What is sacroiliac joint pain, and why does an MRI miss it?

The sacroiliac joints sit where the spine meets the pelvis, under the dimples at the base of the back. They move only a few degrees. The thickest ligaments in the body hold them. And they cause a real share of chronic low back pain: a comprehensive review put it at roughly 15 to 30% of patients with chronic axial pain tested with diagnostic blocks. The joint rarely shows on a lumbar MRI, because the lumbar MRI stops above it. So for years it gets treated as a disc, a facet or a hip.

Why does farm work cause SI joint pain?

Monroe County is farm country south of the bluffs. Farm work loads this joint in a specific way. The first cause is mechanical: the joint is stressed by uneven load. Think of climbing down from a cab onto one leg, working a pedal for hours, or lifting from one side. A systematic review of muscle and joint problems in farmers found low back pain the most common problem across studies. The second cause is biology. In a body running high insulin, the ligaments that hold the joint are stiffer, more inflamed and slower to repair. So the same step hurts more. The third cause is money and the calendar. Planting and harvest do not wait for a joint to settle. There is no sick leave on a family farm, so the joint is loaded through the weeks it needed rest. We hear the same story from Metro East warehouse docks and delivery trucks.

What does SI joint pain feel like, and what is mistaken for it?

How is SI joint pain diagnosed and treated?

The ablation evidence is small and honest. A 2008 sham-controlled trial of 28 patients with block-confirmed sacroiliac pain found meaningful relief in most treated patients at one and three months. Almost none on sham got relief. Later trials are mixed. Part of the reason: the nerves that supply the joint vary between people, and a technique that misses them cannot work. The practice’s position: it is worth doing when the block was clearly positive and the technique covers the whole anatomy, not a single spot.

What he called not too bad

For twenty years Dr. Gurpreet Singh Padda, MD, MBA, MHP looked at a fasting glucose in the high nineties and called it not too bad. He was wrong. The ligaments around this joint are one place it showed: tissue that should have healed in weeks stayed inflamed for years. That is why the first Columbia visit draws blood before anyone mentions a needle.

The 40 to 50% that stabilizes the joint

Muscle holds the joint shut as much as ligament does, so behavior is half the plan. Strong glutes close the joint with every step. Rebuilding them is what makes an injection or an ablation last. Hip mobility takes the uneven load off the pelvis. We prescribe sleep, since a short night lowers tomorrow’s pain threshold. Cutting acellular carbohydrate lowers insulin and calms the inflammatory tone of the ligaments themselves. A licensed pain-trained clinician inside this practice delivers Acceptance and Commitment Therapy, because a body that has learned to guard one side has to be taught to trust it. And rural work is done alone; we treat isolation as the pain driver it is.

From Columbia and Monroe County

IL-3 north to I-255, over the Jefferson Barracks Bridge, around on I-255 and I-270 to I-70, then east to the Woodson Rd exit. About 45 minutes and 29 miles with no traffic. Free-flow times from the towns north of you:

Frequently asked questions

How do you tell the sacroiliac joint from the spine?

By a cluster of provocation tests on exam, then a diagnostic block under fluoroscopy, as the sacroiliac joint pain page describes. No scan settles it.

Is a sacroiliac injection done by feel?

The joint is too deep and uneven to enter reliably by feel. So it is done under fluoroscopy with contrast. The sacroiliac joint injection page explains what the picture proves.

Can the sacroiliac nerves be ablated like facet nerves?

The lateral branch nerves that carry the joint’s signal can be ablated after a positive block. The radiofrequency ablation page explains why the technique matters more here than at the facets.

Is the drive from Monroe County worth it for one joint?

The plan is staged so each trip over the bridge answers one question. The first visit from Illinois article explains what to bring so the first one counts.

Where can I get pain management near Columbia, IL?

Our clinic is at 4499 Woodson Rd in St. Louis, off I-70 next to Lambert airport. From Columbia, take IL-3 north to I-255, cross the Jefferson Barracks Bridge, and follow I-255 and I-270 to I-70, then exit at Woodson Rd. It is about 29 miles and 45 minutes with no traffic. The practice also has an Illinois office in Troy.

Will SI joint pain heal on its own?

It can take far longer than it should. The ligaments that hold the joint heal slowly when insulin runs high, and in some people they stay inflamed for years instead of weeks. Farm and warehouse work keeps loading one side through the weeks the joint needed rest. That is why the first visit draws blood as well as examining the joint, and why glute strength, sleep and diet are part of the plan.

What should you avoid with sacroiliac joint pain?

Uneven load is what stresses this joint. Stepping down from a truck or tractor cab onto one leg, working one pedal for hours, and lifting from one side all strain it. So does pushing through the weeks it needed rest. Rebuilding glute strength and hip mobility takes that load off the pelvis. A leg that goes weak, groin numbness, bladder or bowel changes, or fever need imaging within the week.

Related reading

• Sacroiliac joint pain
• Sacroiliac joint injection
• Radiofrequency ablation
• Hip pain
• Injured at work
• What an orthobiologic is, and who it fits