SIJ arthritis causing pain? Think again, another non-link

By Christina Nowak BSc, MScPT, PhD(c)

Low back pain and hip pain are two large contributors to pain and disability as we age. Many doctors prescribe XRays as a first means to investigate what might be going on. Previously, I have done articles related to back pain and knee arthritis that has shown that the degree of arthritis does not seem to predict pain and dysfunction. In fact, taking images of persons without knee pain or back pain has shown signs of degeneration in a majority of cases.

Is this going to be true of all joints?

Maybe? A study published this month in the Journal of Bone and Joint Surgery (1) by Eno and colleagues did a similar investigation into the sacroiliac joint (SI joint). The SI joint is located at the base of the spine and is the link between the spine and the pelvis. In this study, they looked at 500 individuals who were going into an abdominal CT scan for unrelated circumstances (for example abdominal cancer) and therefore had no complaints of hip or low back pain. What they found was that the older you are, the more likely you are to have degeneration in that joint. This makes sense as living life creates more wear and tear of the joints in your body.

In persons as young as 50-59, 68% of persons had some evidence of degeneration in the SI joint, with 29% of those cases deemed significant. When you go up to the 80-89 age category, those numbers jump to 91% and 43%. This is showing that even persons who are asymptomatic, i.e. have no back pain, can show breakdown at this joint.

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So is arthritis a cop out? 

In my opinion, the answer is we don’t really know. Do I think that we can use this as a reason to not perform activities to strengthen and maintain the integrity of our joints? No. Persons do get relief after joint replacements but this opens the question as to whether this is the real cause of the pain or something else related to the arthritic process. Conservative management of arthritis at a variety of joints has been shown to be effective in relieving pain related to arthritis which usually consists of stretching and strengthening of joints in the lower body. Maybe we should be pushing for an intake process that requires an exercise-based intervention be trialed before entering into a surgical intervention.

Studies such as these provide further proof that even though a picture says 1000 words, sometimes it doesn’t tell the whole story.


1. Eno JT, Boone CR, Bellino MJ, Bishop JA. The prevalence of sacroiliac joint degeneration in asymptomatic adults. J Bone Joint Surg Am. 2015. 97: 932-6.

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Christina Prevett

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  1. Steve Gladstone says

    Hi there, while I agree with age-associated pain and degeneration is no more than an excuse ti give up and cop out, I also think that there often comes a time whe staving off medical intervention ( joint replacement/enhancement) is the best logical option for regaining lost ground. I write this after having enjoyed Crossfit for the past 4 years ( in New Zealand, Crossfit First Light) but two weeks ago had no choice but to have a total hip replecement/left side, due to the bone-on-bone situation and danger of breaking the femoral ball off inside my pelvis. I have kept the bone-end and it is not pretty. I am now in a strict process of physiotherapy and rehab in the hope of having another crack at the worlds in 2016 ( I competed 2014 & 15 ) I am 61 yrs old and am wondering if you have any articles/programmes etc I can give to my coach ( who is also my son!!) to keep my recovery progressional and not so ambitious that I do more harm than good. Before the op I could deadlift 150kg, and bang out 25 consecutive kipping pullups, but I want to get back to that and more. So here’s the challenge for you, don’t tell me that it’s not going to be possible, tell me that I can do it, and show me how.
    kind regards, Steve G.

    • says

      Hi Steve,

      This is amazing! Absolutely you can do it – with the joint replacements the first thing is going to be ensuring that you follow the hip precautions set out by your surgeon so that the implant heals properly and then you’re right its a gradual return to activity and the stronger your body is the less stress it places on the implant. Keep up your upper body strengthening for now, just do everything seated with the hip at more than a 90 degree angle

      Email me at and we can talk more about resources for you going through the rehab process! I am by no means a “you can’t do this anymore” type of physio! Focus on your rehab for now!


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