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The SIJ is a complex structure that connects the spine to the legs. Located in the lower back, the SIJ is composed of 2 different structures: the sacroiliac joint (SIJ) and the posterior sacroiliac joint ligaments. These structures have different nerve innervation (Burnham et al, 2020).
SIJ pain can be acute or a chronic process. Sacroiliac joint pain can cause radiating pain into the back, buttock, groin, and lower extremities. The majority of the time (94%) of patients will have pain in the low back.
Up to 60% of patients will also have leg pain (Murakami et al 2007). Leg pain typically occurs in the upper part of the leg (buttock, thigh, and groin). Some patients will have numbness or a tingling sensation as well, making it sometimes challenging to distinguish SIJ pain from other causes of low back pain.
SIJ pain cannot be diagnosed by imaging studies (Schwarzer et al 1995; Cohen 2005). SIJ pain can be identified by assessing the location of the pain, movement, and posture of the patient and by physical examination.
Typical treatments include NSAIDs, physical therapy, and corticosteroid injections. Physical therapy can address any asymmetry of the pelvis that may stress the SIJ and nonsteroidal anti-inflammatory drugs (NSAIDs) used for pain relief.
OMM aims to address somatic dysfunctions in the SI joint, by addressing unequal tensions of surrounding ligaments and positioning of joints to restore balance and “normal” function.
In some cases, the treatment of SIJ pain remains a challenge. In cases that fail therapy, steroid injections are commonly used. These injections have been found to be effective to treat SIJ pain in some patients. Studies have shown that periarticular SIJ injections are more effective than an intra-articular injection (Murakami et al 2007), which indicates that SIJ pain originating from the ligaments may cause the majority of SIJ pain.
Sometimes the effects of cortisone are short-lived, and repeated steroid injections can decrease bone density and suppress hormones (Bouvard et al 2010; Younes et al 2007). In some cases, radiofrequency neurotomy or surgical fusion is used to manage pain.
PRP is currently the mainstay of regenerative medicine treatment for SIJ and is rich in growth factors that enhance the body’s natural healing response. While insurance companies still consider this procedure experimental, the studies available show promising results.
Given the underwhelming evidence for other therapeutic procedures (i.e. physical therapy, steroid injections, and radiofrequency neurotomy) the novel approach using PRP is welcomed (Urits et al 2019). In 2 case series of patients with SIJ laxity and pain, injecting PRP into the SIJ ligaments led to significant improvement in pain scores (Ko 2010; Singla et al 2017).
In a prospective randomized controlled study of 40 patients that got either a steroid injection or PRP injection, patients were followed for 3 months. In this study, PRP injections were more effective than steroid injections for SIJ pain with 90% of patients after PRP experiencing significant pain relief compared to only 25% of patients after the steroid injection (Singla et al 2017). Unlike the short-term benefits of a steroid injection, another study found that patients can still have pain relief even at 4 years out from the PRP injection (Ko 2010).