Sacroiliac Joint Injections

An X-ray guided injection that shows whether the sacroiliac joint is causing your low back and buttock pain, and can help relieve it.

Mountain Home870-706-2557
Harrison870-233-9960

What is sacroiliac joint pain?

The sacroiliac (SI) joints connect the base of the spine (the sacrum) to the pelvis on each side. They move only a little, but they carry the weight of the upper body.

SI joint pain is usually felt in the buttock and low back below the belt line, sometimes spreading to the groin or thigh. It is often worse with sitting, standing up from a chair, climbing stairs, or lying on the painful side. It can follow a fall, pregnancy, arthritis, or a prior lumbar fusion.1

Because SI pain can look like pain from the spine or hip, an injection that numbs the joint is the most reliable way to confirm it.1

Illustration of the pelvis showing the sacroiliac joints on either side of the sacrum
The SI joints sit on either side of the sacrum.

How it works

  1. Exam

    Specific movements during your exam that reproduce your pain point to the SI joint.

  2. X-ray guided

    After numbing the skin, a thin needle is guided into the joint, and contrast dye confirms the position.

  3. Numbing medicine and steroid

    Local anesthetic tests the joint. A steroid is often added to calm inflammation.

  4. Track your relief

    You note how your usual pain changes over the next several hours and days.

  • QuickUsually 10 to 20 minutes, and you go home the same day.
  • DiagnosticStrong short-term relief helps confirm the SI joint as your pain source.
  • TherapeuticWhen a steroid is used, relief may last weeks to months.
  • Guides next stepsResults help decide whether longer-lasting treatments are a good fit.

After the injection: your options

A strong response confirms the SI joint as your pain source. From there, care depends on how long your relief lasts.

If relief lasts

Repeat injections and therapy

Physical therapy focused on the hips and core, with repeat injections when they provide months of relief.

If relief is short

Peripheral nerve stimulation

SPRINT PNS is a drug-free, 60-day treatment that can provide longer-lasting relief for SI-region pain.

For lasting stability

SI joint fusion

A minimally invasive implant stabilizes the joint when diagnostic injections confirm it as the pain source.

Many insurance plans require diagnostic SI injections with at least 75% relief of your usual pain before covering more advanced treatment.2 Our staff will check your plan’s requirements.

What to expect

Before your injection

Tell us about your medications, especially blood thinners, and whether you have diabetes or a contrast allergy. We’ll tell you whether any medication should be paused. Please don’t stop one on your own.3

During your injection

You lie face down while the skin is numbed. You’ll feel pressure and possibly a brief increase in your usual pain as the medicine enters the joint.

After your injection

Do the activities that normally hurt and note how your pain changes. Your leg may feel numb or weak for a few hours, so bring a driver. A steroid usually starts working in 3 to 7 days.

Is an SI joint injection right for you?

It may be an option if

  • Your pain is mainly in the buttock or low back below the belt line, on one or both sides
  • It is worse with sitting, rising from a chair, stairs, or lying on that side
  • Exam tests reproduce your pain
  • Physical therapy and medications haven’t provided enough relief

Another approach may fit better if

  • Pain shoots below the knee with numbness or tingling, which may point to a pinched nerve
  • Pain is mainly in the groin with stiffness, which may point to the hip joint
  • You have an active infection or a bleeding problem that can’t be managed safely

Common questions

Why does my physician care about the first few hours?

That window shows the effect of the numbing medicine alone. Strong relief then confirms that the SI joint is the source of your pain.

How long will a steroid help?

It varies from a few weeks to several months. If relief is short, other options such as nerve stimulation or SI joint fusion may provide longer-lasting results.

Can both sides be done?

Yes. Both joints can be treated at the same visit when both are painful.

Will insurance cover it?

Most plans cover image-guided SI joint injections when symptoms and exam findings point to the joint. Our staff will check your benefits and request any required prior authorization.

Talk with a specialist about low back and buttock pain

Our physicians will review your symptoms and exam to decide whether an SI joint injection, or another treatment, is the right next step.

Schedule a consultation

New pain management patients need a referral. Your provider can fax it to 870-706-2428.

Risks

Possible side effects include soreness at the injection site, temporary leg numbness or weakness, a short-term increase in pain, bleeding, infection, and steroid side effects such as temporary high blood sugar, flushing, or trouble sleeping. Your physician will review the risks with you before your procedure. Individual results vary.

Sources

  1. Sayed D, et al. The American Society of Pain and Neuroscience (ASPN) evidence-based clinical guideline of interventional treatments for low back pain. J Pain Res. 2022;15:3729-3832. doi:10.2147/JPR.S386879
  2. American Society of Interventional Pain Physicians. Sacroiliac joint injections and procedures: a new LCD effective 3/19/2023. asipp.org
  3. Narouze S, et al. Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications (second edition). Reg Anesth Pain Med. 2018;43(3):225-262. doi:10.1097/AAP.0000000000000700

Illustration: Blausen.com staff, “Medical gallery of Blausen Medical 2014,” WikiJournal of Medicine, CC BY 3.0, adapted.