Sciatica Or SI Joint Dysfunction? Find The True Cause Of Pain
SACROILIAC dysfunction and instability”, generally refers to pain in the sacroiliac joint region that is caused by abnormal motion in the sacroiliac joint, either too much motion or too little motion. It typically results in inflammation of the sacroiliac joint, and can be debilitating. SCIATICA is a fairly common cause of back pain. It is characterized by sharp nerve pain that shoots down the buttocks and into the leg, usually on one side of the body.
It is important to note that another common cause of lower back pain, sacroiliac (SI) joint dysfunction, can cause a very similar pain pattern. Common symptoms include lower back pain, buttocks pain, sciatic leg pain, groin pain, hip pain , urinary frequency, and “transient numbness, prickling, or tingling. Pain can range from dull aching to sharp and stabbing and increases with physical activity.Symptoms also worsen with prolonged or sustained positions (i.e., sitting, standing, lying).Bending forward, stair climbing, hill climbing, and rising from a seated position can also provoke pain. Pain is reported to increase during menstruation in women.
Sciatica is more well-known than SI joint dysfunction, so the chance of receiving a proper back pain diagnosis for SI problems is lower.
Affected muscle groups in SI JOINT DYSFUNCTION Edit
Many large and small muscles have relationships with the ligaments of the sacroiliac joint including the PIRIFORMIS, rectus femoris, gluteus maximus and minimus, erector spinae, latissimus dorsi, thoracolumbar fascia, and iliacus. Any of these muscles can be involved or spasm with a painful and dysfunctional sacroiliac joint.The SI joint is a pain-sensitive structure richly innervated by a combination of unmyelinated free nerve endings and the posterior primary rami of spinal segments L2-S3. The wide possibility of innervation may explain why pain originating from the joint can manifest in so many various ways, with different and unique referral patterns for individual patients.Patients with sacroiliac joint dysfunction can also develop tightness and dysfunction in the hamstring, quadriceps, iliotibial tract and hip flexors, including the psoas muscle.
Sciatica is caused by a compression or irritation of the sciatic nerve, which runs from the lumbar spine down to the foot on each side of the body. The condition has a number of potential causes, including lumbar disc herniation and piriformis syndrome, spinal stenosis, spondylolysthesis. The pain generally starts in the lower back and can travel as far down as the foot.
The SI joints are located at the back of the pelvic girdle where the hip bones (ilia) meet the base of the spine (sacrum). A number of situations can cause an SI joint to be either too mobile or not mobile enough. Impact from a fall, for example, can wrench the joint out of its normal limited range of motion. Hormonal changes during pregnancy cause ligaments to loosen, potentially causing the SI joints to become hypermobile. Poor body mechanics, such as gait problems due to flat feet or leg length discrepancy, can cause excess stress on an SI joint. Any biomechanical dysfunction affecting the alignment of and forces on the pelvis can irritate one or both SI joints. The symptoms of this condition are very similar to sciatica: a sharp pain that shoots through the buttocks and down the leg.
A few common discrepancies between symptoms may help to differentiate the two conditions. SI joint pain often doesn’t travel lower than the knee, though it can; sciatica symptoms often occur below knee level. If the SI joint is hypermobile, it can tug on the dense web of ligaments and muscles that support it. Pain from this can be expected to manifest mainly in the hips and lower back, and may radiate to the groin. SI pain is usually triggered by standing on the leg on the side of the affected joint.
On top of the similarity of symptoms, distinguishing between these two conditions is further complicated by the fact that SI joint dysfunction and sciatica may co-exist. When an SI joint is irritated, either by hyper- or hypomobility, it becomes inflamed. The sciatic nerve, which runs near the joint on its journey down to the leg, can become irritated by this inflammation.
Exercise therapy is also used for both conditions, but the exercises prescribed differ. Whether the SI joint is hyper- or hypomobile also needs to be determined, since hypermobility requires stabilization and hypomobility requires mobilization.
Being aware of common misdiagnoses puts you in a position to find your real back pain cause. There is significant overlap of symptoms between sciatica and SI joint dysfunction; be aware that these two conditions are often distinct phenomena that require different treatments.
Written and complied by
Dr Divya Gaur