When Back Pain Doesn’t Add Up
You’ve tried stretching, therapy, or even imaging — but your back pain won’t quit.
For some, this pain isn’t purely mechanical. Many Lyme disease patients report chronic back or hip pain that actually stems from sacroiliac joint inflammation — a form of sacroiliitis.
Sacroiliitis occurs when the SI joints (where the spine meets the pelvis) become inflamed, leading to pain that radiates into the lower back, buttocks, or thighs.
It’s often mistaken for degenerative disc disease or sciatica, but in Lyme disease, the root cause may be infectious inflammation rather than structural damage.
What Is Sacroiliitis?
The sacroiliac joints connect the spine to the pelvis, supporting much of the body’s weight.
When inflamed, these joints can cause deep, aching pain that worsens when sitting, standing for long periods, or climbing stairs.
While sacroiliitis is classically linked to autoimmune or inflammatory disorders like ankylosing spondylitis, Lyme-related sacroiliitis is increasingly recognized as part of the Lyme arthritis spectrum — often misdiagnosed as mechanical low back pain.
How Sacroiliitis Appears in Lyme Disease
Lyme disease can inflame multiple joints, including the sacroiliac (SI) joints, resulting in deep, persistent pain.
Typical symptoms of Lyme disease sacroiliac joint pain include:
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Aching or stabbing pain in the lower back or buttocks
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Pain that may affect one side more than the other
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Morning stiffness that improves with movement
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Fluctuating pain patterns or migrating joint symptoms
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Imaging that shows inflammation without clear structural damage
This fluctuating, migratory nature of pain is a key sign of Lyme arthritis SI joint involvement.
Why It’s Often Missed
Because SI joint inflammation is hard to detect on routine X-rays and often mistaken for muscle strain, many cases of Lyme-related sacroiliitis go undiagnosed.
Patients are frequently referred for pain management, orthopedic care, or even surgery before the infectious cause is considered.
Recognizing Lyme disease back pain as a possible inflammatory process — not just mechanical — can prevent unnecessary procedures and years of chronic discomfort.
Treatment and Recovery
When sacroiliitis occurs in Lyme disease, inflammation in the sacroiliac (SI) joint is often driven by both infection and immune activation. Effective care must address both causes:
Treatment typically begins with antibiotic therapy guided by established Lyme protocols, aimed at eradicating the underlying infection. Targeted physical therapy helps restore pelvic stability and mobility while preventing compensatory strain. Anti-inflammatory medications may be added to ease pain and swelling, supported by rest, gentle movement, and progressive strengthening.
With an integrated approach, many patients experience steady improvement in SI joint pain, flexibility, and function, often avoiding long-term disability or the need for invasive procedures.
When Back Pain Signals Something Deeper
For patients with chronic Lyme disease sacroiliac joint pain, identifying sacroiliitis as part of Lyme’s inflammatory process can be life-changing. Persistent hip or buttock pain that defies standard treatment deserves a closer look — infection-driven inflammation is often the missing link.
Have you experienced back or hip pain that didn’t respond to standard care? Share your story below — your insight could help another patient find answers.
Frequently Asked Questions
Can Lyme disease cause sacroiliitis?
Yes. While less commonly recognized than Lyme arthritis in the knee, Lyme disease can cause inflammation of the sacroiliac joints, leading to persistent low back and hip pain.
How is Lyme-related sacroiliitis different from other causes?
Lyme-related sacroiliitis often has a migratory or fluctuating pattern, may not show up clearly on standard imaging, and typically appears alongside other Lyme symptoms like fatigue or cognitive issues.
Will my SI joint pain go away with Lyme treatment?
Many patients see significant improvement in SI joint pain once the underlying infection is treated. However, recovery timelines vary, and some patients need additional physical therapy or anti-inflammatory support.
Should I get tested for Lyme if I have unexplained sacroiliitis?
If you have persistent SI joint pain that hasn’t responded to standard treatments, especially with a history of tick exposure or time spent in Lyme-endemic areas, Lyme testing should be considered.
