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SI Joint Syndrome

In traditional spine care today, steroid injections are the standard go-to when conservative therapies aren’t effectively addressing pain and inflammation. Steroid injections are commonly used to temporarily relieve sacroiliac (SI) joint syndrome in the lower back, but the catch is, they’re riddled with side effects—many well-known and some you might not be aware of. We’ll cover these in a moment, but first, let’s take a look at the SI joint.

Defining Sacroiliac Joint Syndrome

The sacroiliac joints reside between the sacrum (the tailbone segment of the spinal column) and the prominent wing-like iliac bones that form the pelvic girdle. There are two SI joints, one on the left and one on the right (highlighted in red in the image above), and along with the symphysis pubis joint at the front of the structure, they are critical for transferring forces and energy back and forth between the spine and the lower limbs.

Causes of SI Joint Syndrome

There are a number of reasons that an SI joint can become painful and inflamed, leading to SI joint syndrome. Trauma, such as a fall injury to the tail bone or a forced injury from a car accident for example, obviously can create problems in the SI joint and/or in the supporting ligaments and muscles. Even pregnancy and childbirth can stretch out these joints and ligaments, creating some instability in the SI region. There are also degenerative issues, such as arthritis and wear and tear, that can affect the SI joint, and if injuries are left to linger for months or years, wear and tear and arthritis are likely to set in. Finally, a fusion in the lumbar spine (the spinal segment above the sacrum) can create adjacent segment disease, which overloads the adjoining sacrum along with the SI joints.

Symptoms

SI joint syndrome is a condition that can cause pain in the lower back and hips. The main symptom of sacroiliac syndrome is pain in these areas, which may be worsened by activities such as walking, running, or climbing stairs. Other symptoms may include inflammation or swelling of the joints in the hips and lower back, numbness or tingling in the legs, and difficulty standing or sitting for long periods of time. Some patients experience knee and foot pain and numbness.

Traditional Treatment 

Conservative treatments for SI joint syndrome consist of rest, ice, physical therapy, and so on. When these fail, the next step in traditional medicine is typically steroid injections to temporarily relieve pain and inflammation. While high-dose steroid injections for SI joint syndrome may buy a few weeks or months of relief, there’s a big downside—the side effects. A handful follows:

And what’s the potential next step in traditional treatment when steroid injections fail to relieve or are no longer relieving the pain from SI joint syndrome? Surgery. Specifically, SI joint fusion, which involves opening the SI joints and removing the cartilage from between the sacrum and iliac bones and inserting metal screws to force and hold the bones together while they “heal” into one solid (fused) piece of bone. SI joint fusions, as you can imagine, also come with problems, such as lack of motion and bone protection and overload in the structures in adjacent areas.

Regenerative Treatment for SI Joint Syndrome

Regenerative treatments with orthobiolgics, such as PRP or prolotherapy, may allow you to skip the steroids and all their harmful side effects and the surgery for SI joint syndrome.

Platelet rich plasma (PRP) is a concentration of your own platelets, and this concentration can be reinjected into the SI joint. PRP stimulates the local healing stem cells to wake up and get to work. We’ve injected several hundred SI joints over the last decade. One research study found that 90% of SI joint patients still had significant pain relief after three months following a PRP injection, compared to only 25% of SI joint patients who had steroid injections. The same study showed worsening scores for function in the steroid group and improved scores for function in the PRP group.

Even the tried-and-true prolotherapy treatments, which involve creating a local inflammatory reaction to stimulate healing, have been shown (see study at link above) to significantly outperform steroid injections for pain relief, with 60% still having solid pain relief at 15 months post treatment compared to 10% of the steroid group..

So while steroid injections may temporarily relieve SI joint syndrome pain, the relief is likely to lessen with subsequent injections. Even more concerning is the long list of side effects associated with steroids. With studies showing PRP and prolotherapy can offer longer-term relief, this leads us to recommend that you skip the side effect-laden steroids and opt for regenerative treatments for SI joint syndrome instead.

Big Toe Numbness

Believe it or not, one of those significant issues that can present as numbness stems from the low back. In the lumbar spine, the nerve that exits the spine at the L5 level branches down through the hip, thigh, knee, lower leg, and, yes, all the way into the foot and toes. So a pinched or irritated nerve at that L5 level in the back can create problems, such as pain, numbness, tingling, and so on, anywhere along the nerve branch. So what can irritate the L5 spinal nerve? The list is long, but it includes disc issues, such as herniated…

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Front of Hip Pain

Arthritis might be your first thought when you’re experiencing chronic pain at the front of your hip, but the truth is, there are many different issues that could be causing that hip pain. The ultimate goal, of course, is to fix the pain, but eliminating the pain once and for all involves also fixing the problem that is causing it…not just applying a temporary solution for pain relief. 5 Possible Causes for Front of Hip Pain Today we’re going to explore the hip and 5 possible causes for pain specifically in the front of the hip as well as cover ways you can test for each.

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Gluteus Medius Pain

The gluteus medius is one of the major muscles in your buttock and hip. There are three gluteal muscles you have probably heard about: They layer one upon the another much like a layer cake. The gluteus minimus is closest to the body followed by the gluteus medius and then the larger gluteus maximus.Gluteus Minimus – The gluteus minimus is the smallest of the three gluteal muscles. It is a small triangular muscle that lies underneath its bigger brother, the gluteus medius. It functions to stabilize the hip, rotate the thigh, and move the hip in an outward direction.Gluteus Medius -A powerful muscle that starts at the backside of your waist bone…

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Leg Gives Out

Have you ever been walking and your leg gives out? It can be both surprising and alarming What would cause your leg to give out? Can sciatica cause your leg to give out? How do you treat weak legs? Let’s dig in.Weakness in the leg can arise from three principal sources: nerve problems, muscle weakness, and SI joint dysfunction. Weakness in the legs may indicate a significant nerve problem. In many cases, it may be the first indication of a nerve problem. There are three common causes of nerve injury: low back disorders, nerve compression as it descends down into the hip, thigh, and shin and medical conditions such as diabetes…

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Lower Back Pain When Sitting

After a long day on your feet sitting down is supposed to be way to relaxing. Unfortunately for some sitting for any length of time can be painful. Most people experience low back pain at some point in their life. The lifetime prevalence of low back pain is 85% (1). Let’s take a deeper look at the different types of pain and causes of low back pain when sitting. Pain can present in many different ways. It can be intermitent or constant. The quality of the low back pain can also vary depending upon the actual source of injury. Common examples include: Sharp and Stabbing, Dull and Aching, Throbbing/ Pulsating, Pins and Needles, Burning, Electrical

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Lower Back Pain When Standing

When you’re seated, the facet joints in your lower back are in an open and slightly flexed position. When you stand up, these joints compress. If they are painful or have arthritis, you’ll have pain as you stand up because this puts pressure on the painful joints. In addition, if there is any type of movement of one vertebra forward on another (called spondylolisthesis), then this shift will have occurred as you sit. This is called degenerative spondylolisthesis. When you get back up, the vertebrae will come back into position after a few seconds, leading to that awkward “walk it out period” that starts out painful and ends up more normal.

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Outer Hip Pain

The hip is a ball-socket joint. The ball is the top part of the thigh bone (femur). The socket is formed by the ilium bone which is one of three bones that make up the pelvis. The ball-socket joint moves in different directions and is lined with cartilage. The actual hip joint is located approximately at the crease between your stomach and top of your thigh. This area is also known as the groin. The top of the ilium bone is called the iliac crest (waist bone). If you firmly place your hand on your waist you can feel a bone that spans your side.

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SI Joint Pain

The SI Joint is an important joint in the lower back that can cause pain and dysfunction.  Pain is typically one-sided involving the low back and buttock but when severe can radiate down the leg.  Each of us has a right and left SI joint.  The pelvic ring consists of the two SI Joints and the symphysis pubis.  Each is rich in supporting ligaments that provide stability for the joint.  SI Joint pain is aggravated by ligament instability and muscle weakness. Physical therapy is the first line of treatment for SI Joint injuries.  For best clinical results the stability of the joint and muscle strength must be evaluated and treated…

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Sit Bone Pain / Ischial Tuberosity

The ischial tuberosity, also called your Sitz bone, sis a  pair of rounded bones that extends from the bottom of the pelvis. They are the bones that we sit on. The pelvis consists of three strong bones fused together: the ilium, ischium and pubis. The ilium are the tall, thin bones that create the iliac crest aka the waist bone.  The pubis bones are the small anterior bones that are joined together by the pubic symphysis.  The ischium forms the lower and back part of the pelvis.  It is situated between the ilium and pubis  A tuberosity is defined as a large prominence…

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Tight Hamstrings & Calves

The hamstrings are a group of muscles in the upper leg. They are located on the backside of the upper leg and are comprised of three muscles:  biceps femoris, semitendinosus, and semimembranosus.  The calf muscles are located on the backside of the lower leg and are comprised of two muscles: the gastrocnemius and soleus.  Tight hamstring and calf muscles can be painful, limiting someone mobility.  They also make lower extremity muscles more vulnerable to injuries.  Tight hamstrings and calves can arise from different sources which include: medication, muscle and tendon injury, overuse, muscle imbalance, dehydration, poor posture, low back injury…

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Weak in Knees

Weakness in the knee can be a symptom of many different knee conditions. Some of the most common causes of weakness in the knee include ligament tears, meniscus tears, and arthritis. Another important but often overlooked cause of knee weakness is irritation or injury of the nerves in the low back. If you are experiencing any type of weakness in your knee for long durations of time (3 weeks), it is important to see a doctor to determine the cause. Some of the most common symptoms of knee weakness include difficulty standing up from a seated position, difficulty walking, climbing or descending stairs…

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Our Doctors Who Treat Sacroiliac Joint Syndrome

Christopher J. Centeno, MD

Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…

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John Schultz, MD

My passion and specialization are in the evaluation and treatment of cervical disc, facet, ligament and nerve pain, including the non-surgical treatment of Craniocervical instability (CCI). I quit a successful career in anesthesia and traditional pain management to pursue and advance the use of PRP and bone marrow concentrate for common orthopedic conditions. I have been a patient with severe pain and know firsthand the limitations of traditional orthopedic surgery. I am a co-founder of the Centeno-Schultz Clinic which was established in 2005. Being active is a central part of my life as I enjoy time skiing, biking, hiking, sailing with my family and 9 grandchildren.

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John Pitts, M.D.

Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.

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Jason Markle, D.O.

Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.

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Matthew William Hyzy, D.O.

Doctor Hyzy is Board Certified in Physical Medicine and Rehabilitation (Physiatry) and fellowship-trained in Interventional Orthopedics and Spine. Dr. Hyzy is also clinical faculty at the University of Colorado School of Medicine in the Department of Physical Medicine and Rehabilitation; In addition, Dr. Hyzy is an Adjunct Clinical Assistant Professor at The Rocky Vista University College of Osteopathic Medicine. Dr. Hyzy also maintains an active hospital-based practice at Swedish Medical Center and Sky Ridge Medical Center. He is also recognized and qualified as an expert physician witness for medical-legal cases and Life Care Planning. He is published in the use of autologous solutions including…

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Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…

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Mairin Jerome, MD

Mairin Jerome, MD

Dr. Mairin Jerome is a physiatrist with subspecialty fellowship training in Interventional Orthopedics and Regenerative Medicine. This subspecialty serves to fill the gap for patients who are interested in therapeutic options that lie between conservative treatment and surgery. Dr. Jerome uses regenerative medicine techniques, including prolotherapy and orthobiologics, via X-ray or ultrasound guidance to precisely deliver injections to areas of musculoskeletal injury or degeneration. Orthobiologics refers to tissue harvested typically from a person’s own body, such as platelets (platelet-rich plasma, PRP) or bone marrow, for use in treating painful musculoskeletal conditions. The goal is to stimulate the body’s healing mechanisms to improve pain, function, and decrease inflammation.

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Other Resources for SI Joint Pain

The Spine Owner’s Manual: How to Avoid Back Pain & Life-Altering Surgery

This e-book from Dr. Chris Centeno focuses on the spine and how it functions within the human musculoskeletal system and the body as a whole. Everything in our bodies works together like a well-tuned symphony to support our well-being, and a strong spine (including all of its component parts, such as spinal nerves, ligaments, muscles, etc.) is critical to complete health.

Using the Regenexx SANS approach, The Spine Owner’s Manual provides a series of tests and clearly defined exercises that you can do on your own to measure and monitor your own spinal health. These musculoskeletal tests will allow you to monitor where your own body might be struggling to maintain proper stability, articulation, symmetry, and neuromuscular function.

  • Alternatives to Laminectomy

    If you have had an MRI of your spine, you are probably like most patients. You read the MRI report and then google every term on your MRI report from the Radiologist trying to figure out what it all means! Alternatives to Laminectomy should be an important part of that search. Today you’re in luck, … Continued


  • Spinal Fusion Does More Harm than Good!!!

    Back and neck fusions are surgeries we place into the category of “Damage to Accomplish a Goal,” and, indeed, these spinal fusions are perhaps some of the most damaging orthopedic surgeries out there. Only in the most extreme cases, where the extensive harm this surgery creates is sure to be less than the good that … Continued


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This book is full of tests and exercises to understand what is happening to cause your orthopedic pain. 

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