Back pain is not always caused by back problems

By Dr. Cornelis Elmes, Special to the Daily Republic

Low back pain is a common health complaint among adults, and the risk of lower back pain increases as you get older.

With lower back pain, it’s common for patients and their doctors to investigate the usual suspects: the muscles and discs of the spine. But sometimes, the culprit is actually rooted somewhere else.

In 15 to 30% of patients with chronic low back pain, the cause isn’t the spine at all. Instead, it’s a problem with the sacroiliac (SI) joints. These joints link the iliac bones (hips) to the sacrum, or the lowest part of the spine above the tailbone.

The SI joint is an important but often under-appreciated and unknown cause of low back pain. I call it the great masquerader because it cna look like a hip problem or back problem.

The SI joints are important because they are essentially shock absorbers for impacts from the lower extremities to your spine, for example, when running or lifting heavy objects. These joints don’t move as much as other joints in the body, but they move just enough to help diffuse some of the forces and decrease the risk of injury to the spine.

If injured, however, an SI joint may have more motion than normal which can cause it to become a very painful problem.

Symptoms can range from aching to sharp or radiating pain in the back, hips or buttocks. It can radiate down the leg, mimicking sciatica or nerve pain, and patients can feel the pain whether sitting or standing or even laying down. They often have trouble just getting comfortable and will fidget and move around a lot.

There are several treatment options to address SI joint pain, starting with physical therapy and exercises, especially those that help to strengthen the body’s core muscles. Wearing a sacroiliac belt, or a device designed to limit movement of the joint, can help provide support for the area as well. For some patients, steroid injections in the area can provide relief for a short time.

When that’s not effective, surgical interventional in the form of SI joint fusion is an option. The procedure involves a small incision along the side of the buttock through which small triangle-shaped titanium implants are inserted across the sacroiliac joint. The implants, which are
porous, encourage bone ingrowth, which essentially fuses the joint so that it can no longer move, thus relieving the cause of the pain.

The procedure has proven effective in more than 90% of patients and because it is a minimally invasive procedure, recovery is faster. Fusing the SI joint does not limit a patient’s flexibility. The SI joint is not supposed to move much anyway.

Dr. Cornelis Elmes is an orthopedic specialist at NorthBay Healthcare.