Hip Check: Are Your Sacroiliac Joints Causing Chronic Low Back Pain?

Very few people get through life without ever feeling the sharp twinge or nagging dull ache of back pain. In fact, about 65 million Americans report they’ve had a recent bout with back pain, and they spend more than $12 billion every year desperately seeking relief. 

One of the reasons pain relief is so elusive is that, in some cases, the source of the pain isn’t in the back at all — it’s in the sacroiliac joints.

Dr. Jay M. Shah at SamWell Institute for Pain Management in Colonia and Livingston, New Jersey, approaches back pain differently. He understands the complex relationships between all your body’s seemingly independent systems, knowing that problems in one area can trigger pain in another. 

This is especially true when it comes to your sacroiliac joints, also known as your hip joints. 

It’s all in the hips

Your sacroiliac joints (SI) connect your hip bones to your sacrum, which is the triangular bone at the bottom of your spine. These joints allow you to bend forward and backward and absorb shock from your upper body. 

Although your SI joints are surrounded by supportive muscles and ligaments, problems can occur if you over- or underwork them. 

Overuse of your SI joints can lead to instability, causing pain that often radiates to the lower back and groin area.

Underuse of your SI joints can lead to tense muscles, limited mobility, and pain that radiates through your buttocks and leg and/or one side of your lower back.

SI joint dysfunction can occur for a variety of reasons, including gait issues, injuries, pregnancy and childbirth, repetitive stress, and even injections and lower back surgery. 

The hip-back connection

For years, medical professionals suspected that SI dysfunction could be the culprit behind low back pain, but previous research only revealed SI dysfunction as the primary pain source in 10%-25% of cases. 

Newer research shows that the number is much higher: up to 63% of patients experiencing chronic lower back pain — especially those who have undergone lumbar fusion or have failed back surgery syndrome also known as persistent spinal pain syndrome — can cause over working of your SIJ joints and lead to eventual SI dysfunction. 

The reason for the connection is that SI dysfunction, whether it stems from injury or past lower back surgery, results from an alteration in the SI joint. That change leads to a misalignment of the sacrum and the iliac, and therefore your back, as well.

Unfortunately, some physicians don’t screen for SI dysfunction when you complain about lower back pain. And if you’re not experiencing any discomfort in your SI joint, your hips may never enter the conversation.

Dr. Shah, however, is keenly aware of the potential for SI dysfunction to cause chronic lower back pain, and he always screens you for this possibility when appropriate.

How to help your hips and your back

When your SI joints are causing your back pain, Dr. Shah offers several treatments that can bring you relief. He always starts with the most conservative measures first, and in this case that means ice, heat, and rest. Often, this is all it takes to reduce inflammation and stop the pain.

Physical therapy is always a great way to restore proper SI joint function. By strengthening the supporting muscles and increasing your range of motion, PT may be all you need.

If your muscles are tight and preventing movement, prescription muscle relaxants can loosen them up and allow you to participate in PT to get your joints moving freely again.

Anti-inflammatory steroid injections delivered directly into your SI joints contain a local anesthetic that halts pain instantly and a long-acting medication to keep inflammation and pain at bay for weeks or months.

In some cases, Dr. Shah recommends electrical stimulation to block pain signals between your nerves and your brain, or radiofrequency denervation, which destroys the offending nerve to block pain for 1-2 years at a time.  This procedure can be safely repeated as well.

When SI dysfunction and related low back pain are severe and don’t respond well to other treatments, Dr. Shah may recommend sacroiliac joint fusion to prevent painful movement and nerve irritation for good. 

During this procedure, also called SIJ stabilization, Dr. Shah uses minimally invasive techniques to place a bone graft or an implant on one or both sides of your sacrum, which is the top part of your pelvis. Over time, new bone growth fuses your sacrum and ilium together and keeps them stable and pain-free. 

If you have chronic low back pain, but no clear indication of a back problem, it may be in your hips. Schedule an appointment with Dr. Shah using our online booking tool, or call either of our offices, and find out if your SI joint is the culprit.