si joint pain

[trishmac]

I have had si joint pain for the past 7 months, went for xrays and nothing showed abnormal.  I figured it out on my own that it was my si joint on the left side of my back, I checked on google and I have all the symptoms of si joint problems.  I have also read up alot on si joint problems, and have discovered that they are many different types and causes pertaining to the si joint.  My question is what type of si joint problem do I have???   Symptoms for myself include, pain and tenderness in left side of lower back, the pain wraps around my left side into my pelvic bone, and sometimes pain down my left leg.   Thanks

[Tuckamore]

I hope Trishmac is reading. You are so correct Audrea.

I "chased" a cure and had several non-invasive procedures. I was so blessed to have a new and very astute PCP D.O. that specialized in SIJD. She guided me and I did my research. I even considered the SIJ fusion but the horror stories of failure are significant.  My PCP allowed me to do so and come to my own conclusions and then gave me her opinion and always it was in agreement with mine.

However I must clarify that I had SIJD for almost ten years before it was diagnosed and treated....far too long. Had it been caught early on the out come may have been different. I live with the pain through meds and OMT. I know that this is my life and I no longer search for the allusive "cure" as I believe there is none.....and all my physicians are in the same agreement.

I am sorry Audrea that apparently you have not had knowledgeable physicians that provided you with the pros and cons. However I have not had the prolotherapy and still have horrid, burning and disabling pain. Both hyper and hypo SIJ's can be extremely painful.

I wish you both the very best in the future. We can hope that someday this will change and there will be better, successful treatment options for SIJD.

Peace,
~Tuck

[nurseaudrea]

Tuck you are so correct about how the ins. companies are now denying these injections for the SI joint. I also had a "Diagnostic" block done several months ago. It helped so much but was very short lived. I went to a second opinion doc. about the nerve ablation and he agreed that it "could" help. He said he has had about a 50% success rate when it is known to be the SI joint that is the problem. My PM doc. states the same. I just hope I would be in that 50% but am doubtful at this point. Having the prolotherapy for me has really caused too many problems only because I also have a fusion from L4-S1. My SI joint was hypermobile at that point and is why I opted for the prolotherapy. I was also very naive at that point and was still at University and trusted everything a doctor told me. I just knew I would try anything. That was also when the internet was not as widely used and did not have the wealth of information it does now. I did not even do any research before I had it done because I "trusted" the doctor that almost killed me during surgery. I have researched the surgery they do to mechanically fuse the SI joint. It looks horrendous. They put huge screws, or "bolts" through the SI joint running through the pelvis for "purchase". It looks very extreme and painfull. There are so many muscles in the gluteal area. I can't imagine the recovery for that surgery. The prolotherapy is supposed to chemically fuse the area with the accumulation of scar tissue due to the aggravating chemical agents that are introduced into the area. The injections I had were painful. I did not have any sedation or fluoroscopy and when the chemicals went in it burned like fire. Was way worse than getting a lidocaine block. And the pain afterwards lasted around a week. It hurt extrememly bad just to walk.

I would suggest anyone having SIJD to do a lot of research and self assessment before deciding to do anything a doctor suggests. Getting the diagnostic block really does help in determining if the SI joint is the pain generator and the risks of having that done is less as opposed to more invasive procedures and is well documented.

Hope this helps and good luck in your endeavor.
Audrea

[Tuckamore]

We always appreciate your "two cents" worth Audrea, our fellow SIJD pain sufferer! :o)

What I didn't add is that the SIJ injections are being denied for payment by some insurance companies. It was once believed that the steroidal injections were a viable treatment. Studies have revealed that the benefits are very short lived and therefore discredited by some insurances, other then for diagnostic purposes.

I've had two of these injections. They were effective for several weeks but soon the pain returned to at least the level it had been prior to injections.

It's correct that the SIJ needs to be mobile, but too much mobility can be as painful as too little mobility. To be honest after years of treatments and tests no one has determined which mine is, too much or not enough. I am not upset by this lack of diagnostic knowledge because in my case it makes no difference. There is nothing that can be done to "cure" the joint. So be cautious of claims of a cure or a fix. Unfortunately the "fix rate percentage" is extremely low.... as low as 20% with surgery.  The complications are still huge and far too high for me to even seriously consider it. ...and all my consults including my PCP agree.

It's my understanding that Nerve Ablation is hit and miss. Prolotherapy has been discussed as a treatment possibility but I too am concerned about the very issues that Audrea is now experiencing.

I encourage you to find a treatment plan that eases the pain to a bearable level without the possibility of further damage to the SIJ.

Best of Luck,
~Tuck

[nurseaudrea]

I totally agree with Tuck. I also suffer from that condition due to Spinal fusion of L4-L5-S1. Mine was hypermobile and had prolotherapy done, that is when they put chemicals-schlerosing agents- into the joint to cause scar tissue to form making it immobile, about six months after my fusion. I can't tell you how much worse it made my SI Joint and spinal fusion. I found out from a different doctor that the SI Joint needs to be mobile if you are fused or it can cause many more problems in that area and on your spine. In any case, I also found out through an SI Joint injection where they put local anesthesia and steroids to see if that helped the pain. It was such tremendous relief but does not last long. So where do you go from there. I am trying to get a nerve ablation done to that area but having a hard time for insurance to pay. It is controversial as to wether it really helps enough to do it.
I am sorry you are having so much pain. Does the pain in your leg run down the back of your leg? And the part where Tuck said there are aggravating conditions could not be more accurated. When I was pregnant by the 7th month I could no longer walk, even when using two canes. Had to have daughter 5 weeks early due to the stress, anxiety, and severe pain I was in. I hope your condition does not become worse. Early treatment really does help the prognosis as Tuck said.

Just thought I would put my two cents in as well.
I wish you well and please let us know how you are doing.
Audrea

[Tuckamore]

Hi Trishmac,

Welcome to the Pain Management Forum. I am very sorry to hear that you suffer with SIJD. I've had the condition for years, but wasn't diagnosed till nine years ago. It now has disabled me. Although I do have a medical background I am not a physician or an expert. My response comes from being a SIJD patient, researching and learning, undergoing treatments and procedures and many trial and errors through the process.  

SIJD is an often undiagnosed and over-looked condition. It can only be correctly and positively diagnosed with an fluoroscopic guided SIJ injection. I must apologize that I do not completely understand your question ie: "What type of SI problem do I have?"  Maybe the literature you have found has been confusing or misleading.

The SIJ can be hyper or hypo mobile. It usually cannot be seen on an x-ray or any other type of imaging clearly. The cause of SIJD can vary from no-know-cause to a trauma such as a MVA. It can flare in pregnancy and childbirth. It can also be affected by arthritic conditions usually following an injury or deterioration of the joint like structure. The SIJ is found between the sacrum and the ilium of the pelvis. .... but I don't need to explain the structure or function to you based on your research.

Sciatica is a major symptom of this SIJD along with many others, some of which you mention. It will take a skilled practitioner to determine why your SIJ is dysfunctional and causing you pain and how to effectively treat it. I have found that the average clinician is not skilled in SIJD. However a D.O. (Doctor of Osteopathy) that practices OMT (Osteopathic Manipulation Therapy) is often very astute in SIJ issues. It was a D.O. that finally diagnosed me.  

Be cautious of Physical Therapy.  It can be beneficial. In my experience if PT is ordered make sure they are up on the latest approaches for the condition as often it is not simply a matter of strengthening the joint or surrounding structures.

I wish you well. The sooner the condition is treated the better. It left untreated or undiagnosed condition can have life long consequences. I urge you to consult a specialist in the disorder.

I hope you'll let us know how you are doing and what you discover. If you have additional questions please feel to ask. I can't promise we will know that answer but we do offer out support and understanding.

Take Care,
~Tuck