Sacroiliac joint syndrome (ISG syndrome) refers to low back pain that occurs in the lower back. The sacroiliac joint uses ligaments to connect the hip bones to the sacrum. Sacroiliac joint syndrome can occur in both young and older people.
What is sacroiliac joint syndrome?
Severe low back pain may be a sign of sacroiliac joint syndrome. Sacroiliac joint syndrome (ISG syndrome) is a painful condition in the lower back. The sacroiliac joint is not a movable joint like the knee, for example. It serves as a connection between the sacrum and the hip bones. Due to the rigid fixation by means of ligaments, the mobility of the ISG is severely limited. The sacrum is located between the lumbar vertebrae and the coccyx and consists of five vertebrae, but they are fused together. In sacroiliac joint syndrome, the joint surfaces shift against each other. This is often associated with very severe pain and restricted movement. Because a great deal of stress is placed on the lower part of the spine in particular, pain and also degenerative changes often occur in this area. Sacroiliac joint syndrome (ISG syndrome) is among the most common forms of back pain.
Causes
Sacroiliac joint syndrome can have many causes. In particular, poor posture and incorrect stress in sports and at work often lead to signs of wear and tear and thus to low back pain. Lack of exercise and thus underdeveloped muscles also promote the development of sacroiliac joint syndrome. Another cause can be diseases. Bekhterev’s disease, rheumatoid arthritis or even osteoporosis can trigger sacroiliac joint syndrome. Bacterial infections, common in Lyme disease, for example, can also cause inflammation in the sacroiliac joint. Often sacroiliac joint syndrome occurs during pregnancy, because during this time the muscles as well as the ligaments in the area of the lower spine are heavily stressed. In the case of low back pain, the psychological factor should not be ignored. Stress and other psychological strains often manifest themselves in the form of sacroiliac joint syndrome.
Symptoms, complaints and signs
One possible symptom that may indicate dislocation of the sacroiliac joint is diffuse low back pain. These are usually accompanied by a sharp pain in the ISB, which may radiate to the legs, abdomen, and lumbar region. Also typical is the sensation of slouching or jamming in the hip joint, often associated with limited range of motion. In general, the pelvis and lower back appear unstable and ache with severe forward or backward bending. The pain occurs predominantly when there has been prolonged lingering in one posture. Thus, after lying, standing or sitting, there is persistent pain and stiffening of the muscles, which is slow to subside. When lying on the back, there is usually extreme pain that radiates from the joint to the surrounding regions of the body. The typical pain can affect the entire pelvic region. If the condition is not treated, serious complications can develop. If left untreated, the pain develops into a chronic condition that also occurs at night and during periods of rest. In addition, severe inflammation can develop, which considerably restricts the mobility of the affected joints. Accompanying this, there are usually also mental upsets and irritability.
Diagnosis and course
Sacroiliac joint syndrome is usually diagnosed by an orthopedist. Here, the physician applies various examination methods. In addition to a detailed medical history (taking the patient’s history, describing the symptoms), tests are performed both while the patient is standing and while the patient is lying down. The so-called forward movement phenomenon and the backward movement phenomenon are tested. These tests are used to check the mobility of the sacroiliac joint. In addition to physical examination, imaging techniques are also used. However, X-rays cannot detect sacroiliac joint syndrome. X-rays, MRIs and CT scans are used to rule out other conditions and injuries to the spine and discs. A blood test can be used to determine if inflammation is present. A bone scintigram can be used to visualize the inflammation in the area of the IS joint.If sacroiliac joint syndrome is diagnosed, the disease is usually not limited to the sacroiliac joint, but the hip and lumbar spine are also affected over time. The course of sacroiliac joint syndrome varies, as it depends on the cause as well as the treatment. Often the symptoms only occur for a short period of time and improve with the help of medication and physiotherapy. In about 30 percent of all those affected, sacroiliac joint syndrome develops into a chronic condition.
Complications
Due to sacroiliac joint syndrome, the patient suffers from severe pain in various regions of the body. In most cases, however, it affects the back and hip. Often, the pain leads to restricted movement and thus to psychological discomfort. Furthermore, there may be tension in the muscles and pain in the knees. The daily life of the affected person is restricted by the sacroiliac joint syndrome and many physical activities or sports activities can no longer be performed. If the pain also occurs in the form of pain at rest at night, this can lead to sleep disturbances. Long-term treatment of the pain with the help of painkillers is not recommended in this case, as they have a negative effect on the stomach. In case of inflammation, antibiotics and other medications can be used to stop it. In this case, no further complications occur. However, the affected person is dependent on physiotherapy to treat the symptoms. However, this does not always result in a positive course of the disease, so that the affected person may suffer from restrictions for the rest of his or her life. Life expectancy is not affected by sacroiliac joint syndrome.
When should you see a doctor?
Unusual low back, back or buttock pain should always be examined by a family doctor or an orthopedist. If there is already a concrete suspicion of a serious illness, rapid clarification is required. Affected patients should talk to their general practitioner or visit a specialist clinic with their symptoms. Since sacroiliac joint syndrome is usually chronic, close monitoring is indicated. If side effects or interactions occur during treatment, the responsible physician must be informed. The same applies if the pain increases in intensity or new symptoms are added. Typical warning signs that must be clarified immediately are restricted movement or signs of paralysis in the area of the back and buttocks. People suffering from ankylosing spondylitis or osteoporosis are particularly susceptible to developing sacroiliac joint syndrome. Rheumatoid arthritis or a bacterial infection can also trigger the condition. Individuals suffering from any of these conditions should talk to their doctor if they experience the symptoms and discomfort mentioned above.
Treatment and therapy
There are several treatment options for sacroiliac joint syndrome. Initially, the treatment plan includes physical therapy and pain management. Then, the cause of the discomfort must be found and adequately treated. If an infection is present, it is treated with antibiotics. If a rheumatic disease is present, cortisone preparations are usually administered in combination with painkillers, as these are the most effective. If very severe pain is present, an anesthetic can be injected into the joint space. This relieves the discomfort, and it also improves mobility because injecting fluid stops the joint surfaces from rubbing against each other. Physiotherapy is used both as an immediate measure and as a long-term therapy. Stimulation current treatments, heat applications, physiotherapeutic and occupational therapy exercises, underwater gymnastics, etc. have proved particularly effective in this respect. The aim of physiotherapy is to relieve pain, restore mobility and correct incorrect posture. Since in sacroiliac joint syndrome the joint is blocked, manual therapy can be used to try to release the blockage. So-called alternative treatment methods have also proven successful in sacroiliac joint syndrome. Yoga, progressive muscle relaxation and acupuncture offer a good alternative to conventional medicine.
Outlook and prognosis
The prognosis in ISG syndrome differs from patient to patient. Thus, among other factors, the age of the affected person as well as the severity of the disease and the selected therapeutic measures play a decisive role in the course of the disease. An ISG syndrome that has not been present for long has the best prognosis. It can usually be treated with the help of physiotherapy and targeted exercise. Spontaneous improvements are also more common in this form of ISG syndrome. An ISG syndrome that has already existed for a longer period of time, on the other hand, is difficult to treat. Despite sporting activities, massages or physiotherapy, patients continue to suffer from pain. However, there are differences in the quality and quantity of pain. While some patients only experience pain in the ISG region during overexertion, others complain of pain even at rest. The quality of the pain varies from barely noticeable to very severe. Especially in younger patients between the ages of 15 and 40, the ISG syndrome hardly shows any improvement despite appropriate treatment. The quality of life and everyday life of those affected suffer greatly. It is not uncommon for them to be dependent on taking pain medication for the rest of their lives in order to cope with their daily lives. In some cases, however, the usual pain medications are only very weakly effective in ISG syndrome, so patients have to learn to live with the pain.
Prevention
There are several ways to prevent sacroiliac joint syndrome. Exercise is a must, as well as avoiding obesity. Furthermore, it makes sense to attend a so-called back school. This is offered by all health insurance companies or you can learn it from a physiotherapist. These are special exercises for the back. With their help, you learn to recognize and avoid incorrect posture and incorrect strain. Important: If one already has pain, one should move lightly, because resting can make sacroiliac joint syndrome (ISG syndrome) even worse.
Aftercare
Follow-up care for sacroiliac joint syndrome depends on the severity of the condition as well as the patient’s age. If diagnosed early, symptoms can be relieved quite well. Post-treatment is primarily a matter of targeted physiotherapy. This helps with the right movements to make the joint mobile on the one hand and to stabilize it on the other. For those affected, sporting activities are irreplaceable, also in order to avoid possible overweight. Depending on the problem, the doctor may recommend participation in a back school. These are sometimes offered by health insurance companies, but individual physiotherapy is also helpful. With the health-promoting exercises, those affected strengthen their backs and learn the ideal posture. Conscious handling of one’s own body prevents further incorrect strain and has a correspondingly positive effect on the quality of life. Even if patients feel pain, they should exercise sufficiently and not take long-term painkillers. Resting may make the affected joint even worse. For aftercare, doctors often recommend heat applications or special relaxation methods such as yoga. Gentle exercise also improves the back muscles, whereupon the symptoms recede. The exercises are also suitable for home use after an intensive introduction.
What you can do yourself
In sacroiliac joint syndrome, the patient has various self-help options that can significantly alleviate the discomfort of this condition. First and foremost, various heat applications have a very positive effect on the symptoms and can relieve the pain. Relaxing exercises such as yoga or other light sports can also strengthen the back muscles and reduce the symptoms. Acupuncture can also have a positive effect on the course of sacroiliac joint syndrome. Furthermore, many patients also rely on physiotherapy or physical therapy. These exercises can often be performed at home, so that movement is restored. The patient should further note that long-term use of painkillers is not recommended, as it can damage the stomach. Therefore, the use of painkillers should always be coordinated with the doctor. The symptoms of sacroiliac joint syndrome can also be limited by underwater gymnastics.These exercises are usually performed in a group, but can also be done alone. However, if the pain is severe, the patient should consult a medical professional, as it can be relieved with an anesthetic. In most cases, sacroiliac joint syndrome results in a positive course of the disease.
