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  • Q&A with Australian Health Practitioners

    What surgery treatment is available for sacroilliac joint dysfunction?

    Related Topics
    Back & Neck Pain Pain Sports Injuries & Prevention
    I was diagnosed about 8 years ago with Sacroiliac Joint Dysfunction as a result of a sports injury I have had back physiotherapy, manipulation , exercises, back rehabilitation class, steroid injections x2 and an SI Joint belt. Nothing has helped I basically live on pain killers, ice gels and ice packs.

    I cannot bend at all, struggle to walk for more than 15 minutes, unable to do any exercises. I do exercises I picked up of the Internet at least 3 times a day , I can sometimes feel my SI joint click back into place. I am at a point where I think the only option is surgery , I have looked on the internet and it appears only America offer the ifuse operation. Please could you shed any light on this , is it available in Australia ? Is it worth me perusing it with my local Dr?
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    Richard McMahon

    Acupuncturist

    Richard McMahon is an energetic practitioner with over 12 years of experience in complementary health. Richard holds a Bachelor Degree in Acupuncture and a Diploma … View Profile

    Sacraoiliac pain can be intense and you are obviously suffering, however fusing the joint may cause more problems than it solves. If you feel strongly that this is the path that you wish to try, than you should have a long talk to your doctor about it and find out exactly what sort of results are common for the operation and how long the procedure has been in use.

    Sacroiliac dysfunction is due to an alteration in the normal joint motion. This can be caused either from hypermobility and instability of the joint or hypomobility and fixation of the joint. The “clicking back into place” that you describe does suggest that there is some instabilty that would need to be addressed but there will also be excess tension in some of the hip musculature and some inflammation of the joint itself.

    Acupuncture is excellent in the treatment of this condition however you will have to make sure that your therapist has a good understanding of sports medicine assessment which will allow them to pinpoint the type of dysfunction. This is especially true due to the chronic nature of the condition and subsequent compensation in your system.

    This will assist the body to clear out inflammation, relax excessive tension and help the joint movement to improve. You will need a regime of stability exercise and some careful stretching to consolidate the results.

    If your therapist is on the right track you should notice good improvements within a few sessions but it will need to be managed for the first few months.

    Whatever therapy you choose to go with, find a therapist you trust and stick with it for a while as chronic conditions can take some time to stabilize.

    Kind Regards,
    Richard McMahon

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    Sandra McFaul

    Physiotherapist

    Do you suffer from chronic lower back pain or neck pain? Based in SYDNEY, Sandra is 1 of ONLY 15 Physiotherapists in Australia with ADVANCED … View Profile

    Sorry to hear about your problem. 
    Before any surgery, it is important to know what the source of the pain is.  If it is your SIJ…. then why haven't you got at least some relief from the SI injection or the SIJ belt????

    I know you have seen lots of thearpist, but have you seen a McKenzie Method Physio - specifically one who has a Diploma. (Dip MDT)  There are only 17 of us in Australia.  It is important to rule out your back as the source of pain.  Do SIJ tests.  And then prescribe spcific exercises for you, according to your pain and movements…. not general exercises that you found online.

    I suggest you GOOGLE - The McKenzie Method.  I wouldn't consider surgery until having a full mechanical assessment from a Dip MDT Physiotherapist.  Hope this helps……

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    Brett Rawlings

    Acupuncturist, Myotherapist

    I’m an Acupuncturist, Credentialed McKenzie Method Therapist and Clinical Myotherapist with 20 years clinical experience treating musculoskeletal pain and dysfunction.10 years ago I made the … View Profile

    Most pain felt in the SIJ region is referred from the lower lumbar spine. This can be difficult for patients to accept because the SIJ region is often tender to the touch when there is lumbar spine pathology. In my experience, the SIJ is RARELY the cause of lower back/SIJ region pain. I agree with Sandra, if you haven’t seen a qualified McKenzie Method practitioner, it would be a smart move. The official McKenzie Method website will provide you with a list of practitioners in your area who have completed the appropriate training.  All the best!

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    Dr Stephen Leow

    HealthShare Member

    There are some key question to see if the pain is indeed arising from the SIJ.

    Did the steriod injection provide immeadiate complete relief? There is usually a local anaesthetic given with the steriod and if the SIJ is the only source of pain, it usually gives relief straight after the proceedure.

    When it “clicks back” into place, is the pain relieved? If it is, it points to the SIJ as source of the pain.

    If it is not the source, it might be a refered pain or a chronic pain (syndrome) the danger being that any operative proceedure would not have any effect on the pain.

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    Richard Murray

    HealthShare Member

    I have the same problem, accept I additionally have lumbar facet ware and associated instability.  I believe the damage to both the facets and SI joints are purely mechanical.  Damage to the SIJ's was primary due to heavy seated rowing back in 1990, and I believe damage to the lumbar facets due to regrettable chiropractic manipulation which commenced in 1991. I have recently discovered I do not have the HLA-B27 gene.  My left SIJ is about 60% the issue versus the right side 40. The two times I have had left SIJ injections, the relief each time lasted exactly one week only.  Interestingly,  the lumbar facets tendended to remain correctly aligned during this period of SIJ relief.  I believe this week of improved facet joint stability was due to the SIJ inflamation being controlled and therefore less associated tightnessness around the SIJ's (periformis and pressure points etc) and lumbar region tightness, that would have otherwise been causing lumbar facet misalignment.   My daily life is totally limited with ongoing treatement identical to that of the person who submitted the above questions.  I am seeing both Sydney's top Spinal Surgeon and Rheumatologist who have proscribed further comformational diagnostic SIJ injections. After 24 years, I am now at the point of considering the ifuse system, and looking into it's availability here in Sydney Australia.  I understand and infinitely appreciate all your responces above.  Thanks very kindly , Richard Murray - BSc Aviation.

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    Emma Jane Paterson

    HealthShare Member

    I drove from adelaide last week to see dr Anil nair in sydney... i liked him as he listened... i had injection into sacroiliac joint today... incredibly painful... ive had all kinds of therapy too and injections... nothing has worked... have to endure this injection again n see what happens... i enquired about the ifuse system too 

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    Anonymous

    Hi Corrina,

    Thanks for your post. I'm looking at having my Si Joint fused and as you mentioned there isn't alot of information about having the procedure done in Australia.

    I've tried chiro, physio, steroid injections to help stabilise the joint and lots of medication in-between. I consider myself relatively young to have this problem (and have suffered since I was 17, now in my early 30's) and I'm worried what will happen in another happen in another 15-20 years if I don't consider the surgery.Some days I can barely walk.

    I'm not sure when you put this post up but how has your progress been? I understand everyone is different but I'm trying to get a better understanding of the procedure and what others have been through.  

    Thanks in advance

    Daniella 

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    Emma Jane Paterson

    HealthShare Member

    May i ask if you have found a surgeon xxx

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    Corrina Hawkins

    HealthShare Member

    Hi Daniella,

    I put this post up in June 2016. I am now currently 4 weeks post op with the fusion of my left SI Joint as well (so both sides fused now) Second operation was performed Oct 2016.

    I am 45 and have been living with a bad bak since a fall in January 1999. 

    My progress has been fantastic in terms of pain levels. At most my pain has only ever risen to about a 5 since surgery and thats ONLY when I have had a very active day and didnt rest when I first felt some pain.

    It is a catch 22 with recovery as sitting too long causes some discomfort as does doing to much - you've just got to find that 'happy medium'. I do take a little time to become 'less stiff' on wakeing in the mornings or after sitting for 2 hours such as watching a movie, but it does settle fairly quickly.

    With both operations I spent 5 days in hospital and immediately after surgery I am up and walking to the bathroom etc. I am assisted by having crutches and continue on 2 crutchers for 2 weeks post surgery then wean down to 1 crutcher for 4 weeks post surgery. Im left with a very 'non invasive' 3cm straight line scar on either side of my hip/pelvic area. 

    Hope this helps somewhat. Dont hestitate to contact me here if you want further information. 

    Good Luck with it all.

    Corrina

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    Michelle Ivers O'Haire

    HealthShare Member

    Hi, I'm 44 and have suffered with SI joint pain for over 15 years. Initially injections would ease pain for around 6 months at a time. Over a number of years I continually had regular injections. After a few years it was getting worse and further scans showed I had an infarction in the right joint (which is the worst side) I could no longer have the injection as surrounding bone was being damaged.

    the past 4 years have been horrible. I have tried acupuncture, physio, specialised physiology, chiro, meds which ended up causing GORD. I have seen OT,s, Rheumotoligist, pain specialists, orthopedic surgeons and a naturopath. I had to give up work 2 years ago. (Suffering the grief and depression on the way) I have been on morphine type pain meds for the past 3 years. Norspan, palexia, endone as well as plaquenil, pariet, pristiq & seroquel.  I also take iron, magnesium, multi vitamin & laculose. 

    I can't sleep for more than a few hours without having to get up and walk around.  I can't sit for very long in the same position for more than half hour. I can't drive anymore, can't go shopping or boating or fishing or much of anything really. I can't stand long enough to wash my hair!

    so far I have tested positive for auto-immune but negative for BL27 gene.  My dad suffers from the same symptoms but only mild.

    the trouble now is I don't see any light at the end of the tunnel. I can no longer get to my appointments an hour away to see the pain clinic at John Hunter Hospital. I was declined for community transport assistance. I'm feeling like my gp, specialists and pain clinic aren't looking at finding what's going on to fix the cause. It's all been managing the pain. 

    Im not managing to live any sort of normal life. My fiancé works away and is only with me 2 days a week.  I can't imagine living like this for the next 30 whatever years. I need a specialist who is going to look at my scans and say they can help with the cause, and fix it!  

    If if anyone knows someone who may be able to help me I would really appreciate you letting me know. I haven't even been told about any surgery options  

    for those going through the same thing, please be careful having too many cortisone injections! And please know you are not alone. Hugs xx

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    Emma Jane Paterson

    HealthShare Member

    Please may i ask who your surgeon was xxx

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    Corrina Hawkins

    HealthShare Member

    Hi Emma Jane,

    Im not sure if your question was for me regarding who my surgeon was/is but my surgeon that consults here in Albury NSW is Dr Terry Hillier (however he doesnt operate anymore due to being semi retired (consults and assists in surgery where needed) and his locum surgeon Dr Hillier uses in Dr Anil Nair from Bankstown NSW. He flies down monthly to perform the surgeries since Dr Hilier is semi retired now.

    Hope that helps you :)

    Corrina 

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    Emma Jane Paterson

    HealthShare Member

    Thank you so much Corinna...i have an appt next week in sydney with dr nair...im from adelaide and not one dr here has heard of the procedure...ive had this injury for nearly 8 years since a DV assault... im so very grateful for your help xxx

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    Karen Roberts

    HealthShare Member

    Hi, I'm in a similar situation. Bilateral SIJD. Planning on another round of radio frequency ablation which hopefully will give me enough relief so that I can work on strengthening my glutes etc, my left leg is quite week now. Had L5/S1 fusion in May 2016, expecting to need the fusion for SIJ in 2017. I have found a surgeon on the Gold Coast who does IFuse. Very interested to hear how others have found this surgery.  Karen 

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    Corrina Hawkins

    HealthShare Member

    Hi Karen,

    I had a back fusion on 3 levels (L3 to S1) in December 2012 as well as 2 disc replacements at the same time (done in 2 separate operations a week apart, was in hospital for 18 days).

    Ive just had my right sacrioiliac joint fused in May2016 and my left was done in Oct 2016. Previous to this I has been through ALL injections, physio etc nothing worked, I even lost 57 kilo's thinking that would help. My right side since surgery in May 2016 has been very good with only niggling pain every once in a while (usually when I have been very active) however Im still having pain in my left side that was done in Oct 2016. Immediately after surgery and for the next 6 weeks or so it was great with only minor pain but since the 6 week mark the pain has been slowly getting worse. I have been off work since March 2016 due to my pain and recovering from surgery and my surgoen is not looking at giving me any sort of date to return to work until March 2017 when he will decide if I can return or not and with what limitations. I have been extremely busy the last few days (being Christmas who isnt?) and last night and today (23/12/16) I am bearly able to weight bare on my left side again (feeling of extreme pressure and pain when putting weight on my left leg to walk) so Im back on crutches to take some pressure of and hoping it settles down. Ive been to see my GP and we are hoping its just taking extra longer to settle after surgery this time and that there isnt any other 'issues'! I see my surgeon again in January 2017 and Im hoping he will have more insight into what may be the problem if any! He has told me in the past I need to be patient with recovery but Im losing my patience when it comes to pain! Since my back surgerys including the SIJ fusions I really struggle to bend to put my shoes on. My pelvis area feels very 'secure' and I dont tend to 'swivel' from the waist now I need to turn my whole body. Putting either foot on to the opposite knee is virtually impossible. I dont get any more than 20 minutes walking around the shops without needing pain medication and needing to stop. Its very frustrating but Im holding on to the hope that its early days (my surgeon says it can take up to 12 months for full healing) and I will still see improvement in the months ahead. Do I regret having the operation? No definitely not as there has been some improvement with pain. I believe I just had unrealistic views as to my pain levels post surgery. 

    I hope this has been able to help you in some way. Feel free to ask me any other questions you may have.

    Good luck with it all.

    Corrina

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    Anonymous

    http://www.specialistnow.com.au/

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