Sciatica from sacroiliac joint injury or degeneration is one of the less common sources of lower body nerve pain and actually qualifies to be called pseudo-sciatica when it does occur. SI joint sciatica is diagnosed far more often than it truly presents itself. More likely is the possibility that the pain is completely unrelated to the normal degeneration in the joints and is merely being blamed on the SI joint due to the lack of a better scapegoat condition. It is a shame, but a fact, that most SI joint pain is completely misdiagnosed.
article will detail how structural issues in the sacroiliac joint can
cause nerve pain. However, we will also look at the often illogical
diagnoses made implicating the sacroiliac in many symptomatic
The SI joints are some of the strongest and best designed in the human anatomy. They must hold up the entire weight of the upper body and distribute incredible force throughout the pelvis. Degeneration occurs in these joints, just like it does in all the joints of the body. Typically, the cartilage wears away, ligaments become too tight or too loose and some structural changes occur. However, these bodily alterations are normal and expected to endure as we age. They are not normally the source of any significant pain or other problematic symptoms.
However, when there is no structural condition available in the spine to explain chronic sciatica, or treatment for a previously misdiagnosed spinal causation has failed time and time again, sacroiliac joint pain is often diagnosed.
The structural changes in the SI joint can be verified by medical imaging, but in the vast majority of cases, no link between these changes and any pathological process are ever established. Too bad this goes unnoticed by most diagnosed patients. Even when rare instances of symptomatic conditions do exist in the SI joint, pain is usually localized and does not follow the usual patterns of radiating sciatica symptoms.
Treatment strategies for SI joint pain mimic care practices for most other lower back pain syndromes. They are mostly symptomatic in nature and often revolve around exercise, physical therapy and chiropractic manipulation.
Of course, the pharmaceutical route is always thrown into the mix, since sciatica drugs are such a popular modality with patients and doctors alike.
Surgery is rarely performed, but will be considered in cases of severe sciatica relating to SI joint concerns. When surgery is performed, results are very unpredictable, offering additional clues to the possible misdiagnosis suffered by many patients.
Like many other dorsopathy conditions, doctors generally throw several often illogical therapies at the pain, hoping something, anything, will work.
I have seen a few patients with verified pain due to sacroiliac injury or extreme SI joint degeneration. These poor souls really had a tough time functioning, since the SI joint is so important to our basic physical abilities. However, virtually all of these patients responded well to appropriate treatment and recovered.
SI joint diagnoses come in 2 main varieties, those which feature joint related bone changes and those which feature soft tissue related joint changes. Sacroiliitis is the usual diagnostic term for bone related changes and these theories generally feature better treatment results than the diagnosis of SI joint dysfunction. This latter conclusion implies that the ligaments in the joint are too tight or too loose, but usually has little supporting evidence.
For patients with unresponsive SI joint pain, I typically advise reconsidering the diagnosis, especially if no definitive pathological component has been ascertained during multiple diagnostic evaluations.