Sacroiliac osteoarthritis: Causes and treatment (What to do?)

Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine

In the general population, 80% of people have back pain caused by problems with the Lumbar spine. However, damage to the sacroiliac joint such as sacroiliac osteoarthritis is also responsible for back pain. In order to avoid confusion with a lumbar or nerve problem sciatica, it is important to have clear information about this condition.

This popularized article will provide an anatomical review of the sacroiliac joint after having defined what sacroiliac osteoarthritis is. It will also address the causes of this pathology, the symptoms, the means of diagnosis without forgetting the means of treatment.

Definition

The sliding of the bones involved in the sacroiliac joint is favored by the articular cartilage. If this cartilage is overstretched and experiences excessive wear, it is likely to become inflamed along with the joint capsule. This is how the patient may feel pain in the lumbar region and suffer from restriction of movement.

These signs are in fact explained by sacroiliac osteoarthritis. It is more common in women, because these joints are especially stressed during pregnancy, and more particularly at the time of childbirth.

Anatomy of the sacroiliac joint

The sacroiliac joints are two joints that connect the iliac bones of the pelvis to the sacrum-coccyx assembly located at the bottom of the spine. They are located deep down, at the bottom of the spine (vertebral column), to the right and left of the sacrum. These are synovial-type joints that therefore have articular cartilage.

The main function of these two joints is to distribute the weight of the body between the top and the bottom. They play a supporting role for the spine.

The sacroiliac joints can make complex movements when bending forward or carrying a load. But these movements remain of low amplitude. These two joints are interdependent on each other: movement on one side leads to movement on the other.

Causes of Sacroiliac Osteoarthritis

Generally, osteoarthritis is due to load instability at the joint, characterized by wear and cracking of the cartilage. The cartilage then becomes thinner and more fragile, resulting in painful inflammation of the ligaments then the joint capsule.

These pains may well occur even without the presence of a concrete injury. The main causes of sacroiliac osteoarthritis are:

• joint injury or pelvic fracture, caused by a fall or automobile accident;
• postural abnormality, such as unequal length of the lower limbs, with overload on one side;
• overweight;
• chronic overload or underload.

In the event of a rheumatic problem, sacroiliac osteoarthritis could easily appear. Moreover, the hormonal changes of menopause in women are pernicious factors in the imbalance of the joint. They cause accelerated degeneration of the sacroiliac joint.

However, it is essential to be evaluated by a specialist to screen for any family history of chronic back problems that can lead to sacroiliac complications, in order to prevent them in time.

Symptoms of the disease

Symptoms ofsacroiliac osteoarthritis do not necessarily operate in the lumbopelvic junction. Pain in the sacroiliac joint affects other parts of the body such as the groin area to the affected leg:

• lower back
• hips
• oldest boy
• buttocks
• thighs
• the back of the leg.

Patients perceive pain at first, often in the morning, and numbness in the lumbar region and pelvis during the day. This pain progresses as the person becomes active and moves.

Small overloads are enough to stimulate the symptoms of sacroiliac osteoarthritis, especially if the patient is in an advanced stage of the disease. With this in mind, the pain becomes more and more pronounced and could even cause permanent immobility.

Excessive loads, such as weight bearing, prolonged sitting, running, or provocative movements are detrimental.

In case of significant signs, it is imperative to immediately consult a health professional so as to rule out any new pathologies. The nerves surrounding this area are strictly to be preserved.

Diagnostic

Like any medical diagnosis, the doctor first performs a thorough history. Questions will be asked of the patient so that the doctor can gather and confirm important information regarding the disease.

Sacroiliac joint provocation tests also exist to support a clinical diagnosis. In addition, patients can undergo medical examinations such as radiography and computed tomography (to scan). This last option is more specialized and allows a closer look at the typical narrowing of the joint space and the surrounding bony structures. The presence of osteoarthritis will thus be easy to detect and classify.

MRI, on the other hand, can accurately diagnose damage to muscle structures and compromised joint capsules.

The main differential diagnosis ofsacroiliac osteoarthritis is the sacroiliac dysfunction simple. The patient's medical history along with an adequate physical examination will allow the physician to tell the difference.

To find out all about sacroiliac pain and its management, see the following article.

Treatment

Treatments exist to fight against osteoarthritis of the sacroiliac joint. The most important thing is to have identified it in time to remedy it as quickly as possible.

Therapy to relieve pain

This treatment is also called conservative therapy. No surgery will be scheduled at this time. On the other hand, the ultimate objective is to soothe the patient of any pain. As a result, the process of alteration of osteoarthritis would be moderate, especially since the symptoms are not necessarily always present.

Therefore, doctors prescribe painkillers and anti-inflammatories to the patient to ease his pains. This treatment should be accompanied by individual training to make it more effective. Muscle and joint techniques are achievable with the physiotherapy (physiotherapy).

This treatment combined with training makes the joint stable. However, if the cartilage has been completely broken down, another treatment should be considered.

There are tools and accessories that can provide short-term pain relief and improve quality of life. It should be noted, however, that they will not necessarily address the cause of the problem.

Among the products recommended by our professionals, we have:

• acupressure mat

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• Heated lumbar belt

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• Postural T-Shirts

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• Ergonomic back cushion

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• massage gun

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• Spinal decompression table

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• Foam roller (sport massage roller)

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• Compex and TENS (electrical stimulation)

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Surgery to treat the sacroiliac joint

The variation from one treatment to another will always remain with a view to relieving the sacroiliac joint. Nevertheless, surgery could be undertaken if conservative treatment fails.

Standard surgical treatment has been experienced for almost a century aimed at performing a open fusion between the iliac bone and the sacrum. This action consists of stiffening the sacroiliac joint by joining these two bones using screws. This will provide relief from the symptoms of osteoarthritis. We speak then sacroiliac arthrodesis. But like any surgical operation, the patient will have to begin a period of rest and readapt little by little.

Other scientific studies have revealed that this stiffening is also achievable in a simpler way or by skin incision. Surgical intervention remains the most appreciated treatment by patients, because they feel their life and their daily life improve considerably with much less pain.

In order to avoid the occurrence of sacroiliac osteoarthritis, here are some prevention rules:

• avoid overweight
• engage in regular physical activity
• preserve the pelvis by avoiding unnecessary repetitive movements.

What about natural remedies?

Although they are not supported by solid scientific evidence, several natural products and home remedies are used to treat various body pains, especially for their anti-inflammatory power.

Here is a non-exhaustive list of plants and essential oils that are effective in controlling pain and inflammation:

• Turmeric : Thanks to its antioxidant and anti-inflammatory powers very powerful, turmeric is one of the most used plants in a culinary and therapeutic context. The composition of turmeric is essentially made of essential oils, vitamins (B1, B2, B6, C, E, K) and trace elements. But it is to its composition rich in curcumin and curcuminoids that we owe them and calm skin of this spice.

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• Ginger : In addition to the special flavor it brings to the kitchen and its aphrodisiac properties, ginger is a root well known for its anti-inflammatory powers. THE gingerol gives it its anti-inflammatory action. It is an active component acting on the inflammatory pain related to chronic joint inflammatory diseases, including rheumatoid arthritis, lupus, rheumatic diseases, etc. It has been proven that this active element is also effective in acting on the inflammation linked to arthritis and sciatica. Ginger also has other benefits thanks to its high potassium content and its richness in trace elements (calcium, magnesium, phosphorus, sodium) and vitamins (provitamin and vitamin B9).

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• Omega-3s : Omega-3 are polyunsaturated fatty acids that play a very important role in the functioning of our body. They are provided by food in three natural forms: docosahexaenoic acid (DHA), alpha linolenic acid (ALA) and eicosapentaenoic acid (EPA). Beyond their action on the brain and the cardiovascular system, omega-3s prove very effective against inflammation. Indeed, they have the ability to act on the inflammatory mechanisms in osteoarthritis by slowing down cartilage destruction, thus they reduce the intensity of osteoarthritis pain. Since sciatica is most often linked to inflammation secondary to a herniated disc, it can also respond to omega-3s if you consume them regularly. 

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• Lemon eucalyptus: Eucalyptus is a plant most often used in the form of herbal tea or essential oil. She would have anti-inflammatory effects which give it the ability to act on the bone and joint pain in general and the pain of sciatica in particular.

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• wintergreen : Wintergreen is a shrub from which a very interesting essential oil is extracted. It is one of the most used essential oils in aromatherapy. This oil extracted from the shrub bearing the same name, is used in massage to relieve sciatica and act like a analgesic. Indeed, it provides a heating effect thanks to its ability toactivate blood circulation locally.

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Conclusion

Sacroiliac osteoarthritis is a disease that affects the sacroiliac joint, located between the bones of the pelvis, to the right and left of the sacrum. This lower back pain is often confused with sciatic nerve pain, or low back pain. It is not necessarily immobilizing, but provides internal pain. The causes of this inflammation are multiple. Their identification is useful in order to find the most suitable treatment.

Videos

Video on sacroiliac pain: 

References

1. https://www.primomedico.com/fr/cure/arthrose-de-larticulation-sacro-iliaque/#treatment-info
2. https://www.physiosthubert.com/nos-services/traitement-articulation-sacro-iliaque/
3. https://www.medisite.fr/maladies-du-dos-sacro-iliite-symptomes-causes-traitements.5570457.524198.htmlhttps://douleurchronique.org/les-maladies/douleur-au-dos-au-cou-et-aux-articulations/douleurs-sacro-iliaques/