Overview

The sacroiliac (SI) joints connect the sacrum — the triangular bone at the base of the spine — to the iliac bones of the pelvis. These joints help transfer weight between the upper body and lower extremities, absorbing shock and providing stability during activities such as walking, bending, and lifting. Although relatively small and supported by strong ligaments, the SI joints are a common source of low back, buttock, and leg pain, especially in adults over 30.

When conservative treatments such as activity modification, physical therapy, and medications do not provide adequate relief, interventional pain management techniques may be recommended. These minimally invasive procedures target the source of pain and can help restore mobility and quality of life.

Understanding Sacroiliac Joint Pain

SI joint pain may develop from several causes, including:

• Degenerative arthritis (wear-and-tear changes to cartilage and joint surfaces)
• Pregnancy-related changes in pelvic alignment and ligament laxity
• Traumatic injury, such as falls or motor vehicle accidents
• Inflammatory conditions like ankylosing spondylitis or psoriatic arthritis
• Post-surgical changes, particularly after lumbar fusion surgery
• Repetitive stress from certain occupations or sports

Symptoms often include:

• Pain in the lower back, buttocks, hips, or thighs
• Pain that worsens with prolonged standing, stair climbing, or running
• Difficulty turning over in bed or getting up from a seated position
• Localized tenderness over one or both SI joints

Diagnostic Evaluation

Accurately diagnosing SI joint dysfunction is essential before considering interventional treatment. Because SI joint pain can mimic other conditions such as lumbar disc herniation, hip arthritis, or sciatica, a comprehensive evaluation typically includes:

• Medical history and symptom review
• Physical examination
• Imaging such as X-ray, CT, or MRI to rule out other causes
• Diagnostic SI joint injection with local anesthetic — considered the gold standard for confirming the joint as the pain source

Conservative Treatment Options

Before proceeding with interventional management, most patients will try non-surgical, conservative treatments, which may include:

• Activity modification to avoid pain-aggravating movements
• Physical therapy focusing on core strengthening, pelvic stability, and flexibility
• Anti-inflammatory or analgesic medications to reduce pain and swelling
• Supportive devices such as pelvic belts or braces
• Lifestyle changes including weight management and low-impact exercise

If these measures fail to provide significant improvement, interventional pain procedures may be considered.

Interventional Pain Management Techniques for the SI Joint

1. Sacroiliac Joint Injections

Therapeutic SI joint injections combine a local anesthetic with a corticosteroid to reduce inflammation within the joint. These are performed under image guidance (fluoroscopy or ultrasound) to ensure accurate placement.

Benefits:

• Can provide pain relief lasting weeks to months
• Allows patients to participate more fully in physical therapy
• Minimally invasive, with low complication rates

Recovery: Most patients resume normal activities within 24 hours, though temporary soreness at the injection site is possible.

2. Regenerative Injections

Potential advantages:

• Targets ligament laxity, a common contributor to SI joint instability
• May promote longer-term structural improvement

These treatments are considered emerging or adjunctive therapies and may not be covered by all insurance plans.  Click here to learn more.

3. Minimally Invasive SI Joint Fusion

For patients with severe, persistent pain who do not respond to injections, RFA, or regenerative techniques, minimally invasive sacroiliac joint fusion may be an option. This procedure uses small implants or screws to stabilize the joint and eliminate motion that causes pain.

Benefits:

• Smaller incision and reduced muscle disruption compared to open fusion
• Shorter recovery period
• High rates of patient-reported pain relief in select candidates

Benefits of Interventional Pain Management

• Targeted treatment addressing the source of pain
• Reduced reliance on oral medications and their potential side effects
• Improved mobility for daily activities
• Facilitation of rehabilitation through better pain control

Risks and Considerations

All interventional procedures carry some risk, though complications are uncommon when performed by trained specialists. Possible risks include:

• Temporary soreness or bruising
• Infection
• Bleeding
• Allergic reaction to medications used
• In rare cases, nerve injury

A careful discussion of benefits and risks with a qualified specialist helps determine the most appropriate course of care.

Recovery and Long-Term Management

Most patients experience immediate or short-term pain relief after diagnostic or therapeutic injections, followed by gradual improvement with ongoing therapy. Long-term management may include:

• Ongoing exercise programs for core and pelvic stability
• Periodic booster injections if symptoms return
• Lifestyle modifications to minimize joint stress
• Regular follow-up to monitor joint health and adjust treatment as needed

When to Seek Care

If you have persistent lower back, buttock, or hip pain that is not improving with rest, over-the-counter medications, or gentle exercise, it may be time to consult a specialist in spine and joint pain. Prompt diagnosis and treatment can prevent chronic pain patterns and improve quality of life.

Frequently Asked Questions (FAQs) About Sacroiliac Joint Interventional Pain Management

1. How do I know if my pain is coming from the sacroiliac joint?
   Because SI joint pain often mimics hip, lower back, or sciatic nerve pain, an accurate diagnosis is key. Your provider will review your medical history, perform a physical exam with specific movement tests, and may order imaging. A diagnostic injection — where numbing medication is placed in the SI joint — is the most reliable method to confirm it as the pain source.
2. What is the difference between a diagnostic and a therapeutic SI joint injection?
   A diagnostic injection uses only local anesthetic to determine whether the SI joint is causing pain. If pain improves temporarily, the diagnosis is confirmed. A therapeutic injection includes both anesthetic and a corticosteroid to reduce inflammation and provide longer-term relief.
3. How long does pain relief from an SI joint injection last?
   Relief duration varies. Some patients experience improvement for several weeks, while others enjoy benefits for several months. The outcome depends on factors such as the underlying cause of pain, severity of joint inflammation, and overall health.
4. How many injections can I receive in a year?
   Most guidelines recommend limiting corticosteroid injections to three or four per year in a given joint to reduce the risk of side effects from repeated steroid use. Your provider will determine an appropriate schedule based on your needs and response.
5. What is radiofrequency ablation, and is it permanent?
   Radiofrequency ablation (RFA) targets the sensory nerves carrying pain signals from the SI joint. It can provide relief lasting six months to over a year, but nerves can regenerate over time. The procedure may be repeated if pain returns.
6. Are regenerative therapies like PRP or stem cells effective for SI joint pain?
   Research on regenerative injections for SI joint pain is promising but still emerging. Some patients report lasting improvement, especially when ligament instability is the main problem. However, these treatments may not be covered by insurance and are typically considered when conventional options have failed.
7. What happens if injections and RFA don’t work?
   If less invasive measures fail to relieve pain, minimally invasive SI joint fusion may be considered. This stabilizes the joint, reduces movement, and can lead to significant pain reduction for appropriately selected patients.
8. How soon can I return to normal activities after an SI joint procedure?
   Most people resume light activities within 24 hours after injections or RFA. Strenuous exercise or heavy lifting is typically delayed for a few days. After SI joint fusion, recovery is longer, often requiring weeks of gradual rehabilitation.
9. Are SI joint procedures safe?
   Yes, when performed by an experienced specialist, SI joint injections, RFA, and related treatments are considered safe with a low complication rate. Risks are rare but can include infection, bleeding, allergic reaction, or temporary nerve irritation.
10. Can lifestyle changes help prevent SI joint pain from returning?
    Absolutely. Regular core-strengthening exercises, maintaining a healthy weight, practicing good posture, avoiding repetitive strain, and using proper lifting techniques can all help keep the SI joints healthy.