Sacroiliac (SI) joint injection for low back and buttock pain

Overview

Your sacroiliac (SI) joints connect the base of your spine to your pelvis, one on each side. When an SI joint is irritated, it can cause pain in the low back, buttock or hip, and sometimes down the leg. SI joint pain can look a lot like other back problems. An SI joint injection places numbing medicine, and often a steroid, into the joint. It may help in two ways: it can show whether the joint is the source of your pain, and for some people it may ease the pain for a time.

GSMC is led by Dr. Dharam Mann, who completed fellowships in pain management, cardiac anesthesia and critical care at Massachusetts General Hospital/Harvard.

Watch: where the SI joint is and how it works

Video: “SI Joint - Where is it and how does it work?” from SI-BONE on YouTube. It loads from youtube-nocookie.com only when you press play. Shown for general education; GSMC did not produce it. Watch on YouTube

What it is

An SI joint injection is an image-guided shot into the sacroiliac joint. It can be:

• Diagnostic: numbing medicine is used to see if your usual pain goes away for a few hours. If it does, the SI joint is likely a source of pain.
• Therapeutic: a steroid is added to calm inflammation and may give longer relief for some people.

Often, one injection does both.

Who it's for

An SI joint injection may help people who have:

• Pain on one or both sides of the low back, buttock or hip
• Pain that may spread to the groin or thigh
• Pain when sitting a long time, climbing stairs, getting up from a chair or standing on one leg
• Exam tests that point to the SI joint
• Pain that has not improved enough with physical therapy, a belt or medicines

What the procedure involves, step by step

1. Before: we review your exam, imaging, allergies and medicines. Blood thinners may need to be paused, but only with approval from the doctor who prescribes them. Come with your usual level of pain if you can, so the test is clear.
2. Getting ready: you lie on your stomach. The skin is cleaned and numbed.
3. Guidance: your physician uses live X-ray (fluoroscopy), and sometimes ultrasound, to guide a thin needle into the joint. A small amount of contrast dye confirms the needle is in the right place.
4. Medicine: numbing medicine, often with a steroid, is injected. This usually takes a few minutes.
5. After: you rest briefly. We may ask you to move in ways that usually hurt, and to track your pain for the next several hours.

Recovery and what to expect

• Most people go home the same day and return to light activity the next day.
• Keep a pain diary for the first 6 to 8 hours and over the next few weeks. This tells us how much of your pain came from the joint.
• The numbing medicine wears off within hours. If a steroid was used, it may take a few days to work.
• Soreness at the injection site for a day or two is common.

Candidacy: who may or may not be a good fit

May be a good fit: people whose history and exam point to the SI joint and who have not improved enough with conservative care.

May not be a good fit: people with an active infection, a bleeding disorder or blood thinners that cannot be safely paused, an allergy to the medicines or contrast, poorly controlled diabetes, or pregnancy. If your pain clearly comes from another source, a different test or treatment may fit better.

Risks in brief

Risks include soreness at the site, a short-term increase in pain, bleeding or bruising, and side effects of the steroid, such as a short rise in blood sugar. Infection is uncommon. Allergic reaction and nerve irritation are rare. Some people have temporary leg numbness or weakness from the numbing medicine, so plan to have a driver.

Alternatives

Other options may include physical therapy focused on hip and pelvic stability, an SI belt, medicines, radiofrequency ablation of the nerves to the SI joint, or, for ongoing confirmed SI joint pain, minimally invasive SI joint fusion.

Frequently asked questions

Insurance

GSMC participates with all Aetna plans, including Aetna HMO, and with many other insurance plans. Coverage for a specific procedure depends on your plan and may need prior authorization; call 732-202-3000 to verify. Our team can help check your benefits before treatment.

See accepted insurance

Related pages

Related conditions

• SI joint dysfunction
• Low back pain

Related treatments and resources

• SI joint fusion
• Radiofrequency ablation
• Spinal injections