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Possible Causes of Sacroiliitis and SI Joint Pain

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Painful inflammatory conditions of our sacro-iliac joint can be a symptom or range of inflammatory conditions, including:

Degenerative Arthritis, also known as osteoarthritis of the sacroiliac joint is caused by wear and tear and breakdown of the joint cartilage. It can also be caused by injuries and direct impacts. The wearing and breakdown of our SI joint cartilage can be caused or aggravated by things like: age (the older generally the more wear and tear); obesity (the heavier the more load is put through the joints); direct trauma; repeated stress on the sacroiliac joints from repetitive movements and strains; or by malformed/misaligned joints.

Ankylosing Spondylitis (AS) usually starts with sacroiliitis, and as ankylosing spondylitis starts in our sacroiliac joints before it starts to travel and inch up our spine through a vicious cycle of inflammation, erosion, and calcification.

To be able to accurately diagnose ankylosing spondylitis, our sacroiliac joints need to be clearly seen to be affected by the inflammation cycle. This detection of AS-related sacroiliitis can be done via X-ray imaging, MRI scans and/or CT scans that is paired with blood tests to detect elevated C-reactive protein (CRP) and/or erythrocyte sedimentation rate (ESR).

Psoriatic Arthritis (PsA) refers to an auto-inflammatory condition that cases pain and swelling in our joints, as well as scaly skin patches (known as psoriasis). Thing is, psoariatic arthritis can be hard to distinguish from rheumatoid arthritis...but psoriatic arthritis is much more likely to cause spondylitis which is the inflammation of the joints in our spine, which also includes the sacroiliac joints.

If sacroiliitis is amongst the symptoms experienced by a patient, then the patient more likely has psoriatic arthritis. Researh estimate that about 10% of patients with psoriasis develop psoriatic arthritis, but the majority 90% of them do not experience any forms of joint pain and swelling.

Gout refers to a painful condition that is caused when the build up of uric acid forms uric acid crystals that can travel and embed painfully into our joints, causing swelling and pain. Gout is a very common form of inflammatory arthritis, and it generally and typically affects one joint at a time (usually the big toe). But unfortunately, some gout patients may experience pain and inflammation in the sacroiliac joints too.

If the usual and typical gout treatments aren't working for your sacroiliac joint symptoms, and there is no inflammatory conditions identified by a doctor, it is possible that you receive direct treatment of the sacroiliac joint, such as diagnostic anesthetic injection to confirm the pain plus steroid compound to treat the gouty pain.

There are many different causes of sacroiliac joint pain and inflammation, and treating them effectively lies mainly in identifying the main cause of the problem and treating the cause.

Non-Arthritic Causes of SI Joint Pain

Not all types of sacroiliac joint pains are related to arthritis, conditions such as direct trauma, pregnancy and even mechanical loads can cause painful SI conditions.

  • Trauma. The SI joint, which is comprised of the ligaments that surround and support the SI joint can be injured by direct trauma, which need not be "strong" or "severe" for damage to be done to the SI joint. You can damage your Si joint by something as simple as stepping a higher grond the wrong way or "jamming" the joint in a fall.

  • Lax ligaments during pregnancy. When we're pregnant, our bodies secrete special hormones relaxin and progesterone to loosen and laxen our joints in order to prepare the body for childbirth. Sometimes, our ligaments get overly-lax and the SI joint can dislodge or slip out of place and this can be really painful. Symptoms often decrease after pregnancy and childbirth is over and the ligament automatically becomes stronger.

  • Mechanical stress. Sometimes some people develop very stiff spines because of conditions like severe arthritis or surgical spinal fusion, which can increase the stress experienced at the SI joint, and over time, lead to degenerative changes and pain.

A trained and experienced specialist physiotherapist can assess, diagnose and treat the root cause of your sacroiliac joint pain and customize a specific treatment plan for you.

Treatment of Sacroiliac Dysfunction

Most of the causes of back pain that is linked to SI dysfunction can be treated with allowing the joint to rest, anti-inflammatory meds, and spine/SI physiotherapy. When our SI joint pain and sacroiliitis are caused by a specific type of arthritis, we need to diagnose and treat the main cause underneath.

Sometimes the inflamed SI joint can be "slightly misaligned" and our specialist spine/SI physiotherapist can help to realign the joint with gentle, graded and guided exercise and joint manipulation. In other times, injections are helpful to decrease the inflammation and in some cases, surgical intervention is required for SI dysfunction that doesn't respond to non-surgical interventions.

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Initially, our specialist physiotherapists will carry out a thorough assessment, helping them to select the most appropriate treatment to help you recover. They then provide expert treatment for your pain as well as prescribing specific exercises to reduce your risk of re-injury and giving you a long term solution.

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We are a wholly Singapore Private Limited group of licensed physiotherapists, hand therapists, podiatrists, chiropractors, sports massage therapists, clinical pilates practitioners and TCM physicians practicing in our scope of rehabilitation and its areas of specializations. As listed in our website are the list of services we provide our clients as referred by their medical doctors or by self referrals/word of mouth.

The range of rehabilitation results vary from patients to patients, depending on a variety of factors and reasons such as severity of condition, genetics, gender and age. However, we will still deliver the best evidence-based-practice of physiotherapy, hand therapy, TCM, sports training and deep tissue release therapy that we can deliver.

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