What is the difference between SI Joint inflammation and dysfunction?

In the video above, Dr. Ty, a spine surgeon who operates on the SI joint using the Zyga implant, describes a very important concept for people suffering from SI joint dysfunction to understand.

SI Joint Dysfunction vs. Inflammation

SI Joint Dysfunction is “an umbrella term for an abnormality within the joint.”  Although this umbrella term can include inflammation in the joint, Dr. Ty explains that most often when clinicians use the word, they are using it to refer to “either an abnormal motion or an abnormal position of the SI joint.”

Now, when the SI joint is out of place, this means that the ligaments that are supposed to hold it in place are not doing their job, and have become slightly stretched out.

This is what Dr. Ty means by the term “ligamentous laxity”– ligaments that are lax, or loose.

The overlap between SI joint dysfunction and inflammation occurs here, at the ligaments:

“When ligaments become loose, they can become inflamed, and this is typically what we refer to as SI joint inflammation.”

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This has been a question that I’ve really thought about a lot in the past few years.  I always considered the main problem with my SI joints to be that they were constantly rotating out of place and then getting stuck that way.  (This would be in the first category Dr. Ty describes: SI Joint Dysfunction, an abnormal motion or position of the joint).

However, many of the interventions that were suggested to me by various physicians all seemed to be targeting a problem that was caused more by inflammation.

I actually haven’t written about this previously because it wasn’t super helpful, but I did see an orthopedist once who offered to do a lidocaine injection into my SI joints.  This is supposed to be one of the gold standards for diagnosing SI joint pain (the idea is that if the injection helps, then it really was your SI joint causing pain, versus something similar like the lower back).

However, I really questioned the orthopedist on this and explained that my level of pain really seemed to be dependent on the position my SI joints were in.  When they were out of place (or stuck) I had pain, but then as soon as my chiropractor put them back into place, the pain went away.  (This was before I learned to adjust them myself, an important part of my story).

I asked him, if the pain goes away as soon as my joints are put back into place, is the lidocaine injection really going to make that much of a difference?

He had to admit no, not really.  I asked him a bunch of questions, and determined that the lidocaine injection would help more with an inflammation-based problem that was not so dependent on the positioning of the joint.   He said that, based on the way I described my symptoms, it was not really clear whether or not the lidocaine shot would help.

He still was more than willing to do it– I think it is drilled into the head of every doctor who treats the SI joint that lidocaine injections are the first step.  However, I personally decided it wasn’t worth it for me, since I’d had a bad response to a cortisone shot in my knee once and ended up in even more pain, simply from having fluid injected into a joint that was already inflamed.

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So I really appreciated this video because I think it helped to sort of clarify what went on for me back then.

As I noted during my post about my second visit with a physiatrist, it seems that most physicians that treat the SI joint without actually performing surgery are more comfortable with the idea of SI joints that are hypermobile or inflamed, but not necessarily getting stuck in the wrong place.

I believe this is the main reason why MD’s were never really able to help me– I was only really helped from people who had been trained in directly addressing the positioning of the joint, such as chiropractors and PT’s.

(Now, there are MD’s who do deal with the positioning of the SI joint, however these are generally surgeons, who are operating in order to fix its positioning and stabilize it in a good place).

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This is definitely a complicated concept, and possibly one of my most complicated posts yet, but I hope it is useful to you guys!

I know it’s always helpful for me to write all my thoughts out and link to related resources, as I try to generally tie everything together in order to come up with a better understanding of this joint.

So I hope you enjoyed reading it as well!  Any comments or questions, feel free to drop me a line or leave a comment below.

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A note on SI joint surgery: I have not written a ton on SI joint surgery yet, because thankfully, I have not had to learn much about it in order to heal my own problems.

However, there are a few different surgical options which are being developed.  I am not well educated enough on any of them to make a pronouncement yet.  So, if I share resources that are produced by the various companies behind these devices, it is in the spirit of collecting information, and because I’m interested in what the doctors who perform these procedures have to say.  Like everything I share here, of course, it’s important to simply take what is useful to you, and of course, consult your own doctor with questions about your next steps!

 

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