dysfunction from workplace traumatic events should be considered in the differential diagnosis and workup of patients with low back pain. Treatment options are available and effective. I recommend early referral to a double board-certified and fellowship-trained interventional pain physician for the most efficient and comprehensive solution.

Jordan Lee Tate, MD, MPH, is an interventional chronic pain medicine specialist who dedicates herself to comprehensive, holistic care for her patients. She graduated from Vanderbilt University with a focused study on Neuroscience and earned her medical degree from Emory University School of Medicine. Dr. Tate obtained a master’s degree in Health Education from Rollins School of Public Health at the CDC where she dedicated her thesis work to initial research on clinical opioid use, misuse, and diversion. As an active clinician, researcher, and busy mom of three, Dr. Tate is also passionate about traveling, education, and wellness. She practices in Jasper, Georgia at Southern Pain and Spine. Currently, she directs several research projects on Spinal Cord Stimulation and Peripheral Nerve Stimulation and runs a subspecialty clinic on Chronic Pelvic Pain.