Sacroiliac Joint Prolotherapy.

What is the SIJ?

The sacroiliac joint (SIJ) helps form the ring of the pelvis, connecting the sacrum to the ilium. They are the largest joints in the body and connect the spine to the pelvis. The joint is inherently stable, held together by strong ligaments that provide compression and limit motion.

What Causes SIJ Pain?

Sacroiliac joint dysfunction can occur when there is instability, or stretch, in these ligaments.  Excess movement can also stress surrounding structures. Referred pain down the leg may also occur.

It is often related to hypermobility, and is more common in females, especially during and following pregnancy. Biomechanical factors can contribute. It is occasionally caused by trauma with significant force.

What Can Fix This?

First an accurate diagnosis should be confirmed – lower back and buttock pain can be caused by a myriad of structures, from different parts of the lumbar spine, nerves, tendons, bursa and of course, the SIJ.

A strengthening programme of the core and pelvic floor muscles, supervised by a physiotherapist, is integral to rehabilitation and will often fix symptoms. A specific SIJ belt may also provide relief.

If these measures do not relieve the pain, prolotherapy may well be indicated after a thorough medical assessment.

What is Prolotherapy?

Prolotherapy involves injecting a solution of concentrated dextrose and local anaesthetic. The injection is performed under image guidance to aid in accurate placement.

How Does Prolotherapy Work?

Through a series of biological events, it causes a release of pre-collagen growth factor, to stimulate fibroblasts, to deposit collagen which is the principal component of ligaments, in doing so, making the SIJ more stable.  This process can take around 6 weeks, which is why people do not immediately feel better.

What Can I Expect?

Prolotherapy does not relieve pain immediately. As explained above, it stimulates fibroblasts to deposit collagen, to make the ligaments stronger and the SIJ more stable which takes weeks. The injection often initially increases pain, which usually settles in 3 to 4 weeks.  Your physician will provide pain relief. Avoid non steroidal anti-inflammatories such as Nurofen and Voltaren as these may interfere with the process.

Often the procedure will need to be repeated at 6 weekly intervals, up to a total of  3  times.

In order to maintain the effects of the injections, you will need to continue your physiotherapy exercises. You will be advised to wear a sacroiliac joint belt.

References

Cusi M, Saunders J, Hungerford B, Wisbey-Roth T, Lucas P, Wilson S.  The use of prolotherapy in the sacroiliac joint. British Journal of Sports Medicine, 2010 Feb, 44(2):100-4. doi: 10.1136/bjsm.2007.042044

Kim WM, Lee HG, Jeong CW, Kim CM, Yoon MH.  A randomized controlled trial of intra-articular prolotherapy versus steroid injection for sacroiliac joint pain. J Altern Complement Med. 2010 Dec; 16(12): 1285-90. doi: 10.1089/acm.2010.0031.