Sacroiliac (SI) Joint Pain: Treatment Options and What to Expect

If you have stubborn pain low in your back that sits to one side and spreads into your buttock or hip, the problem may not be a disc or your hip joint at all – it may be your sacroiliac (SI) joint. The good news is that SI joint pain usually responds to a step-by-step plan that starts with the least invasive options. Here is what the SI joint is, how it is treated, and what to expect from an SI joint injection and the steps beyond it.

What is the sacroiliac joint?

Your sacroiliac joints are “the connection between your spine and pelvis,” where “the sacrum (the triangle-shaped last section of your spine) meets the ilium (the top part of your pelvis)” (Cleveland Clinic). You have one on each side, just below the small of your back. They do not move much, but they carry a lot of load, so when one becomes irritated it can cause real, focused pain.

What is SI joint pain and sacroiliitis?

When an SI joint becomes inflamed, the condition is called sacroiliitis – “painful inflammation in the joints where your spine connects to your pelvis (your sacroiliac joints)” (Cleveland Clinic). “Pain in your lower back is the most common sacroiliitis symptom,” and it can “radiate (spread) from your low back into your butt (your buttock muscles), hips or thighs.” Many people also notice morning stiffness. Because this pain can mimic a disc problem or hip arthritis, pinning down the SI joint as the culprit is an important first step.

How SI joint pain is diagnosed

Diagnosis starts with a “physical exam and some imaging tests,” which can include “Pelvis X-rays,” a “CT scan,” or an “MRI” (Cleveland Clinic). Imaging helps rule out other causes, but the SI joint can be tricky to confirm on a scan alone. That is one reason a numbing injection into the joint is so useful: if placing anesthetic in the SI joint relieves your pain, it points strongly to that joint as the source. In this way an SI joint injection can be both a test and a treatment.

What is an SI joint injection?

A sacroiliac joint injection (SIJI) is “a shot of an antiinflammatory medication and an anesthetic into the joint capsule of the SI joint” (Cleveland Clinic). The goal is “to treat the pain in your low back, buttock, or upper leg” and “to improve your spine motion as well as provide pain relief.” The two ingredients do different jobs: the anesthetic numbs the joint quickly, and the anti-inflammatory medicine works over the following days to calm the inflammation.

What to expect during and after

It is a short, in-office procedure. “The procedure usually takes 10 to 30 minutes” (Cleveland Clinic). Afterward, “pain relief may begin immediately after the medication has been injected,” though “you may experience a brief recurrence of your former pain until the antiinflammatory medication takes effect.” That early relief comes from the numbing medicine; the steadier, longer relief builds as the anti-inflammatory takes hold. Plan to take it easy that day – Cleveland Clinic advises “do not drive or operate machinery for at least 24 hours after the procedure.”

The SI joint treatment ladder

At Empire Minimally Invasive Spine and Pain we treat SI joint pain with a step-and-ladder approach: start with the least invasive option that can solve the problem, and only move up a rung if you need to.

1. Conservative care first. Physical therapy is “the most common treatment” for sacroiliitis, often paired with anti-inflammatory medication (Cleveland Clinic). For many people, targeted PT and activity changes are enough.

2. A targeted SI joint injection. If pain persists, the injection described above can both confirm the SI joint is the source and provide relief.

3. Radiofrequency ablation for longer relief. If the injection helps but the relief fades, radiofrequency ablation can quiet the small nerves carrying pain from the SI joint for a longer stretch. You can read how that works in our guide to radiofrequency ablation for back pain, or on our radiofrequency ablation page.

4. Fusion, only when needed. Surgery for the SI joint is uncommon and reserved for the minority of cases that do not respond to less invasive care. For those patients, sacroiliac joint fusion is a minimally invasive option that stabilizes the joint. Because we house interventional pain management, orthopedics, and spine surgery under one roof, you can move between these steps without starting over with a new referral.

How Empire approaches SI joint pain

We examine you first and, when appropriate, use a diagnostic injection to confirm the SI joint is truly the source before committing to a longer-term plan – so treatment is aimed at the right joint. Our injections and ablations are image-guided for precise placement. We also treat SI joint pain that follows a work injury or motor-vehicle accident and can help coordinate workers’ compensation and no-fault documentation. The aim is simple: get you lasting relief with the least invasive step that works.

Is an SI joint injection safe?

For most people, yes. Cleveland Clinic lists the main risks as “bleeding,” “infection,” and a “temporary increase in pain” (Cleveland Clinic). Serious problems are uncommon, and your physician will review your specific risks before the procedure.

Frequently asked questions

Where is SI joint pain felt?

Usually in the lower back to one side, and it can spread into the buttock, hip, or thigh. Lower back pain is the most common symptom of sacroiliitis (Cleveland Clinic).

What is injected in an SI joint injection?

An anti-inflammatory medication together with a numbing anesthetic, placed into the SI joint capsule to relieve pain and improve movement (Cleveland Clinic).

How long does the procedure take?

The injection itself usually takes 10 to 30 minutes, and pain relief may begin right after the medicine is placed, with steadier relief as the anti-inflammatory takes effect (Cleveland Clinic).

Can an injection both diagnose and treat SI joint pain?

Yes. Because the anesthetic numbs the joint, meaningful relief after the shot points to the SI joint as the source, while the anti-inflammatory medicine provides the treatment. Imaging tests like X-ray, CT, or MRI are also used to evaluate the joint (Cleveland Clinic).

What if the injection helps but wears off?

That is common and useful information. If a targeted injection relieves your pain but the relief fades, your physician may discuss radiofrequency ablation for longer-lasting relief, and reserve fusion for cases that do not respond to less invasive care.

Sources

• Cleveland Clinic – Sacroiliitis
• Cleveland Clinic – Sacroiliac Joint Injection (patient handout)