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Suggest treatment for sacroiliac joint dysfunction

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Posted on Fri, 22 Jul 2016
Question: I have had sacro-iliac pain for about four months now - it started from overdoing it on an exercise bike. I have had various physiotherapy and osteopathy treatments but it keeps coming back. It's especially painful laying on it at night. I use heat packs and try and do some stretching exercises. I don't exercise much now as it's winter and I'm worried I'll make it worse.
doctor
Answered by Dr. Naval Mendiratta (41 minutes later)
Brief Answer:
Sacroilitis

Detailed Answer:
Good evening

Thank you for writing on health care magic

Well, it is a bit unusual for the pain to go on for that long, especially if it started due to wrong exercises...AS in it should have subsided by now.. So we do need to look into other causes, which may be prolonging it..Physio and osteo can only provide temporary relief in relaxing the muscle as the sacro iliac joint is very deep and will need more aggressive treatment...

I would like to address a few things in your case:

1. It is important to localize the pain and the source of pain--> that is if it coming from the joint or there is a ligament tear or if there is associated hip joint involvement. So a MRI of the sacroiliac joints would be of utmost help in your case as it will give us the exact idea if there is edema going on in that area..And if something else is happening( like arthritis or some infection) , which is not going on in itself.

2. I would suggest you try anti inflammatory for a short course..The medicines you are trying are only analgesic, but none of them is anti inflammatory..SO it is worth giving a trial to short course of anti inflammatory like Celecoxib....

I have a few queries regarding to your pain

1. How does it feel in the mornings when you wake up??

2. Have you got any blood tests done like ESR, CRP?

3. Anyone in your family had history of low backache?

4. Any skin problems like psoriasis you have had or your family member had?

Do let me know these queries as well...Will give us a clue if there is arthritis going on or not in the sacroiliac area

REgards
Dr Naval
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Naval Mendiratta (20 hours later)
Dear Dr Naval,

Many thanks for your response. I will ask my doctor for an MRI and those blood tests. In answer to your questions:
- it is sore in the mornings from laying on it - it helps when I get up and move around
- no blood tests yet
- my Mother had lower back pain but mostly from holding her children on her hip (I don't have any children!). Her father used to get sacroiliac pain that went down his leg
- my Dad had allergic rash after age 60 to various foods and one of my brothers also gets it

Thanks
doctor
Answered by Dr. Naval Mendiratta (19 hours later)
Brief Answer:
Is it arthritis

Detailed Answer:
Good evening

Sorry for the delayed reply..Had a long duty today

Well, your pain does seem more of inflammation than mechanical here...As mechanical pain tends to get better with rest and does not get stiff in the mornings..

SO I would suggest an MRI of the pelvis area--> Which will look at both the sacroiliac joint and the hip joints and help us localize where exactly the pain is coming from.

MEanwhile, while you wait for the appointment try an anti inflammatory like Etoricoxib or Celecoxib( provided you are not allergic to any medicines). Give it a trial for a week and see if it makes a difference. Also try to be as active as you can.. Move around and do some physiotherapy...

I hope the information was useful

Do let me know when you get the results and the response to anti inflammatory as well

REgards
Dr Naval
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Naval Mendiratta (2 days later)
Dear Dr Naval,

Many thanks for your reply. I took 20 mg Piroxicam last night (that's the one I usually take when I get flare-ups of things) and yes, it has helped a lot - this morning I don't have the pain.

So I will take it for a week, as you suggest. Should I still try to get an MRI? If it responds to the anti-inflammatory, what is it likely to be, and is it likely to be something chronic?

Many thanks,
Louise
doctor
Answered by Dr. Naval Mendiratta (5 hours later)
Brief Answer:
Sacroilitis

Detailed Answer:
Good evening

Well, that s good that you have responded well...But yes, this is a temproary solution. We need to see what exactly is the cause..Since it has responded, it goes more in favor of inflammation.

YEah, MRI will tell us what exactly is going wrong where...And how long do we need to take the treatment..Please get the blood tests too...SO we have the complete picture ready...And start exercising as well, mainly brisk walk for 30 minutes daily..

I hope the information was useful

Do let me know for more queries

REgards
Dr Naval
Above answer was peer-reviewed by : Dr. Nagamani Ng
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Follow up: Dr. Naval Mendiratta (6 hours later)
Many thanks - I will do these things!
doctor
Answered by Dr. Naval Mendiratta (25 hours later)
Brief Answer:
Further course

Detailed Answer:
good evening


take care.. hope you get better soon...

regards.
Dr naval
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Naval Mendiratta

Rheumatologist

Practicing since :2007

Answered : 754 Questions

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Suggest treatment for sacroiliac joint dysfunction

Brief Answer: Sacroilitis Detailed Answer: Good evening Thank you for writing on health care magic Well, it is a bit unusual for the pain to go on for that long, especially if it started due to wrong exercises...AS in it should have subsided by now.. So we do need to look into other causes, which may be prolonging it..Physio and osteo can only provide temporary relief in relaxing the muscle as the sacro iliac joint is very deep and will need more aggressive treatment... I would like to address a few things in your case: 1. It is important to localize the pain and the source of pain--> that is if it coming from the joint or there is a ligament tear or if there is associated hip joint involvement. So a MRI of the sacroiliac joints would be of utmost help in your case as it will give us the exact idea if there is edema going on in that area..And if something else is happening( like arthritis or some infection) , which is not going on in itself. 2. I would suggest you try anti inflammatory for a short course..The medicines you are trying are only analgesic, but none of them is anti inflammatory..SO it is worth giving a trial to short course of anti inflammatory like Celecoxib.... I have a few queries regarding to your pain 1. How does it feel in the mornings when you wake up?? 2. Have you got any blood tests done like ESR, CRP? 3. Anyone in your family had history of low backache? 4. Any skin problems like psoriasis you have had or your family member had? Do let me know these queries as well...Will give us a clue if there is arthritis going on or not in the sacroiliac area REgards Dr Naval