Back Out of Whack? It Could Be Your Sacroiliac

With lower back pain, it’s common for patients and their doctors to investigate the usual suspects: the muscles and discs of the spine. But what if the culprit is actually rooted somewhere else?

In up to 30 percent of patients with chronic low back pain, the cause isn’t the spine at all. Instead, it’s a problem with the sacroiliac (SI) joints. These joints link the iliac bones (hips) to the sacrum, or the lowest part of the spine above the tailbone.

NorthBay Healthcare orthopedic specialist Cornelis Elmes, M.D., points to the sacroiliac joint, which can be the real cause of lower back pain.

And thanks to an innovative, minimally invasive outpatient procedure now offered at NorthBay Healthcare, patients are finding relief from SI joint pain they never thought possible.

Cornelis Elmes, M.D., an orthopedic surgeon at NorthBay, said the biggest challenge in treating pain from the SI joint is identifying it as the source of the problem in the first place.

“The SI joint is an important but often under-appreciated and unknown cause of low back pain,” said Dr. Elmes. “I call it the great masquerader because it can look like a hip problem or back problem.”

The SI joints are important because they are essentially shock absorbers for impacts from the lower extremities to your spine, for example, when running or lifting heavy objects.

The joints don’t move as much as other joints in the body, but they move just enough to help diffuse some of the forces and decrease the risk of injury to the spine. 

“If injured, however, an SI joint may have more motion than normal which can cause it to become a very painful problem,” said Dr. Elmes.

NorthBay Center for Orthopedics offers several treatments to address SI joint pain, starting with physical therapy and exercises, especially those that help to strengthen the body’s core muscles. When that’s not effective, interventional treatment such as a SI joint fusion is an option. 

The procedure involves a small incision along the side of the buttock through which small triangle-shaped titanium implants are inserted across the sacroiliac joint. The implants, which are porous, encourage bone growth, which essentially fuses the joint so that it can no longer move, thus relieving the cause of the pain. 

The procedure has proven effective in more than 90 percent of patients and because it is a minimally invasive procedure, recovery is faster. 

Fusing the SI joint does not limit a patient’s flexibility, he added. “The SI joint is not supposed to move much anyway,” he said.

For more information on the procedure visit

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