Non-Surgical SI Joint Therapies
Several options are available to address SI joint dysfunction, starting with non-surgical therapies that may be performed repetitively. Some people respond well to physical therapy and exercises. Others may benefit from treatments like therapeutic SI joint injections, and SI joint fusion.
Just about all SI joint treatment plans start with non-surgical therapies. The goal of these therapies is to decrease the pain and improve the function of the joint and address conditions that contribute to your pain, although the relief may be only temporary.
With non-surgical therapies, your goals may be to:
- Improve posture, symmetry, and balance
- Improve muscle strength to stabilize the sacroiliac joint
- External support for the sacroiliac joint
- Attempt to optimize the sacroiliac joint position
- Improve mobility of the joints and tissue above, below, and surrounding the SI joint**
- Decrease and manage pain in the tissues that surround and support the sacroiliac joint
- Normalize gait (walking pattern)
- Understand optimal sacroiliac joint anatomy and function
First talk to your doctor and ask if he or she is trained in diagnosing and treating SI joint dysfunction. If not, consider finding a provider trained in SI joint pain treatments to design the right course of treatment for you. If appropriate non-surgical options have been tried and do not provide relief, your surgeon may consider other options, including minimally invasive surgery, like iFuse.
Non-Surgical SI Joint Treatment Options
Your healthcare provider may prescribe NSAIDs, opiods, or other medications to help relieve your SI joint pain. Pain medication may help treat the symptoms of SI joint pain, but does not change the underlying physical impairment.
Even with additional interventions such as physical therapy, steroid injections, or radiofrequency ablation, you may need ongoing treatment with pain medications. Please be aware that there may be significant risk of developing opioid dependence with long term narcotic use.
Chiropractors have different schools of thought on how to treat patients with SI joint pain. Chiropractors use various methods to optimize SI joint alignment and alignment of the joints above and below the SI joint and throughout the body. Chiropractors may also recommend exercise, bracing, and other modalities as part of their treatment to help reduce pain and improve function.
Physical therapy consists of a physical evaluation and an individualized treatment plan. Treatment may vary in length based on your needs and usually continues until the deficits are resolved and you have regained pain-free function. For optimal results, its essential that you understand the cause of your symptoms and actively participate in your treatment, which will likely include a home exercise program.
Yoga isn’t a single discipline and varies greatly based on the type of class taken. Yoga may help address many of the impairments that can contribute to SI joint dysfunction and pain including posture, balance, and muscle length and strength imbalance. Consider limiting the practice to poses and stretches to those that do not elicit SI joint pain.
Massage therapy may help improve blood flow to, flexibility of, and relief of pain in muscles that may be contributing to SI joint pain and/or dysfunction or that are stiff or painful as a result of SI joint pain/dysfunction.
As with other disciplines like yoga, massage therapy has many variations and can be performed in many ways based on the educational background of the massage therapist. Use proper positioning and communicate with the therapist about your pain for optimal results.
Therapeutic SI Joint Injections
One common non-surgical treatment option includes injection of medications (steroids) into the joint to decrease inflammation and pain. Steroids are powerful anti-infammatory medications. Therapeutic SI joint injections are often a temporary solution, lasting a few days or weeks. With repeat steroid use, there are potential negative side effects; most health plans will authorize only two or three injections per year.
RF Denervation or Radiofrequency Ablation (RFA)
Radiofrequency ablation (RFA) is a procedure where heat or cold is used to temporarily deaden the sensory nerves over or around the SI joints in order to decrease their ability to transmit pain signals coming from the SI joint. Clinical literature about its effectiveness is mixed; some studies show temporary pain relief of up to six to nine months, and some show minimal pain relief. No published studies have shown long lasting relief using RFA.
SI Joint Belts
SI joint belts, also called sacral belts, SI joint braces/bands, or SI joint stabilization belts, are non-elastic straps placed temporarily around the pelvis to provide external support of the SI joints. The SI belt may reduce the sensation of abnormal SI joint motion and may temporarily help decrease pain and improve function.60
Proper placement of the belt and incorporating it into a comprehensive treatment plan are key to its ability to relieve symptoms. Many types of belts are available for temporary relief of pain.
* No high quality published clinical studies exist that evaluate the effectiveness of this treatment for SI joint dysfunction.
** There is high level clinical evidence that manual manipulation of the SI joint does not change the position of the joint