Sacroiliitis causes pain in the lower back or buttock region. Identifying the right medical professional is an important step for diagnosing and managing this condition. Understanding sacroiliitis and the specialists involved can help individuals navigate their treatment.
Understanding Sacroiliitis
Sacroiliitis involves inflammation of one or both sacroiliac (SI) joints, located in the lower back where the spine connects to the pelvis. These joints link the sacrum (the triangular bone at the base of the spine) with the ilium (the upper part of the pelvis). The SI joints help transfer weight and forces between the upper body and legs, and also serve as shock absorbers.
Symptoms of sacroiliitis include pain in the lower back and buttocks, which can radiate down the legs, hips, or feet. This pain may be sharp or dull, often worsening after prolonged sitting, standing, or with movements like turning the hips or climbing stairs. Sacroiliitis symptoms can resemble other lower back conditions, such as a herniated disc or sciatica, making diagnosis challenging.
Primary Care: Your First Stop
When experiencing symptoms of sacroiliitis, the initial step is to consult a primary care provider (PCP), such as a family physician or general practitioner. These doctors conduct an initial assessment, which involves taking a medical history and performing a physical examination. During this examination, the PCP may use specific movements or tests to reproduce the pain and identify its source.
Primary care physicians can order diagnostic tests to clarify the condition or rule out other pain causes. These tests might include X-rays for degenerative changes or blood tests for inflammatory markers. After diagnosis, PCPs often recommend conservative treatments like rest, ice, and over-the-counter pain relievers. If symptoms persist or the condition is complex, the PCP coordinates care by providing referrals to specialized medical doctors for further evaluation and management.
Specialized Medical Doctors
Rheumatologists
Rheumatologists specialize in inflammatory and autoimmune diseases that often affect joints, including the sacroiliac joints. They diagnose sacroiliitis when caused by systemic inflammatory conditions like ankylosing spondylitis or psoriatic arthritis. These specialists use specific blood tests for inflammatory markers or genetic indicators associated with autoimmune diseases. They also use advanced imaging, such as magnetic resonance imaging (MRI), which can detect early inflammation in the SI joint not visible on X-rays. Treatment may include nonsteroidal anti-inflammatory drugs (NSAIDs) or, for autoimmune disease, biologics and other disease-modifying antirheumatic drugs (DMARDs) to manage inflammation.
Orthopedic Surgeons
Orthopedic surgeons focus on musculoskeletal conditions and become involved when structural issues or severe, persistent pain require direct intervention. While surgery for sacroiliitis is rare, an orthopedic surgeon might consider it as a last resort for chronic pain unresponsive to other treatments. They may perform diagnostic injections into the SI joint to confirm it as the pain source, which can also provide temporary pain relief. In specific and severe cases, an orthopedic surgeon might perform a sacroiliac joint fusion, a procedure to stabilize the joint by permanently joining the sacrum and ilium bones.
Pain Management Specialists
Pain management specialists alleviate chronic pain using various interventional techniques. For sacroiliitis, they employ targeted injections, such as corticosteroid injections directly into the sacroiliac joint, to reduce inflammation and pain. They might also use radiofrequency ablation, a procedure that uses heat to disrupt nerve pathways transmitting pain signals from the joint. These specialists often adopt a multidisciplinary approach, combining interventional procedures with other therapies, to provide comprehensive pain relief and improve a patient’s function and quality of life.
Allied Health Professionals and Other Therapies
Physical Therapists
Physical therapists are important for the rehabilitation and long-term management of sacroiliitis. They design individualized exercise programs to strengthen muscles supporting the SI joint and improve flexibility. Their methods include therapeutic exercises, manual therapy techniques to restore joint movement, and posture correction to reduce stress on the joint. Physical therapists also educate patients on proper body mechanics for daily activities, helping prevent future flare-ups and manage pain independently.
Chiropractors
Chiropractors focus on spinal manipulation and musculoskeletal alignment, treating sacroiliac joint dysfunction through manual adjustments. They aim to restore proper movement and alignment to the SI joint and surrounding structures. Before consulting a chiropractor, individuals with sacroiliitis symptoms should receive a medical diagnosis to ensure the treatment is appropriate. Seeking care from a licensed and experienced chiropractor who understands sacroiliitis is also important.
Other Potential Therapies
Other supportive therapies can complement sacroiliitis treatment. Occupational therapists assist individuals in modifying daily activities and work environments to reduce strain on the SI joint, improving comfort and function. Complementary approaches such as acupuncture may also help manage pain, often used with conventional medical treatments.