Last updated 18/03/2022 by The pain clinics - Interdisciplinary Health

Everything You Should Know About Sacroilitis [Great Guide]

The term sacroilitis is used to describe all types of inflammation that occur in the iliosacral joint. For many known as pelvic inflammatory disease.

The iliosacral joints are joints located on each side of the lumbosacral junction (in the lower spine), and which are connected to the pelvis. They are, quite simply, the connection between the sacrum and the pelvis. In this guide you will learn more about this diagnosis, classic symptoms, diagnosis and, not least, how it can be treated.

Good tip: At the bottom of the article, you will find free exercise videos with exercises for those who suffer from hip and pelvic pain.

- At our interdisciplinary departments at Vondtklinikkene in Oslo (Lambert seats) and Viken (Eidsvoll Sound og Raw wood) our clinicians have a uniquely high professional competence in the assessment, treatment and rehabilitation training of pelvic pain. Click on the links or here to read more about our departments.

In This Article You Will Learn More About:

• Anatomy: Where and what are the Iliosacral Joints?

• Introduction: What is Sacroilitis?

• Symptoms of Sacroilitis

• Causes of Sacroilitis

• Treatment of Sacroilitis

• Exercises and Training in Sacroilitis (includes VIDEO)

Anatomy: Where are the Iliosacral Joints?

Pelvic anatomy - Photo: Wikimedia

In the image above, taken from Wikimedia, we see an anatomical overview of the pelvis, sacrum and coccyx. As you can see, the hip bone consists of ilium, pubis and ischium. It is the connection between the ilium and the sacrum that provides the basis for the iliosacral joint, ie the area where the two meet. There is one on the left and one on the right. They are also often called the pelvic joints.

What is Sacroilitis?

Sacroilitis is often detected as part of the symptoms of several different inflammatory rheumatic conditions in the spine. These diseases and conditions are grouped as "spondyloarthropathy", and include disease states and rheumatic diagnoses such as:

• Ankylosing Spondylitis (Bekhterevs)

• Psoriatic arthritis

• Reactive arthritis

Sacroilitis can also be part of arthritis linked to various conditions such as ulcerative colitis, Crohn's disease or osteoarthritis of the pelvic joints. Sacroilitis is also a term that is sometimes used interchangeably with the term sacroiliac-related joint dysfunction, because both terms can technically be used to describe pain that comes from the sacroiliac joint (or SI joint).

Symptoms of Sacroilitis

Most people with sacroilitis complain of pain in the lower back, pelvis and / or buttocks (1). Characteristically, they will usually mention that the pain is located over "one or both bones on each side of the lower back" (anatomically known as PSIS - part of the iliosacral joints). Here it is essential to mention that it is especially movements and compression of the pelvic joints that cause aggravated pain. Furthermore, the pain can often be described as:

• Some radiation from the lower back and into the seat

• Exacerbated pain when standing upright for a long time

• Local pain over the pelvic joints

• Locking in the pelvis and back

• Pain when walking

• It hurts to get up from a sitting to a standing position

• It hurts to lift the legs in a sitting position

This type of pain is usually called "axial pain". This means biomechanical pain that is primarily defined to a single area - without it radiating anything particularly down the leg or up the back. With that said, pelvic pain can refer pain down to the thigh, but almost never past the knee.

To understand the pain, we must also understand what the pelvic joints do. They transfer shock loads from the lower extremities (legs) further up into the upper body - and vice versa.

Sacroilitis: A Combination of Pelvic Pain and Other Symptoms

The most common symptoms of sacroilitis are usually a combination of the following:

• Fever (low-grade, and in many cases almost impossible to detect)

• Low back and pelvic pain

• Episodic referred pain down to the buttocks and thighs

• Pain that worsens when you sit for long periods or turn in bed

• Stiffness in the thighs and lower back, especially after getting up in the morning or after sitting still for long periods

Sacroilitis versus Pelvic Lock (Iliosacral Joint Dysfunction)

Sacroilitis is also a term that is sometimes used interchangeably with the term pelvic lock, because both terms can technically be used to describe pain that comes from the iliosacral joint. Both sacroilitis and pelvic blockage are common causes of low back pain, iliosacral area and referred pain to the buttocks and thighs.

But there is an important difference between the two conditions:

In clinical medicine, the term "-it" is used as a reference to inflammation, and sacroilitis thus describes inflammation that occurs in the iliosacral joint. The inflammation can be caused by malfunction in the pelvic joint or have other causes as mentioned earlier in the article (for example due to rheumatism).

Causes of Sacroilitis

There are several different causes of sacroilitis. Sacroilitis can be caused by inherent problems with the pelvis and pelvis - in other words if there is a malfunction in the pelvic joints or if the ability to move the pelvis is impaired. Naturally, inflammation can be caused by altered mechanics in the joints that surround the iliosacral joints as well - for example, the lumbosacral junction. The most common causes of sacroilitis are thus:

• Osteoarthritis of the pelvic joints

• Mechanical Malfunction (Pelvic Lock or Pelvic Loose)

• Rheumatic Diagnoses

• Trauma and Fall Injuries (may cause temporary inflammation of the pelvic joints)

Risk factors for Sacroilitis

A wide range of factors can cause sacroilitis or increase the risk of developing sacroilitis:

• Any form of spondyloarthropathy, which includes ankylosing spondylitis, arthritis associated with psoriasis and other rheumatological diseases such as lupus.
• Degenerative arthritis or osteoarthritis of the spine (osteoarthritis), which leads to the breakdown of the iliosacral joints which then turns into inflammation and joint pain in the pelvic joint region.
• Injuries that affect the lower back, hip or buttocks, such as a car accident or a fall.
• Pregnancy and childbirth as a result of the pelvis becoming wider and stretching the sacroiliac veins at birth (pelvic solution).
• Infection of the iliosacral joint
• Osteomyelitis
• Urinary tract infections
• Endocarditis
• Use of intravenous drugs

If a patient has pelvic pain and has any of the above diseases, this may indicate sacroilitis.

Treatment of Sacroilitis

Treatment for sacroilitis will be determined based on the type and severity of the patient's symptoms and the underlying causes of the sacroilitis. The treatment plan is thus adapted to the individual patient. For example, ankylosing spondylitis (ankylosing spondylitis) can be an underlying inflammatory joint disease, and then the treatment must be adapted accordingly. Physical therapy is normally performed by a publicly approved physiotherapist (including MT) or a chiropractor. Physical treatment has a well-documented effect on pelvic joint pain, pelvic asymmetry and malfunction in the pelvic region (2).

Sacroilitis usually consists of both inflammatory reactions and mechanical malfunction. Therefore, the treatment also usually consists of both anti-inflammatory drugs and physical therapy. We would like to see a combination of the following treatment for sacroilitis and pelvic pain: 

• Anti-inflammatory (anti-inflammatory) drugs - from the doctor

• Physical Treatment for Muscles and Joints (Physiotherapist and Modern Chiropractor)

• Joint treatment against pelvic locking (Chiropractic joint mobilization)

• Custom Home Exercises And Training

• In very severe cases, cortisone injections may be appropriate

Tips: Changing your sleeping position can help relieve pain while you sleep and when you wake up. Most patients find it best to sleep sideways with a pillow placed between their legs to keep their hips even. Others also report good results from implementing an anti-inflammatory diet.

Recommended Self-help against pelvic pain

Pelvic cushion (The link opens in a new browser window)

You may be aware that many people in connection with pregnancy get pelvic pain? To get a more ergonomic sleeping position, many of these use what is often called a pelvic pillow. The pillow is specially designed to be used when sleeping, and is shaped so that it is comfortable and easy to have it in the right position through the night. Both this and what is called coccyx are two common recommendations for those who suffer from pelvic pain and sacroilitis. The purpose is to reduce misalignment and irritation to the pelvic joints.

Other Self-Measures for Rheumatists

• Compression Noise (such as compression socks that contribute to increased blood circulation to sore muscles or specially adapted compression gloves against rheumatic symptoms in the hands)

Click on the image to read more about compression gloves.

• Toe pullers (several types of rheumatism can cause bent toes - for example hammer toes or hallux valgus (bent big toe) - toe pullers can help relieve these)
• Mini tapes (many with rheumatic and chronic pain feel that it is easier to train with custom elastics)
• Trigger point Balls (self-help to work the muscles on a daily basis)
• Arnica cream or heat conditioner (can relieve pain in muscles and joints)

Chiropractic treatment for Sacroilitis

For patients with pelvic pain, a variety of chiropractic procedures can be used, and they are often considered as the first step in the treatment process - in combination with home exercises. The modern chiropractor will first perform a thorough functional examination. He will then inquire about your health history, among other things to find out if there are coexisting diseases or other mechanical malfunctions.

The goal of chiropractic treatment for pelvic pain is to use methods that are best tolerated by the patient, and that provide the best possible outcome. Patients respond better to different procedures, so the chiropractor may use several different techniques to treat the patient's pain.

A Modern Chiropractor Treats Muscles And Joints

Here it is important to mention that a modern chiropractor has several tools in his toolbox, and that they treat with both muscular techniques and joint adjustments. In addition, this occupational group often has good expertise in pressure wave treatment and needle treatment. At least that is the case our affiliated clinics. Treatment methods used would like to include:

• Intramuscular Acupuncture

• Joint Mobilization and Joint Manipulation

• Massage and Muscular Techniques

• Traction treatment (Decompression)

• Trigger point therapy

Normally, in the case of pelvic problems, joint treatment, treatment of the gluteal muscles and traction techniques are particularly important.

Joint manipulation against pelvic pain

There are two general chiropractic manipulation techniques for pelvic joint problems:

• Traditional chiropractic adjustments, also called joint manipulation or HVLA, provide impulses with high speed and low power.

• Calmer / minor adjustments also called joint mobilization; thrust with lower speed and low force.

The advance in this type of adjustment usually leads to an audible release called cavitation, which occurs when oxygen, nitrogen and carbon dioxide escape the joint where it was pulled past the passive degree of mobility within the boundaries of the tissue. This chiropractic maneuver creates the typical "cracking sound" that is often associated with joint manipulations and that sounds like when you "break up the bones".

Although this "cracking" description of chiropractic manipulations may give the impression that this is uncomfortable, the feeling is actually quite liberating, sometimes almost immediate. The chiropractor will want to combine several treatment methods to have the best possible effect on the patient's pain picture and function.

Other Joint Mobilization Methods

Less powerful joint mobilization methods use low-speed techniques that allow the joint to stay within passive mobility levels. More gentle chiropractic techniques include:

• A "drop" technique on specially made chiropractor benches: This bench consists of several sections that can be unscrewed and then lowered at the same time as the chiropractor pushes forward, which allows gravity to contribute to the joint adjustment.
• A specialized adjustment tool called an Activator: The activator is a spring-loaded instrument used during the adjustment process to create a low pressure pulse against specific areas along the spine.
• The "flexion distraction" technique: Flexion distraction involves the use of a specially designed table that gently extends the spine. The chiropractor is thus able to isolate the pain area while the spine is bent with pumping movements.

In short: Sacroilitis is usually treated by a combination of anti-inflammatory drugs and physical therapy.

Are You Suffering From Prolonged Pelvic Pain?

We are happy to help you with assessment and treatment at one of our affiliated clinics.

Exercises and Training against Sacroilitis

An exercise program with stretching exercises, strength and simple aerobic cardio training is usually an important part of most treatment regimens used for sacroilitis or pelvic pain. Custom home exercises can be prescribed by your physiotherapist, chiropractor or other relevant health specialists.

In the video below, we show you 4 stretching exercises for piriformis syndrome. A condition in which the piriformis muscle, in combination with the pelvic joint, puts pressure and irritation on the sciatic nerve. These exercises are highly relevant for those who suffer from pelvic pain, as they help to loosen up the seat and provide better pelvic joint movement.

VIDEO: 4 Clothes Exercises for Piriformis Syndrome

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Sources and References:

1. Slobodin et al, 2016. "Acute sacroiliitis". Clinical Rheumatology. 35 (4): 851–856.

2. Alayat et al. 2017. The effectiveness of physiotherapy interventions for sacroiliac joint dysfunction: a systematic review. J Phys Ther Sci. 2017 Sep; 29 (9): 1689–1694.