Many patients seeking relief for chronic lower back pain find that standard imaging, such as an X-ray, returns “normal” results.
When symptoms persist despite these findings, the source of the pain may not be the lumbar spine, but the sacroiliac (SI) joint.
The sacroiliac joint is responsible for an estimated 15% to 30% of cases of chronic lower back pain. Because its symptoms mimic other conditions like disc herniations or hip bursitis, it is frequently overlooked in primary care settings.
Understanding your SI joint pain treatment options starts with an accurate clinical diagnosis.
What is the Sacroiliac Joint?
The sacroiliac joints connect the sacrum (the triangular bone at the base of the spine) to the ilium (the large pelvic bones).
Unlike the highly mobile joints in your shoulders or knees, the SI joint is designed for stability and shock absorption. It transfers the weight of your upper body to your lower limbs during movement.
Causes of SI Joint Dysfunction
Dysfunction occurs when the ligaments supporting the joint become too loose (hypermobility) or too stiff (hypomobility), leading to inflammation.
Common triggers include:
- Trauma: Falls or sudden impacts to the pelvis.
- Pregnancy: Hormonal changes that loosen pelvic ligaments.
- Biomechanical Stress: Uneven leg length or gait changes that place asymmetrical load on the joint.
- Inflammatory Conditions: Certain types of arthritis that specifically target the SI joints.
The Challenge of Diagnosis
SI joint dysfunction is difficult to diagnose through imaging alone. Inflammation in this joint often does not appear on a standard imaging.
Instead, a subspecialty-trained physician relies on a physical examination consisting of “provocation tests.” These maneuvers are designed to stress the SI joint specifically to see if they reproduce the patient’s typical pain.
The Diagnostic Injection
The clinical “gold standard” for confirming SI joint pain is a diagnostic injection. Using real-time imaging, a specialist places a small amount of local anesthetic into the joint.
If the patient experiences a significant reduction in pain shortly after the injection (typically 75% or more), the SI joint is confirmed as the pain generator.
SI Joint Pain Treatment Options
Once a diagnosis is confirmed, a range of interventional and conservative strategies can be employed.
1. Conservative Management
For mild cases, physical therapy focused on core and pelvic stabilization is the first line of defence. SI joint belts may also be used to provide external support and stability during daily activities.
2. Image-Guided Therapeutic Injections
If pain prevents a patient from participating in physical therapy, a therapeutic injection is often the next step. At Clinically Managed Injections (CMI), our physicians perform SI joint and pelvic injections under ultrasound or fluoroscopic guidance.
By delivering a corticosteroid directly into the inflamed joint, we can reduce swelling and provide a window of relief. This allows the patient to return to the strengthening exercises necessary for long-term joint health.
3. Radiofrequency Ablation (RFA)
For patients with chronic dysfunction who respond well to injections but find the relief is temporary, RFA may be considered.
This procedure uses thermal energy to desensitize the small nerves that carry pain signals from the SI joint. CMI specialists can evaluate if this or other spine-related injections are appropriate for your specific case.
Why Specialist Care Matters
The SI joint is deep and surrounded by dense ligaments, making it difficult to access without specialized training. Studies indicate that “blind” injections (performed without imaging) miss the SI joint target in a significant percentage of cases.
At CMI, we remove the guesswork. Every procedure is image-guided to support the safety and accuracy of the treatment.
Questions About Diagnosis and Treatment for SI Joint Pain
1. How can I tell if my pain is SI joint or a disc problem?
SI joint pain is typically felt on one side of the lower back or buttocks and often worsens when standing up from a chair or rolling over in bed. Disc pain more frequently radiates down the back of the leg. However, a specialist assessment is the only way to confirm the source.
2. Are SI joint injections painful?
Most patients describe the sensation as a brief period of pressure. We use a local anesthetic to numb the skin and superficial tissues to make sure your comfort during the procedure.
3. How long does relief from an SI joint injection last?
Relief varies by patient. Some experience improvement for several weeks, while others find relief for several months. Combining the injection with a specialized physical therapy program typically leads to more sustained results.
4. Can I drive home after the procedure?
Because the local anesthetic can temporarily affect the sensation in your hip or leg, we recommend having someone drive you home after an SI joint injection.
5. Is this procedure covered by my insurance?
CMI is a private, fee-for-service clinic. While we do not bill MSP, many extended health providers offer partial coverage for interventional procedures. Visit our pricing page for transparent cost information.
Precision Care for Pelvic and SI Joint Pain
You should not have to live with a “hidden” source of pain. At Clinically Managed Injections, we specialize in identifying and treating the conditions that standard imaging often misses.
Our Vancouver clinic offers immediate access to subspecialty physicians who prioritize accuracy through image-guided technology.
If you are ready to move past nonspecific “back pain” and get a clear diagnosis, the first step is to download our referral and questionnaire forms. Once your healthcare provider has signed them, submit them to our team to book your assessment.
Disclaimer: The content on this blog is for informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Every patient is unique, and individual results will vary. Please do not use this information to diagnose yourself. Always consult a qualified physician regarding your specific medical condition.
