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SJD diagnosis and MRI

smartenssmarten Posts: 8
edited 06/11/2012 - 8:51 AM in Sacroiliac (SI) Joint Problems
Diagnosing sacroiliac joint problems is somewhat difficult and that area of the back isn't always included in an exam for low back pain.

Here's a Spine-health forum post on the subject:

"I have had severe back pain lately and I suspect SI problems because it is worst when there is pressure below the waist on my back side. Will sacroiliac joint problems show up in an MRI? What would be the best way to diagnose this? If an MRI would come out inconclusive anyway, I’d rather not pay for one."


  • dilauroddilauro ConnecticutPosts: 12,072
    When I have flare ups in my lower back, almost 90% of the time its due to problems in my sacroiliac joint.
    I am going through one of these right now. It started with a severe groin pull in my left leg, which after several weeks of proper walking, my right leg and drop foot started to act up.

    My Deep Tissue person described as a lock up from L4 to S1. He did some foot/heel/toe treatments which gave me some relief, but he stated I will need more.

    I was in standard Physical Therapy this past week, in the first thing my therapist noted was I was tilting to one side. My hips were out of alignment and my right leg was almost 1/2" longer than my left leg.

    She performed some re-alignment treatments to straighten out my hips and since with all of my lumbar surgeries, none being fused, she could also straighten out my discs.

    So, now I am in the middle of standard Physical Therapy and weekly sessions of Deep Tissue Massage.

    The overall feeling of my doctors and therapist is that this is a fall out of my past year two complete shoulder replacements, which prohibited me from Aqua Therapy , which in turn just left my muscles much tighter. All of these came into play for my current
    flare up in S1.

    I am confident though with continued treatments and getting back to Aqua therapy this current condition will subside.

  • S1 problems are no fun the only thing that helps my is shot and water PT
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  • Sacroiliac (SI) joint problems require appropriate interpretation of a patient’s history, clinical exam results, and imaging studies. Differential diagnostic approach, including the SI joint, the spine, and the hip, must be used to accurately assess and identify the actual pain generator(s).

    During physical exam, patients with sacroiliac (SI) joint disruption and dysfunction exhibit any/all of the following symptoms:

    Low back pain
    Palpable tenderness of the posterior pelvic sacroiliac (SI) region
    Pain from provocative maneuvers to the hip (i.e. Faber test) and the absence of neurologic deficit
    Joint asymmetry may be seen on CT and MRI.

    When the SI joint is suspected as the source of the patient’s low back pain, confirmation is provided by CT or fluoroscopic guided injection. If Lidocaine is injected into the joint and symptoms temporarily resolve, this is confirmation of the SI joint as the source, or a source, of the patient’s low back pain (as multiple pain generators may co-exist).

  • further to your above post.....

    i do have severe advanced probs in my lower lumbar, which needs fusing, however......

    i saw a massage person , for a massage, she said my hips looks out of line, and told me i needed realigning, i told her i was not allowed to be manipulated as i was told many years ago by surgeon this could paralize me

    she convinced me that it would be gentle , and allthough agaisnt my better judgement and having depression and her persuavive nature, she said i had to have this done

    she manipulated my pelvic area.....hips
    on returning home i had symptoms of all 4 limbs, pins n needles, pain , abd burning,and i was aware something was very wrong

    had not experienced this b4
    the next day it became apparent that i had symptoms which i did not have prior to her manipualtion

    which consisted of an inability to stand without severe pain in lower back, an inability to sit or drive without severe pain, an inability to walk very far with severe pain and then shuffling steps of approx 1 inch forward movement , till i could no longer do that, an inability to walk up stairs, and inabiliity to walk up the smallest of incline (signs of SIJ instability??, did not have this prior to manipulation)

    i can no longer do any ADL"s of any meaningfull duration
    have severe pain in lower lumbar and aching and tenderness over SIJ
    on movement

    i am also extemely weak and find it very difficult to perform one squat, whereas before , i was very strong in being able to do this repeatatly and for long durations (this is a symptom of SIJ"S instability?, as i did not have this previously)

    i have been in bed for 2 years now as it is too painfull on moving

    now as i said i have severe lumbar issues , lomg standing , which require fusion, but the new symptoms have been debilating to do ADL"S

    so looking at my scans its easy to see the damage to lumbar , lonstanding, and therefore i think , my SIJ"S have been overlooked

    i am 100 % sure thses new symptoms occured after thr manipulation
    my question, going by thses symptoms , it seems more likely my SIJ"S have sustained some damage?
    is a ct appropriate to show anything?
    what treatments could i investigate , specifically P/T , what sort of exercises would be appropriate, Would they improve my mobility??

    thought, comments, much appreciated
  • I have problems with my SI joint my hip rotates and looks out of line and is out of line I have been told by my doctor that the reason it does the rotating is due to the S1 joint, the first time they put mine back I had a lot of pain and I do mean a lot due to it being that way for so long and was told that would happen, so I kept up the treatment and it did help and it does help. When I have it done it will go back in and can go right back out and it is very painful and stay that way unless you keep up with TP for S1 joint and I have pressure on the nerve in my hip and down my leg, I also have grade 2 anterolisthesis of L4-L5 and that goes along with the S1 joint and the hip rotating. A good TP that does S1 joints is great and shots
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  • the symptoms/movement incapacities like the ones i stated , before the massage person manipulated me.

    so allthough i had/have severe symptoms/damage to lumbar, i didnt have SI joint instability

    now i have, due to the manipulation

    do you have any movement disability, directly related to your SI joints

    i need a lot of information on this as i am not allowed to be manipulated as it can cause me paralyisis
  • I stongly suggest you see a physician in regards to your increased symptoms and changed in neurological status. Before you start any other type of treatment program I would see a medical professional.
  • i did see my GP, he agreed that the massage person had done something, but GP has thought that it was probably a further assault to my lumbar

    so no mention or tests have been done for SI joints, just my lumbar

    so, i need to go back to GP and let him no to investigate SIJ

    as i have so much damage to lumbar, its sorta assumed

    thanks for your reply
  • hi
    for over 10 years i was being treated for lower back pain and one surgeon although he had an MRI scan done said yes he could see the discs n movement in my lower back said nothing more he could do as the facet joint injections hadnt worked..he had done them at L4/5
    so my GP sent me for a 2nd opinion this surgeon said from the scans i had last may he could see that the problem layed at S1/L5/4
    he said he would operate doing a spinal fusion taling discs out
    i had the operation on the 1st march 2011 5 hours in theatre S1/L5/4 boned trimmed discs out and fused with rods and screws
    after op i had no feeling down left hand side at all ... back to theatre for another 3 hour op to remove blood clots from nerve ends...
    now i have movement in left side still weak but no feeling.... back pain from before eased but too early to say if its worked yet but everyday im a bit stronger and thats the main thing
    i await the outcome if its a sucess when all the swelling n bruising has gone down

    good luck to u all u only have one back treat it with care and get a 2nd opinion if ur not sure

    Hayley x
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