Pain in the Butt
There are many different possible causes for a “pain in the butt”, but one common cause is dysfunction of the SI joint (sacroiliac joint). This joint lies at the conjunction of the spine and the pelvis. More specifically, it is the articulation of the tailbone (sacrum) and posterior hip bone (ilium). This joint is crucial for transferring energy from your lower body to your spine, and thus acts as a “shock absorber”. This joint is not a “hinge” like the knee but rather rotates slightly as we move, walk, and shift our weight from side to side. The joint can become painful due to various reasons: trauma (i.e. a car crash or falling on your behind), pregnancy (this joint loosens to allow passage of the baby’s head), it can become arthritic like any other joint through “wear and tear”, or it may be injured due to overload after a lumbar fusion. Unlike other joints, the SI joint has thick posterior ligaments that create significant stability, and contribute to its shock absorbing capability. These ligaments can also be injured along with the joint generating pain and instability.
The first step in managing this pain includes proper evaluation which consists of a history, physical examination, and possibly imaging studies to rule out other causes of pain in this area. This hypothesis can then be tested via an interventional diagnostic/therapeutic injection. Utilizing x-ray guidance, we can inject a combination of anesthetic (numbing) medication with steroid into the joint and into the posterior ligaments of the joint. If the pain goes away for the first few hours post-procedure, this indicates that your sacroiliac joint is most likely the cause of your pain. Once a diagnosis is confirmed, we can discuss possible next steps in treatment.
The core of good musculoskeletal care is proper muscle strengthening and alignment of the spine and pelvis. Physical therapy treatment with a skilled physical therapist is a key component of treating the underlying movement issues and helping to create proper movement patterns and long-term relief.
If your pain persists despite steroid injections and physical therapy, the next best step would be to consider injection of platelet-rich plasma (PRP) into the sacroiliac joint and surrounding ligaments. This process involved taking your own blood via an IV, and spinning it down and concentrating the healing factors. While this therapy is not covered by insurance, the studied results are significant and could save you from potential surgery in the future. In fact, there are recent studies showing the superiority of PRP vs. steroid injections for long-term benefit of the sacroiliac joint: https://pubmed.ncbi.nlm.nih.gov/27677100/ . Another treatment option that is often seen is that of sacroiliac joint fusion surgery. This surgery keeps the sacroiliac joint from moving at all with the assumption that a joint that doesn’t move can’t hurt. Unfortunately, while this may be an enticing option, the outcomes for these surgeries are not great and can cost tens of thousands of dollars vs. around $2000 for PRP injections.
If you are tired of dealing with a “pain in your butt”, please schedule a consultation so that we can properly diagnose your pain and then develop a customized, comprehensive treatment plan to help alleviate your pain and get you ready for pool season!