Sacroiliac Joint Dysfunction
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Overview
Dysfunction in the sacroiliac joint is thought to cause low back pain and/or leg pain. The leg pain can be particularly difficult and may feel similar to sciatica or pain caused by a lumbar disc herniation. The sacroiliac joint lies next to the bottom of the spine, below the lumbar spine and above the tailbone (coccyx). It connects the sacrum (the triangular bone at the bottom of the spine) with the pelvis (iliac crest).
The joint typically has the following characteristics:
- Small and very strong, reinforced by strong ligaments that surround it
- Does not have much motion
- Transmits all the forces of the upper body to the pelvis (hips) and legs
- Acts as a shock-absorbing structure
Symptoms
The most common symptoms for patients are lower back pain and the following sensations in the lower extremity: pain, numbness, tingling, weakness, pelvis/buttock pain, hip/groin pain, feeling of leg instability (buckling, giving way), disturbed sleep patterns, disturbed sitting patterns (unable to sit for long periods, sitting on one side), pain going from sitting to standing.
Causes and Risk Factors
While it is not clear how the pain is caused, it is thought that an alteration in the normal joint motion may be the culprit that causes sacroiliac pain. This source of pain can be caused by either:
Too much movement (hypermobility or instability): The pain is typically felt in the lower back and/or hip and may radiate into the groin area.
Too little movement (hypomobility or fixation): The pain is typically felt on one side of the lower back or buttocks and can radiate down the leg. The pain usually remains above the knee, but at times pain can extend to the ankle or foot. The pain is similar to sciatica — or pain that radiates down the sciatic nerve — and is caused by a radiculopathy.
Diagnosis
Accurately diagnosing sacroiliac joint dysfunction can be difficult because the symptoms mimic other common conditions, including other mechanical back pain conditions like facet syndrome and lumbar spine conditions including disc herniation and radiculopathy (pain along the sciatic nerve that radiates down the leg). A diagnosis is usually arrived at through physical examination (eliminating other causes) and/or an injection (utilized to block the pain).
Treatment
Treatments for sacroiliac joint dysfunction are usually conservative (meaning nonsurgical) and focus on trying to restore normal motion in the joint:
- Ice, heat and rest.
- Medications: acetaminophen, as well as anti-inflammatory medications (such as ibuprofen or naproxen) to reduce the swelling that is usually contributing to the patient's pain.
- Manual manipulation provided by a chiropractor, osteopathic doctor or other qualified health practitioner may help. This can be highly effective when the sacroiliac joint is fixated or "stuck." It may be irritating if the sacroiliac joint is hypermobile. The manipulation is accomplished through a number of methods, including (but not limited to): side-posture manipulation, drop technique, blocking techniques and instrument-guided methods.
- Supports or braces for when the sacroiliac joint is "hypermobile," or too loose.
- Controlled, gradual physical therapy may be helpful to strengthen the muscles around the sacroiliac joint and appropriately increase range of motion. In addition, any type of gentle, low-impact aerobic exercise will help increase the flow of blood to the area, which in turn stimulates a healing response. For severe pain, water therapy may be an option, as the water provides buoyancy for the body and reduces stress on the painful joint.
- Sacroiliac joint injections.
When these treatments fail, surgery may be offered. In surgery, one or both of the sacroiliac joints may be fused with the goal of eliminating any abnormal motion.
© 2000-2022 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.
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The groin is the area between the lower abdomen and the upper thighs. Females may experience stabbing pain on the left side of the groin for many reasons.
Below, we look at various reasons why a female can experience this pain, as well as treatments and home care strategies and when to see a doctor.
A strain in the groin may result from injury or overexertion, and a past groin injury increases the odds. A strain can occur on the left or right side.
Authors of one 2015 review observe that groin strains are very common among people who play sports that require kicking, sidestepping, or quick changes in direction, such as football and ice hockey.
According to the United Kingdom’s National Health Service (NHS), symptoms of a groin injury include:
- sudden, sharp, stabbing pain
- dull aching
- tenderness
- bruising
- swelling
- delayed pain after the injury
These symptoms can also affect the inner thigh muscle. If the injury extends to the abdominal muscles, sneezing or coughing may trigger or worsen the pain.
Treatment
A person may be able to treat a mild groin strain at home. The NHS recommend resting the hip and groin area for the first 24–48 hours after the injury.
However, it is important to avoid long periods of inactivity; a person should move the area gently for 10–20 seconds every hour during the day. After 48 hours, try to increase the movement.
The NHS also advise that if pain from the injury lasts longer than 2 months, the person should see a physiotherapist. They can provide treatment and recommend exercises to do at home.
Learn more about exercises for groin strains here.
A person may experience left sided groin pain due to a health issue affecting the hip.
A stabbing pain in this area may be due to:
- Hip bursitis: This occurs when a fluid-filled sac on the inside or outside of the hip becomes inflamed. Hip bursitis is more common in females and older adults.
- Labral tear: This is a tear in the tissue surrounding the hip socket.
- Impingement: This occurs when there is friction between the ball and socket of the hip joint, due to an abnormal shape of either structure.
A person with any of these issues may feel pain during specific movements or in certain positions. The pain may be sharp, and there may be a sensation of the hip catching or snapping.
Treatment
The best approach to any of these conditions may involve the following, often in combination:
- rest
- nonsteroidal anti-inflammatory drugs, known as NSAIDS
- physical therapy
- steroid injections
- surgery
People with hip bursitis may also benefit from an assistive device, such as a cane or crutches.
A kidney stone in the left kidney may produce a sharp, stabbing pain in the back and left side that extends to the left groin.
The pain may be sudden and come and go. Other symptoms include:
- an urgent need to urinate
- frequent urination
- a burning sensation when urinating
- blood in the urine
- nausea and vomiting
Treatment
Smaller stones may pass without medical treatment.
The doctor may recommend waiting for up to 6 weeks for the stone to pass — providing that the pain is bearable, there is no sign of infection, and the kidney is not fully blocked. A person should stay hydrated as usual during this time.
Otherwise, a person may need shock wave treatment or surgery to break up or remove the stone.
Pain in the groin may result from a hernia, which may be inguinal or femoral.
An inguinal hernia occurs when contents of the abdomen bulge through a weakened area in one of two passages on either side of the groin, called the inguinal canals.
A femoral hernia forms deeper within the groin, in passages called the femoral canals. Femoral hernias are less common overall but more likely to develop in females than in males.
Femoral and inguinal hernias are more likely to appear on the right side of the body, but they can form on the left.
A hernia in the left groin can cause pain, other discomfort, and a feeling of heaviness in the area.
Treatment
Surgery may be necessary to treat a hernia.
Also, it is important to note that severe, sudden pain can indicate that a hernia is cutting off blood flow within the intestines, in which case it is called a strangulated hernia. This requires immediate medical care.
Endometriosis occurs when tissue similar to the lining of the uterus develops outside of the uterus.
It can cause pain in the lower abdomen that may radiate to the groin and legs. The pain may be stabbing, sharp, or burning.
Symptoms of endometriosis also include:
- abdominal pain or cramps
- fatigue
- painful periods
- pain during or after sex
- rarely, swelling in the groin
Treatment
Endometriosis treatment tends to involve pain relief medications, hormone therapy, and in severe cases, surgery.
Pregnancy can lead to other causes of pain on the left side of the groin, including:
Round ligament pain
The round ligaments are two bands of tissue that connect the uterus to the pelvis.
During pregnancy, the ligaments become looser in order to stretch as the uterus expands. As the ligaments stretch, they can spasm and cause pain.
Round ligament pain is a common issue during pregnancy, and it poses no threat to the woman or fetus. It usually starts in the second trimester, though it can happen earlier.
The pain may be stabbing and sharp and may extend within the groin. A woman may feel the pain on one or both sides, and sudden movements, laughing, or coughing can make it worse.
Treatment
Warm baths, lying on the side with a pillow between the knees, and antenatal yoga may help ease this pain.
Pelvic pain
According to Tommy’s, a British pregnancy charity, as many as 1 in 5 women experience pelvic pain during pregnancy.
Doctors may refer to it as symphysis pubis dysfunction or pelvic girdle pain. The issue does not affect the developing fetus.
The pain may be moderate to severe and affect the groin and pelvis. In some women, it is severe enough to interrupt sleep and disrupt daily activities.
A woman with this pain may experience:
- pain in the lower back
- a grinding or clicking sensation in the pubic area
- pain that worsens when parting the legs or leaning on one leg
- pain triggered by certain activities, such as walking or climbing the stairs
Treatment
A healthcare professional can discuss safe options, and they may recommend:
- physiotherapy
- pain medication, such as acetaminophen (Tylenol)
- alternative therapies, such as yoga and massage
- pregnancy support belts or pelvic blocks
If a groin strain is causing the left sided pain, the RICE technique may help. RICE stands for:
- Rest: Avoid strenuous activity and exercise, and limit walking, particularly for the first 48 hours.
- Ice: To reduce swelling, apply a cold compress or ice pack wrapped in a cloth to the area for 5–10 minutes every 2–3 hours.
- Compress: Wrap the affected area in bandages for support and to help reduce swelling.
- Elevate: If possible, elevate the area with pillows.
After 2 days, a person may find heat more effective than cold. It may help to use a heating pad on the groin for 5–10 minutes, three or four times a day.
The right approach to other types of groin pain depends on the cause, but the following general strategies may help:
- Avoid bending, heavy lifting, and strenuous activity before consulting a doctor or for 2–3 days after symptoms ease.
- Avoid any activity that worsens symptoms.
- Wear clothing that is loose around the groin and abdomen.
- Take pain medication, though pregnant women should consult a doctor first.
To diagnose the cause of groin pain, a doctor first assesses the symptoms and takes a full medical history.
Next, they perform a physical examination of the affected area, which may include the lower back, lower abdomen, and hips.
They may also order or conduct further tests, such as an ultrasound, CT, or MRI scan, to diagnose issues such as endometriosis or kidney stones.
Some causes of groin pain resolve without treatment or with home care. However, see a doctor about any of the following issues:
- severe pain
- pain that worsens or does not improve within a few days or with home care
- pain that extends to the abdomen
- blood in the urine
Stabbing pain in the left groin can result from injuries or various medical conditions. Pain in this area can also be an expected part of pregnancy, but it is important that a doctor makes the diagnosis.
Anyone who has severe or persistent pain in this area should receive medical care right away.
SHOP FOR ASSISTIVE DEVICESSome products mentioned in this article are available to purchase online, including:
- walking canes
- crutches
- knee cushions
- pregnancy support belts
- pelvic blocks
Anyone purchasing an assistive device should receive medical guidance about the fit and correct use. Crutches, in particular, need to be professionally fitted.
Also, for an insurance plan to cover the cost, the device generally needs to be ordered by a physician.