Ask the Expert: Healthcare, sponsored by Dr. Eric Oberlander

Dr. Eric Oberlander
Board Certified Neurosurgeon

I’ve had back pain for years and nothing has helped. Where do I even start?

The first thing I tell patients is — don’t assume it’s been properly evaluated just because it’s been looked at. The sacroiliac joint is one of the most overlooked sources of chronic low back pain. Studies suggest 15 to 30 percent of chronic low back pain may actually be coming from the SI joint, not the spine itself. That’s a significant number of people walking around with an answer nobody’s looked for yet.

What is the SI joint, and why does it cause so much pain?

The sacroiliac joint connects your pelvis to the base of your spine, and its job is to transfer weight and forces between your upper body and your legs. It functions like the body’s shock absorber. Like any joint, it can degenerate over time or the surrounding ligaments can be injured, and when that happens, it can produce significant, chronic pain that people often mistake for a spine problem.

How do I know if my symptoms are coming from my SI joint?

One of the most telling signs is something we call the Fortin Finger test -patients can point with one finger to exactly where it hurts, right at the base of the spine just below the belt line, almost always on one side. Beyond that, the pattern is recognizable: lower back and buttock pain. a sensation of tingling or weakness in the leg, difficulty sitting for long periods without shifting to one side, and real pain when getting up from a chair. If that sounds familiar, the SI joint should be considered as a contributor to your pain.

Why is SI joint pain so hard to diagnose?

That’s the most common frustration I hear. SI joint dysfunction doesn’t show up on imaging the way a herniated disc does, and many evaluations simply don’t include it. A proper diagnosis requires a thorough physical exam of the lumbar spine, the SI joint, and the hip, combined with specific provocative tests and, most definitively, a diagnostic injection directly into the joint. Without that, it’s easy to miss entirely. I always make sure we’re looking at the full picture.

If the SI joint is the problem, what can actually be done about it?

There’s a real range of options, and we always start conservatively. That means physical therapy, anti-inflammatory medications, SI joint belts for support, and targeted injections with anesthetic and steroids. Radiofrequency ablation is another option. For patients who’ve tried those approaches and are still suffering from chronic, debilitating pain, minimally invasive SI joint fusion can be a very effective next step. The key is finally having the right diagnosis, because the right treatment follows from that.

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