By Jonathan Chu, MD
Interventional Pain Medicine
PM&R

Patients often have a lot of questions after they’ve been diagnosed with sacroiliac joint pain and have been recommend a sacroiliac joint injection as the treatment.

“You mean my pain isn’t coming from sciatica?”

“How is this injection different from getting an epidural?”

While pinched nerves in the low back are very common, they are definitely not the only possible cause of low back pain.

Also, epidurals are not the only effective pain injections available as treatments.

Sacroiliac joint pain is one of the most common causes of back and buttock pain, and is also one of the most frequently overlooked sources of pain.

The sacroiliac (SI) joints are a pair of large joints located below your spine on both sides, connecting your tailbone to the flared part of your pelvis.

They are synovial joints, meaning that they are lined on the inside with smooth cartilage, surrounded on the outside by a tough fibrous capsule, and are filled with a lubricating synovial fluid inside.

These joints bear the entire weight of your upper body throughout the day. They absorb a variety of stresses as you walk, bend, and twist, and so it’s not surprising that they can flare up with painful inflammation from time to time.

You can learn more about your SI joints here.

What To Expect During Your Procedure

The SI joints can be injected with a steroid medication that acts as a potent anti-inflammatory to calm down a painful flare-up.

Here’s how it’s done:

First, your physician will numb the skin and soft tissues over the joint with lidocaine.

Next, a thin spinal needle will be gently directed into the base of the SI joint with the help of X-Ray guidance, also known as fluoroscopy.

Once inside the joint, you physician will inject a small amount of contrast dye to confirm that the needle is the proper place.

Then, your physician will inject a combination of steroid medication and numbing medication into the joint, which will serve as the actual therapy.

Potential Side Effects:

As with any other injection, SI injections have a very small risk of infection, bruising, bleeding, or damage to surrounding structures with this procedure.

Fortunately, overall this injection is extremely safe. The SI injection is really not performed near any major blood vessels or the spinal cord, or really near anything dangerous in general, making it even lower risk than many of the other common pain procedures.

How Well Do SI Injections Work?

For a procedure that is performed so commonly every day all over the country, there are surprisingly few large-scale studies looking at its effectiveness.

Through the years, there’s been a lot of smaller, observational studies showing good therapeutic benefit from SI joint injections.

Of course, randomized controlled trials are considered the most definitive type of research in medicine. Unfortunately, there really haven’t been many powerful studies of this type looking specifically at SI injections.

Of the few randomized studies that were done, all of them demonstrated benefit from SI injections. However, all of these studies had considerable limitations, such as short follow-up and small numbers of participants.

That being said, this is a procedure that I have performed hundreds upon hundreds of times, and I can say from my experience that the procedure works very nicely for patients who are accurately diagnosed.

If the sacroiliac joint is the primary source of pain, it usually provides about 2-3 months of good pain relief.

What’s the Best Way To Utilize SI Injections?

So you’re probably thinking:

“If these injections only last about 2-3 months, do I need to keep having them forever?”

“What’s the point if these injections are only temporary?”

My answer is this:

The SI joint injections should only be one part of your comprehensive treatment program.

When you’re in the midst of a severe sacroiliac joint flare-up, it’s difficult to do anything.  

The goal of the SI injection is to calm your severe flare-up so that you’re able to move better and actually feel like a person again.

Once your pain is under control, you’re able to begin work in physical therapy and develop your long-term home exercise program.

My goal is never to do SI injections for my patients every 3 months for the rest of their lives.

The goal is to make them feel better for significant duration of time, so that they have the opportunity to rebuild their strength, mobility, and flexibility.

Once you’ve built yourself back up, future SI joint flare-ups won’t occur nearly as often, if at all.

This is a common theme of 360 Pain Academy and my approach to the treatment of pain in general.

Sacroiliac joint injections, as with all of the other pain interventions, are powerful tools for helping to control your pain.

However, they are not a be-all and end-all.

My patients get the best results when they combine interventional treatments with their own consistent and dedicated efforts.

In the past, I’ve seen countless patients who were, at first, barely able to tolerate a physical examination due to the severity of their SI joint flare-up.

It’s fantastic to see them get relief with their first SI injection.

However, it’s even more rewarding to see them go on to steadily become stronger and more functional, and eventually no longer need any more injections or pain medications at all. If you’re watching this right now, and you’re experiencing severe SI joint pain, this is also my hope for you in the long term, and I want you to know that it is very possible to achieve with dedicated and consistent effort.

I hope you found this video valuable. Thanks for watching everyone.

References:

Benzon, H. T., et al. (2018). Essentials of pain medicine (4th ed.). Elsevier.

Braddom, R. L. (Ed.). (2010). Physical medicine and rehabilitation (4th ed.). Saunders/Elsevier.

Cuccurullo, S. J. (2004). Physical medicine and rehabilitation board review. Demos Medical Publishing.

Furman, M. B., et al. (2018). Atlas of image-guided spinal procedures (2nd ed.). Elsevier.

Netter, F. H. (2006). Atlas of human anatomy (4th ed.). Saunders/Elsevier.

Rathmell, J. P. (Ed.). (2011). Atlas of image-guided intervention in regional anesthesia and pain medicine (2nd ed.). Lippincott Williams & Wilkins.

Waldman, S. D. (2012). Pain management injection techniques (3rd ed.). Saunders/Elsevier.