Sacroiliitis Causes Treatment and the Role of Obesity in its Occurrence

Sacroiliac joint inflammation is a common condition that causes disturbing pain in the lower back and pelvic region. In some cases, the pain may extend to the buttocks or thighs, making daily movements such as sitting, standing, or walking more difficult. This inflammation occurs due to several different causes, including physical strain, injuries, or certain inflammatory diseases. Lifestyle factors and excess body weight can also play an important role in increasing the risk of developing the condition or worsening its symptoms.In this article from Dalili Medical, we will explore the causes of sacroiliac joint inflammation, its symptoms, complications, and treatment options, as well as its relationship with obesity and excess weight.

What is sacroiliac joint inflammation?

Sacroiliac joint inflammation is a painful condition that affects the joint connecting the lower spine to the pelvic bones. It leads to pain in the lower back and buttocks, and in some cases, the pain may extend down to the legs. This inflammation is often caused by injuries, inflammatory conditions such as arthritis, or overuse of the joint. It is usually treated with pain relievers, physical therapy, and sometimes local injections to reduce pain and stiffness and improve joint mobility.

❓ Is sacroiliac joint inflammation serious?

It is not considered a dangerous condition, but it can be very uncomfortable. If left untreated or poorly managed, it may become chronic and lead to recurring symptoms.

❓ Does it go away on its own?

Symptoms may improve with rest and reduced physical activity, but the condition often returns if the underlying causes—such as muscle weakness or abnormal movement patterns—are not addressed.

❓ How long does recovery take?

Recovery time varies depending on severity:

Mild cases: 1 to 3 weeks
Moderate cases: 4 to 8 weeks
Chronic cases: may take longer depending on response to treatment and adherence

❓ Can I exercise during the condition?

It is recommended to avoid exercise during acute pain. Gradual return to physical activity is possible after improvement, preferably under the supervision of a physical therapist.

❓ What factors worsen the pain?

Several factors may aggravate symptoms, including:

Long-distance running
Climbing stairs
Prolonged sitting with bent knees
Activities on hard surfaces

❓ Is obesity or excess weight related?

Yes, excess weight increases pressure on the joints, especially the hips and lower back, which can worsen symptoms and increase the likelihood of recurrence or prolonged recovery.

❓ Do shoes affect the condition?

Yes, significantly.
Wearing improper footwear or using old, worn-out shoes can contribute to the problem. Poor shoe support affects pressure distribution during movement and increases stress on the joint and surrounding tissues.

Stages of Iliotibial Band Syndrome (IT Band Syndrome)

Iliotibial band syndrome typically progresses through several stages depending on the severity and duration of strain:

Stage 1: Mild irritation

Mild pain during or after physical activity
Pain localized on the outer side of the knee or thigh
Quickly relieved with rest
Often overlooked at this stage

Stage 2: Moderate inflammation

Pain appears earlier during activity
Worsens with running or stair climbing
May significantly affect performance
Area becomes tender to touch

Stage 3: Severe inflammation

Pain persists even during normal walking
Rest alone is not enough to relieve symptoms
Burning or tight sensation appears
Daily movement becomes limited

Stage 4: Chronic (neglected) inflammation

Long-lasting pain that may persist for weeks or months
Usually due to untreated or continued overuse
May alter walking pattern to avoid pain
Requires long-term physical therapy and rehabilitation exercises

Causes of Iliotibial Band Syndrome (IT Band)

Iliotibial band syndrome is usually caused by repetitive strain or mechanical stress during movement. The most common causes include:

1) Overuse of the joint

Long-distance or frequent running
Prolonged walking or standing
Sudden increase in training intensity without gradual progression

2) Muscle weakness or imbalance in the hip and thigh

Weak gluteal muscles, especially the gluteus medius
Imbalance between inner and outer thigh muscles
This increases tension on the iliotibial band beyond normal limits

3) Improper movement or running technique

Incorrect running form
Poor foot landing during movement
Body misalignment while walking or running

4) Foot problems

Flat feet
Excessive foot arch
These affect pressure distribution across the knee and thigh

5) Improper footwear

Wearing old or unsupportive athletic shoes
Choosing shoes that are not suitable for the type of physical activit

6) Running on unsuitable surfaces

Repeated running on hard surfaces such as asphalt
Relying on one side of the road or uneven surfaces consistently

7) Lack of warm-up or stretching

Not performing stretching exercises before and after workouts
Starting physical activity without preparing the muscles for movement

Symptoms of Iliotibial Band Syndrome (IT Band Syndrome)

1) Pain on the outer side of the knee

One of the most common symptoms
Appears on the outer (lateral) side of the knee
Worsens with running or long-distance walking

2) Pain in the outer thigh or hip area

May start in the upper thigh and extend toward the knee
Feels like tightness or a burning sensation on the outer side

3) Increased pain with movement

Pain worsens during running or stair climbing
May also appear with fast walking in some cases

4) Relief with rest

Pain decreases or disappears when resting or sitting
However, it may return once activity resumes

5) Clicking or friction sensation

Some patients feel a clicking sensation on the outer side of the knee
Caused by friction of the iliotibial band during movement

6) Tenderness when pressing the outer knee

The outer knee becomes sensitive to touch or pressure
Pain is usually localized and clear

Diagnosis of Iliotibial Band Syndrome (IT Band Syndrome)

Diagnosis is mainly based on clinical examination and medical history rather than laboratory tests.

1) Medical history

The doctor asks about:

Exact location of pain
Relationship between pain and running or stair climbing
When symptoms started and whether they followed increased activity
Whether pain improves with rest

2) Clinical examination

Includes:

Tenderness on the outer side of the knee
Possible pain extending to the outer thigh
Tightness or stiffness in the iliotibial band

3) Special tests

Noble Compression Test

Pressure is applied to the outer knee while bending and straightening it
Pain at a specific angle suggests IT band syndrome

Ober Test

Used to assess tightness of the iliotibial band
Difficulty lowering the leg indicates tightness or restriction

4) Imaging tests

Usually not required in mild cases
Used only to rule out other conditions such as:
- Osteoarthritis
- Cartilage injuries
- Other knee problems

⚠️ Complications of Iliotibial Band Syndrome

Complications usually occur if the condition is ignored or physical activity continues despite pain:

1) Chronic pain in the knee or thigh

Pain may become daily and persistent
Can occur even during normal walking or rest in severe cases

2) Difficulty in movement

Reduced ability to run or climb stairs
Gradual changes in normal walking pattern

3) Recurrence of symptoms

Symptoms may return after improvement
Often due to untreated underlying causes such as muscle weakness

4) Changes in walking pattern

Patients may alter their gait to avoid pain
This can increase stress on:
- Inner knee
- Hip joint
- Lower back

5) Muscle weakness

Reduced activity leads to weakening of thigh and gluteal muscles
This may worsen the condition and delay recovery

6) Reduced athletic performance

Difficulty returning to previous sports level
Or temporary suspension of sports activities

Medical treatment of IT Band Syndrome

Drug treatment mainly aims to reduce pain and inflammation and is usually combined with rest and physical therapy.

1) NSAIDs (Non-steroidal anti-inflammatory drugs)

Examples:

Ibuprofen
Diclofenac
Naproxen

Benefits:

Reduce pain
Decrease inflammation
Improve mobility

Important notes:

Preferably taken after meals
Should not be used for long periods without medical supervision
Not suitable for patients with stomach ulcers or kidney problems

2) Topical pain relievers (creams and gels)

Example:

Diclofenac gel

Benefits:

Applied directly to the painful area
Provides local pain relief
Fewer side effects than oral medications

3) Paracetamol

Used for pain relief only
Does not reduce inflammation
Suitable for mild cases or in combination therapy

4) Local injections (in severe cases)

Such as corticosteroid injections into the inflamed area
Help reduce inflammation quickly
Should not be repeated frequently to avoid tissue damage

Surgery for IT Band Syndrome and procedure

In reality, surgical treatment for iliotibial band syndrome is very rare. Most cases improve with conservative treatment such as rest, physical therapy, and medications. Surgery is only considered in chronic cases that do not respond to long-term conservative management.

First: When is surgery considered?

Surgical intervention is only considered in the following cases:

Persistent pain lasting more than 6 to 12 months
Failure of physical therapy and medications to improve the condition
Significant impact on walking and daily movement
Presence of severe friction or a clear mechanical problem in the joint

Types of surgery (rare cases)

1) Iliotibial Band Release

Idea:

Partial release or incision of the iliotibial band to reduce tightness and friction

Procedure:

Usually performed arthroscopically (minimally invasive) or through a small incision
Aims to reduce tension on the outer side of the knee without fully removing the band

2) Removal of fibrotic or inflamed tissue

Idea:

Removing a small portion of the iliotibial band if it becomes thickened or fibrotic

Goal:

Reduce repeated friction with the outer knee bone
Improve joint movement

3) Bursectomy (removal of inflamed bursa)

Idea:

Removal of a small fluid-filled sac (bursa) if it is the main source of pain

Goal:

Reduce inflammation and pain caused by tissue friction

4) Corrective mechanical surgery (very rare)

Idea:

Performed when there is a clear structural cause behind the condition, such as:
- Knee misalignment
- Foot or hip deformities

⚙️ After surgery

Even after surgical intervention, rehabilitation remains essential and includes:

Regular physical therapy
Strengthening exercises for the gluteal and thigh muscles
Gradual return to physical activity and movement

Treatment of Iliotibial Band Syndrome (IT Band) with exercises

The main goal of exercises is to reduce tightness, improve muscle flexibility, and strengthen the hip and thigh muscles to relieve pain and prevent recurrence. Exercises should be done gently and without causing significant pain.