However, I wanted to address a larger question I had when I first looked into them, and why I, personally, decided not to proceed.
And again– this blog is based mainly on my own experience as a patient, and the opinions various medical professionals gave me at the time. I can’t promise that what turned out to be true for me will be true for you. However, my goal is to share the answers that I found, to save you the time I spent looking for them.
So why, ultimately, did I decide not to pursue lidocaine or cortisone injections?
A few reasons:
I was confident that I had a problem with SI joint dysfunction, so I didn’t feel I needed a diagnostic lidocaine injection.
I had previously had a bad reaction to a cortisone injection in my knee, and didn’t want to risk the same thing happening again.
However, there’s another overarching reason: neither I, nor the orthopedist I saw, were confident the injections would really help.
To answer this question, we need to first remember that there are different patterns that SI joint dysfunction can seem to follow.
Some people seem to have issues with hypermobility on both sides– the ligaments are sprained and stretched out and don’t hold the joints in place properly. And when the joints are moving around a lot out of their normal position, this can also create inflammation.
However, if you’re like me, one side at a time (and thank God it’s ONLY one side) can get stuck. Specifically, the hip bone can rotate backwards and get jammed against the sacrum. This starts as an issue of hypermobility, because the ligaments aren’t doing their job to hold things in place. However, most of the pain that I felt when my SI joint would lock up would be the pain of having the hip bone stuck, misaligned.
The hip bone and the sacrum are meant to fit together in a certain way. That’s why the surface of one has a bump where the other will have a groove. It’s sort of like a lock and key.
When the joint is misaligned, these bumps and grooves don’t line up. Instead, you can end up with a bump on a bump, which can create a lot of pain. It also affects the mechanics of how you walk– if your hip bone is stuck in a weird position, it also means your hip socket and therefore your leg bone are stuck in a weird position.
So, for me, when my joints would get stuck, I’d have a lot of pain and it would be hard to walk.
And then, when my chiropractor would put the joint in place– boom! All the pain would be gone. (The problem, as I learned later, is that chiropractic adjustments alone were never going to permanently hold the joint in place).
So, the question that I asked my orthopedist at the time was: If the pain I feel is from the joint being misaligned, and the pain goes away immediately when my joint is put into place… will an injection that’s meant to reduce inflammation really help me?
His answer was no. Cortisone wouldn’t work to cancel out that type of pain “bump on bump” pain, because it wasn’t primarily being caused by inflammation. It was caused by the two bones being misaligned, which, biologically speaking… should cause pain. It wasn’t a case of chronic inflammation that had been going on for weeks, which is what cortisone is used to treat.
(Lidocaine would definitely have blocked the pain out, because it cancels out the activity of the nerves that sense pain. However, it wouldn’t have had the same long-term effect).
Because I could get immediate pain relief when my chiropractor adjusted the joint, my orthopedist and I concluded that I probably didn’t have much lingering inflammation in the area– not that was causing pain, anyway– because when my joints were in place I was pretty much pain-free. So trying to target that clear-cut type of pain with an injection just didn’t seem to make sense.
Now… I can’t promise you that another doctor won’t think differently.
The frustrating thing about this appointment, quite frankly, was that I didn’t get the sense that this orthopedist actually knew much about the SI joint (although I appreciated that he’d been open-minded about trying to educate himself on it. Who knows– it’s been five years, maybe he’s proficient at treating it now).
But at the time, I honestly felt that his explanations sounded kind of vague, even just going by the tone of his voice. So if one of you happens to write to me and tell me that you expressed the exact same concern to your doctor and got a different answer… I won’t be terribly surprised. (In fact, with your permission, I’ll probably want to put your comments up on my blog!).
But this is the story, and the explanation, that I got at the time. Between the risk of side effects and the fact that my own doctor didn’t actually think the injections would help… it didn’t seem to be worth pursuing.
However, I do know people who say they’ve found cortisone injections in the SI joints to be helpful.
So… again, everyone is different. I do think there is a big range, from person to person, in terms of what type of dysfunction they actually have, and how much inflammation is present.
If you have significant inflammation, it would stand to reason that cortisone might help you.
And, again– if you and your doctor are having trouble telling where, exactly, your pain is coming from, a lidocaine injection might make complete and total sense.
But this, essentially, concludes all the reasons why I personally chose not to pursue these injections.
In the future? Who knows.
I am hoping to have kids someday and I’m aware that pregnancy and childbirth puts me at a significant risk for re-developing SI joint dysfunction. (In fact, since I had it for so long and I know my ligaments are still stretched out, I’m basically expecting it).
Although I’d expect my same exact symptoms to play out again, based on what I know to be true about my own hypermobile SI joints. But honestly, you never know.
So I’m not ruling out the idea that there are other circumstances under which I’d receive them, in the future.
But here, I’ve explained to the reasons why I, personally, chose not to receive them in the past. The issue of “bump on bump” pain is something I wish doctors treating the SI joint were able to address better.
Okay… that’s all for now! For more, you can also check out:
- SI Joint Injections, Part 1: Lidocaine
- SI Joint Injections, Part 2: Lidocaine and Cortisone Together
- My visit with an orthopedist, and why I didn’t pursue lidocaine and cortisone injections
- What is the difference between SI inflammation and dysfunction? Features a video where a spine surgeon discusses the relationship between SI joint dysfunction and inflammation. It’s helped me formulate some of the ideas I talked about in this post, and it’s definitely a must-watch.
Any comments or questions, share your thoughts below or email me at firstname.lastname@example.org!