Imaging and the SI joint

Hey everyone,

A question my readers and coaching clients ask pretty often is whether imaging, such as an x-ray or MRI, can be used to diagnose SI joint dysfunction.

Technically, imaging cannot be used to diagnose whether your SI joints are in or out of alignment. We are only talking about bones that may move by a few millimeters. It’s not something that a radiologist will be able to pick up on just by looking at the image, because you may not really look that different from a “normal” person.

The only exception to this would be if you’ve been in an accident or experienced a significant trauma to the area, which could have caused a dislocation. But in terms of typical SI joint dysfunction, imaging doesn’t really tell you much about your alignment.

However, imaging is still an important part of the process.

It can be used to rule out other issues, and also to determine the level of inflammation that you may have which can potentially be caused by other health conditions.

Let’s delve into this further:

Ruling out a fracture

If you’ve had some kind of injury to the pelvis and are in significant pain, it will be important to examine the bones themselves and make sure you didn’t actually fracture anything. Thankfully, a minor fracture will heal on its own with time, but it will be important to be aware of before pursuing any kind of treatment plan.

Other potential causes of pain

Of course, I don’t want to scare anyone, but it is possible to have something else going on in the pelvis which may be causing pain. For example, some people may have a tumors or growths (which may be completely benign!) but which could be causing pain similar to SI joint symptoms.

In women, it’s also important to rule out conditions such as endometriosis, which can cause widespread abdominal pain. So imaging such as x-ray, MRI, or potentially even CT scan if indicated, can really help to make sure nothing else is going on.

Check for inflammation

So, of course, any time you’re having joint pain, it makes sense that you’d be having some level of inflammation in the joint.

Osteoarthritis is the type of arthritis caused by biomechanical factors. If your joints have been subject to a lot of wear and tear over the years, it may have begun to affect the surfaces within the joint. This may indicate that you would benefit from treatments in addition to traditional physical therapy, such as oral steroids or cortisone injections.

Autoimmune Conditions

There are certain systemic conditions, such as autoimmune disorders, which can actually cause the inflammation in your SI joints. In this case, although it might feel as though you’re experiencing musculoskeletal pain, it could actually be an overactive immune system creating the inflammation you feel.

Imaging can be key in identifying autoimmune conditions such as anklyosing spondylitis, which would cause a higher level of inflammation in the joint than would be seen in typical SI joint dysfunction. It can also potentially cause changes in the shape and nature of the joint, which would help to confirm the diagnosis.

If you have an autoimmune condition, your treatment course will be different than if you were treating a purely musculoskeletal condition. Your physician will likely prescribe medication to help get your symptoms under control (and I’ve heard from readers they can make a big difference!).

(Note: there is also a blood test that checks for a common marker of autoimmune diseases, called the HLA-B27 gene. This is often used as part of the workup to check for autoimmune conditions, combined with imaging– together, they give the whole picture).

These are just some of the reasons why, if your physician requests it, I highly suggest you follow through on imaging.

Although imaging cannot currently be used to assess your alignment, it is really crucial to identifying the exact nature of the problem.

After all, you don’t want to spend months in physical therapy, only to find out you have an autoimmune condition that needs to be treated with medication.

The future of imaging

Although I say that imaging cannot currently be used to assess your alignment, I’ve had a feeling for a long time that this may also be because radiologists are not trained in what to look for.

I’ve been starting to hear anecdotal stories from readers about new advances in technology at the Mayo Clinic in Rochester, MN. I believe there is a surgeon there (Dr. William Cross III) who is pioneering a new type of SI joint fusion and has also been able to use imaging to diagnose several of his patients, based on the amount of “gas” appearing within the joint.

Although I do not have firsthand experience with this myself, I am very excited to hear about it. I really believe that, as awareness of SI joint dysfunction grows, our ability to treat it is going to expand widely!

Okay… that’s all for now!

Remember that knowledge is power! The more specifically you’re able to identify the nature of your problem, the more pinpointed you’ll be able to be with your treatments.

Happy researching!