Dr. Khitish Mohanty on Sacroiliac Joint Disorders

Sacroiliac (SI) joint disorders are a commonly overlooked cause of lower back and pelvic pain. Despite their prevalence, these disorders often go undiagnosed due to overlapping symptoms with other spinal or hip conditions. Dr. Khitish Mohanty, an experienced clinician in musculoskeletal medicine, has devoted significant attention to the evaluation, diagnosis, and management of SI joint disorders. His clinical insights provide valuable guidance for both healthcare professionals and patients navigating these complex conditions.

Understanding the Sacroiliac Joint

The sacroiliac joints are two joints located where the sacrum (the triangular bone at the base of the spine) meets the iliac bones of the pelvis with Mr. Mohanty. These joints are critical in transferring weight and forces between the upper body and the lower limbs. Though they allow limited movement, their role is more about stability and shock absorption.

Disorders of the SI joint typically arise from inflammation, dysfunction, trauma, pregnancy-related changes, or degenerative processes. Patients with SI joint dysfunction often experience pain in the lower back, buttocks, hips, or even down the legs, making it easily confused with lumbar disc issues or sciatica.

Causes and Risk Factors

Dr. Mohanty emphasizes a multifactorial approach when considering the causes of SI joint disorders. Trauma, such as falls or accidents, can disrupt the normal biomechanics of the joint. Repetitive stress from sports or physical labor may also lead to micro-injuries and chronic inflammation. Pregnancy is another common factor, where hormonal changes and altered posture place additional stress on the pelvic joints.

In addition to mechanical stressors, degenerative conditions such as osteoarthritis can erode the joint surfaces, causing pain and reduced mobility. Individuals with certain inflammatory disorders like ankylosing spondylitis are also at increased risk, as the SI joint is often one of the first areas affected.

Diagnosis: A Clinical Challenge

According to Dr. Mohanty, diagnosing SI joint disorders requires a meticulous clinical examination and thorough patient history. Because the symptoms can mimic other conditions, it's crucial to rule out lumbar spine pathology, hip disorders, and nerve impingement.

Dr. Mohanty often employs a series of physical tests to provoke SI joint pain, helping isolate the source of discomfort. These may include the FABER test, Gaenslen’s test, or the compression/distraction tests. While imaging techniques like X-rays or MRI can aid in diagnosis, they are not always conclusive. Diagnostic injections into the SI joint are sometimes used as both a diagnostic and therapeutic tool — if pain relief is achieved after the injection, it strongly suggests the joint as the pain generator.

Non-Surgical Management

One of the core principles of Dr.  Khitish Mohanty approach is conservative care as the first line of treatment. He advocates a personalized treatment plan that addresses both pain relief and functional restoration.

Physical Therapy
Physical therapy plays a central role in managing SI joint dysfunction. Dr. Mohanty highlights targeted strengthening of the core, gluteal muscles, and pelvic stabilizers as essential to reducing strain on the joint. Stretching tight muscles and correcting posture can also improve biomechanics and reduce recurrence.

Manual Therapy
Joint mobilization and manipulation techniques performed by skilled professionals can help restore mobility and alignment. These interventions are particularly helpful in cases of mechanical dysfunction without underlying inflammation.

Medications and Injections
For inflammation and acute pain, non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used. In some cases, corticosteroid injections into the SI joint provide significant relief and can assist in breaking the cycle of chronic pain. Dr. Mohanty cautions that injections should be used judiciously and in conjunction with rehabilitation efforts.

Support Devices
For patients with hypermobility or instability, the use of pelvic belts or braces can offer additional support to the joint, particularly during activities that aggravate symptoms.

Surgical Considerations

While the majority of SI joint disorders can be managed non-surgically, a small subset of patients may require surgical intervention. This is typically considered when conservative measures fail over an extended period and the patient experiences significant disability.

Surgical fusion of the SI joint is the most common procedure in such cases, intended to stabilize the joint and eliminate painful motion. Dr. Mohanty stresses that such interventions should only follow comprehensive evaluation and when clear diagnostic evidence supports the SI joint as the primary pain generator.

Holistic and Preventive Care

Dr. Mohanty also promotes a holistic view of musculoskeletal health. He encourages long-term lifestyle changes that support joint health, including maintaining a healthy weight, regular low-impact exercise, and ergonomic adjustments in daily life and work environments.

Educating patients about their condition is a cornerstone of his approach. When individuals understand the source of their pain and the rationale behind each treatment modality, adherence improves, and outcomes are generally better.

Looking Ahead

The field of SI joint disorder management continues to evolve, with ongoing research into regenerative therapies, improved diagnostic techniques, and minimally invasive interventions. Dr. Khitish Mohanty remains an active contributor to the clinical understanding of these conditions through his patient-centered practice and continuous exploration of emerging methods.

Conclusion

Sacroiliac joint disorders may be under-recognized, but with careful diagnosis and a well-rounded treatment strategy, patients can achieve substantial relief and improved function. Dr. Khitish Mohanty’s clinical experience underscores the importance of individualized care, early intervention, and a multidisciplinary approach. His work offers hope and clarity to patients suffering from this often misunderstood source of pain.