Sacroiliac Dysfunction

Injury to the sacroiliac (SI) joint can happen for many reasons from physical trauma and to carrying excess weight. When the SI joint is injured and does not heal properly it can lead to pain in the lower back and buttocks. Thus, this pain will worsen and interfere with everyday activities like walking, sitting, lifting, and bending down.

Prolotherapy techniques have been proven effective at restoring joint structures and alleviating associated pain. When it comes to SI joint injury or dysfunction, PRP (platelet-rich plasma) injections are the most effective (1). These not only halt the dysfunction and deterioration of joint structures but (in many cases) prevents the need for surgery and other invasive treatments.

The Sacroiliac (SI) Joint

The sacroiliac joint connects the sacrum (located in the lower spine) to the iliac (or hip) bones, hence the name. Also, it helps hold the pelvic girdle in place and bears the weight of the upper parts of the body including the chest, arms, head, and neck.

This joint is very strong and damage to it can loosen ligaments and destabilize the pelvis and lower back. Furthermore, symptoms associated with an injury of the SI joint include lower back pain, lateralizing pain from the buttocks, posterior leg pain, and pain to the groin area (2).

From Injury to Dysfunction

Injury to the SI joint involves damage to the soft tissue structures (tendons and ligaments that hold it in place. When these are damaged and are not allowed to heal properly the can lose some of their tightness (2). Unfortunately, altered body mechanics and overcompensation occur when the SI joint is not tightly in place. 

What does this mean? It means that the loose ligament will cause chronic microtrauma to proximal sites as there are abnormal movement and rubbing of bones. With time, this microtrauma can become more severe, damage the bone, and cause excruciating pain.

Dangers of Ligament Injury

Unfortunately, overlooking damage to soft-tissue structures often happens because they are not easy to diagnose. Imaging techniques such as x-ray and MRI are not optimal for soft tissue diagnosis and may lead to misdiagnosis as bone abnormalities can be common. Diagnosing soft tissue damage requires direct palpation and accompanied by motion tests to pinpoint the injury.

Persistent unresolved pain will likely lead to the use of anti-inflammatories and other medications. However, this is dangerous, as it creates a false perception of healing and makes us more likely to aggravate an existing injury. Do not ignore persistent pain and seek help to prevent the progression from injury to dysfunction.

PRP for SI Joint

Platelet-rich plasma (PRP) injections have proven to be more effective at treating sacroiliac joint laxity and dysfunction. A 2018 issue of the Journal of Prolotherapy confirmed that PRP is more effective at treating pain and restoring the function of the dorsal interosseous ligament (DIOL) when compared to classic prolotherapy (with hypertonic dextrose). Fewer injection treatments resulted in greater improvement (1).

This difference in effectiveness may be due to a difference in the concentration of healing mechanism elicited by each injection. Hypertonic dextrose heals by recruiting platelets, growth factors, and stimulating fibroblast at the site of injury to heal. PRP involves direct injection of a platelet concentrated solution which leads to even greater recruitment of healing mechanism and collagen maturation (1)(2).

References-

1. Saunders, Jennifer, et al. “A Comparison of Ultrasound-Guided PRP Injection and Prolotherapy for Mechanical Dysfunction of the Sacroiliac Joint.” Journal of Prolotherapy, 27 Sept. 2018, journalofprolotherapy.com/comparison-ultrasound-guided-prp-injection-prolotherapy-mechanical-dysfunction-sacroiliac-joint/.
2. Ko, Gordon D. “Platelet-Rich Plasma Prolotherapy for Low Back Pain Caused by Sacroiliac Joint Laxity.” Practical Pain Management, Sept. 2010, www.practicalpainmanagement.com/pain/spine/platelet-rich-plasma-prolotherapy-low-back-pain-caused-sacroiliac-joint-laxity?page=0%2C2.