Why do we know so little about the SI joint? (Amazing Interview with Dr. Carter Beck).

Recently, I was watching this interview with SI joint surgeon Dr. Carter Beck (the same doctor I had mentioned in my previous post).  The whole time I was watching, I kept thinking to myself, “Wow, that is a great point…. I really need to remember some of the things he is saying.”

So… that means a blog post for you, covering some of his most important points!

One of the things I liked most about this video is that Dr. Beck provided a source of context for why the medical field has overlooked the SI joint for so long.

As a patient who struggled for years to even find a doctor or a PT who knew what I was talking about when I mentioned sacroiliac joint dysfunction, it was incredibly validating for me to hear what Dr. Beck had to say.

According to Dr. Beck, the SI joint is “…one of the last joints that modern medicine has not really fully gotten a handle on.”

He explains that doctors did make some attempts to study and perform surgery on the SI joint decades ago.  However, our surgical procedures back then in general were much more crude– it was harder to be precise, and techniques were more invasive and much more likely to inflict damage on the body.

These initial SI joint surgeries failed to really provide any concrete relief to patients, so doctors moved their attention to pathologies of the spine itself, where their interventions were able to produce much higher levels of improvement.

Another potential reason, he explains, is that compared to many other joints in the body, the SI joint “doesn’t really move.”  He says that the joint is there, largely, because it is related to the way how the skeleton develops (many bones in the body are actually separate bones in a developing fetus), and it also plays a role in childbirth, when the ligaments of the SI joint loosen up dramatically to widen the pelvic outlet for a baby to pass through.

(To be honest, something I found a little confusing was that Dr. Beck did not address the additional functions of the SI joint which I’ve read about in many other places, which have to do with biomechanics of the body and transfer of force.  (This is a good reminder to me of why I always need to cite my sources– yikes!).  For now, I am not going to overthink this point and conclude that he is probably speaking this way because he is comparing the SI joint to other joints of the body which move much more).

Anyway, Dr. Beck explains that he became interested in the SI joint, along with some of his colleagues, after noticing that there were a significant number of patients who still had low back pain after receiving “successful” spinal surgery.

Dr. Beck said that, although he had many mentors tell him that patients in this category were “crazy,” he believed he had simply not fixed their problem, and that they had an additional “pain generator” (source of pain) outside of the spine.

He explained, “It really bothered me that I wasn’t making an attempt to fix these patients who desperately needed help… I started exploring what they had done in the past, and what, maybe, they had overlooked, and maybe what we could do differently in the future.”

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Now, let me stop right here and just say how much I appreciate everything Dr. Beck says.  I spent years wondering why so little help was available for the SI joint, and wondering if I was crazy to believe I had a problem no one seemed to ever have heard of.

I think it takes a really intelligent person and an open mind to be able to give a patient the benefit of the doubt when she says she still has pain, even though you just operated on her and you know you did everything “right.”

I met an orthopedist once with a similar attitude.  I went to him for knee pain, and confessed to him that several other doctors and PT’s had told me they didn’t understand the reason for my pain and had tried to refer me to mental health.  He became EXTREMELY annoyed and said “You know what?  No doctor should ever say that.  That is just what people say when they don’t know how to fix your problem.”  (Then he fixed my problem).

I can tell you I think Dr. Beck is probably the real deal based on this alone.

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Anyway, back to our story.

After enough patients still reported being in pain after spinal surgery, Dr. Beck began looking into SI joint surgery.  He explains that those initial surgeries from decades ago had been “lateral procedures”– meaning the surgeon came in from the side of the body to get to the SI joint.

Dr. Beck’s new procedure involves a “posterior” approach– that means the surgeon comes in from the back of the body.

According to Dr. Beck, this is much safer and has a much lower risk of injury, because the SI joint is much closer to the surface of the body when it is accessed from the back.  This means the surgeon’s scalpel does not have to travel has far, and there is less of the body involved that is at risk for accidentally being damaged.

He also points out that our surgical techniques these days are much safer and much less potentially damaging to the body than the techniques available decades ago when people were last pursuing SI joint surgery.

For that reason, he is really hopeful about the future of the device he is designing, called the Rialto implant.

The reason I was so excited about sharing this video at this point in time is because I am so grateful for the sense of context Dr. Beck provided on the history of SI joint problems overall, and for his conviction that sufferers of SIJD deserve help!

If you’re interested in learning more about Dr. Beck and the Rialto, I definitely recommend watching the entire interview, as well as this scientific study by Dr. Beck and his colleagues on the efficacy of the Rialto..

What did you think of the video?  Do you this explains why the medical profession has been so slow to learn how to treat the SI joint?  Let me know in the comments below!