How to Identify and Treat Sacroiliitis


Up to 25% of lower back pain is caused by an inflammation of the sacroiliac joints, a condition known as sacroiliitis. You have two sacroiliac joints: one on each side of your hips. The sacroiliac joints attach your sacrum (i.e., part of your lower back that lies between the tailbone and your lowest vertebrae) to your ilium (i.e., the upper portion of your pelvic bones).

Brian Fuller, MD, and our expert team members at Mountain Spine & Pain Physicians in Denver, Colorado, recognize that lower back pain can be frustrating to live with and its underlying causes may be difficult to detect. Here, we share a few insights into what sacroiliitis is, how to know if you might have it, and how to treat it.

A joint you can’t move

Normally, when you think about your joints, you think about the “hinge” or “ball and socket” connections between two bones that allow you to do things like bend, flex, and rotate. Your sacroiliac joints, however, are tightly attached to each other with a series of muscles and ligaments. 

Although the sacroiliac joint moves slightly — when it absorbs shock while you walk, run, or perform other activities — it can only move about 2-4 mm up, down, or back and forth. Even that movement happens automatically; you can’t consciously move your sacroiliac joint the way you move your knee or elbow.

Tightness and looseness both cause pain

If the ligaments and muscles that connect your sacrum to your ilium become too tight or inflamed, however, your hips and legs don’t absorb shock as well. When you walk, run, or jump with tight sacroiliac joints, you might feel pain and stiffness in your lower back. 

Conversely, women whose sacroiliac joints get stretched and loosened during pregnancy also could experience lower back pain. When the connecting tissues are too loose, they can’t completely absorb shock in the pelvis, either. The most common symptoms of sacroiliitis are:

  • Pain in buttocks
  • Lower back pain
  • Pain in thighs

Your pain might also get worse when you:

  • Wake up in the morning
  • Run
  • Climb stairs
  • Walk with long strides
  • Stand for long periods
  • Stand with weight on one leg

You might also have trouble sleeping or wake up in the middle of the night with back pain.

How you developed sacroiliitis

You could injure one or more of your sacroiliac joints in a variety of ways. Carrying heavy weight (including your own body weight) can put stress on the joints. Common events that can lead to sacroiliitis include:

  • Pregnancy
  • Car accidents
  • Collisions
  • Falls
  • Wear-and-tear of osteoarthritis
  • Carrying heavy loads

You might also have an underlying condition that triggers inflammation in your sacroiliac joint, such as:

  • Ankylosing spondylitis
  • Juvenile rheumatoid arthritis
  • Psoriatic arthritis
  • Reiter’s syndrome
  • Infection 

To verify that your sacroiliac joint is involved in your back pain, Dr. Fuller conducts a comprehensive examination and may order imaging tests such as an X-ray or MRI.

How to get relief from sacroiliitis

To stop the pain of sacroiliitis, Dr. Fuller may recommend sacroiliac joint injections. These are injections of steroids that he administers directly into your inflamed ligaments and muscles in your sacroiliac joint to subdue inflammation and give you relief.

If he sees that your joint tissues are damaged, he may recommend regenerative therapies, such as platelet-rich plasma (PRP) or stem cell therapies, to accelerate repair and healing. He creates the PRP and stem cell serums by harvesting platelets from your own blood or stem cells from the marrow in your hip bone. Because these regenerative therapies are taken from your own body, they don’t trigger immune responses.

Whether you receive joint injections and regenerative therapy or not, Dr. Fulller also recommends physical therapy to strengthen and stretch the muscles that support your sacroiliac joints. Staying strong and flexible in your core helps your entire body function better and more comfortably.

If you have lower back pain or think you might have sacroiliitis, contact us by calling 303-355-3700. You can also schedule an appointment with our online booking form.

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