Back pain is not always due to back problems

Cornelis Elmes, MD

From Dr. Cornelis Elmes, Special to the Daily Republic

Lower back pain is a common health complaint in adults, and the risk of lower back pain increases with age.

With low back pain, it is common for patients and their doctors to examine the usual suspects: the muscles and discs of the spine. But sometimes the perpetrator is actually rooted elsewhere.

In 15 to 30% of patients with chronic low back pain, the cause is not in the spine at all. Instead, it’s a problem with the sacroiliac joints (SI). These joints connect the pelvic bones (hips) to the sacrum or the lowest part of the spine above the tailbone.

The SI joint is an important but often underestimated and unknown cause of low back pain. I call it the great masquerade because it can look like a hip problem or a back problem.

The SI joints are important because they are essentially shock absorbers for impacts from the lower extremities to your spine, such as when walking or lifting heavy objects. These joints don’t move as much as other joints in the body, but they move just enough to distribute some of the forces and reduce the risk of injury to the spine.

However, if an SI joint is injured, it can move more than normal, which can be a very painful problem.

Symptoms can range from aching to stabbing or radiating pain in the back, hips, or buttocks. It can radiate into the leg mimicking sciatica or nerve pain, and patients can feel the pain while sitting, standing, or even lying down. You will often have difficulty getting comfortable and will fidget and move around a lot.

There are several treatment options to manage SIJ pain, starting with physical therapy and exercise, particularly those that help strengthen the core muscles of the body. Wearing a sacroiliac strap or a device that limits movement of the joint can also help support the area. In some patients, steroid injections in the area may provide short-term relief.

If this is not effective, SI joint fusion surgical intervention is an option. The procedure involves making a small incision along the side of the buttocks through which small triangular titanium implants are placed over the sacroiliac joint. The implants that
porous, promote bone ingrowth, which essentially welds the joint so that it can no longer move and thus alleviates the cause of pain.

The procedure has been shown to be effective in more than 90% of patients, and because it is a minimally invasive procedure, recovery occurs faster. The fixation of the SI joint does not restrict the patient’s flexibility. The SI joint shouldn’t move much anyway.

Dr. Cornelis Elmes is an orthopedic specialist at NorthBay Healthcare.