Sacroiliac (SI) Joint Injections

The sacroiliac (SI) joints connect the base of the spine to the pelvis on each side. When an SI joint is inflamed or moves abnormally, it can cause pain in the low back, buttock, groin or upper thigh. An SI joint injection places numbing medicine and usually a steroid directly into the joint, guided by X-ray or ultrasound.

Like other spine injections, it can relieve pain and help confirm that the SI joint is the source.

These injections are usually performed by a pain management specialist or interventional physician. Dr. Grunch works closely with trusted pain management specialists and will refer you when an injection is a good next step, either to treat your pain or to help confirm where it is coming from.

• Sacroiliac joint dysfunction and SI joint arthritis
• Low back or buttock pain on one side, often worse when standing up, climbing stairs or lying on that side
• SI joint pain after a lumbar fusion or pregnancy

If injections help but relief does not last, options include radiofrequency ablation of the SI joint nerves or a minimally invasive SI joint fusion, which Dr. Grunch performs.

• Ask about blood thinners. If you take a blood thinner such as warfarin, apixaban (Eliquis), rivaroxaban (Xarelto), clopidogrel (Plavix) or daily aspirin, tell the doctor doing the injection. Some injections require stopping it for a few days and some do not. Never stop a blood thinner on your own; the doctor who prescribes it will tell you if and when it is safe.
• If you have diabetes and a steroid will be used, check your blood sugar more often for a few days afterward.
• Tell the team about any allergies, especially to contrast dye, iodine, latex or numbing medicine.
• Reschedule if you have a fever or an infection, or if you might be pregnant.
• Arrange for a driver if you will be given medicine to relax.
• Come with your usual pain if possible, so you can tell how much the injection helps.

You will lie on a table, usually face down. The skin is cleaned and numbed. Using live X-ray (fluoroscopy) or sometimes ultrasound, the doctor guides a thin needle to the exact spot. A small amount of contrast dye is often used to confirm the needle position before the medicine is injected. You may feel pressure or a brief, familiar pain. The injection itself usually takes 10 to 30 minutes.

Note how much your usual pain improves in the first few hours, when the numbing medicine is working. The steroid usually begins to help within a few days and can last weeks to months. Rest the day of the injection.

SI joint injections are generally safe. Possible side effects include soreness, temporary leg numbness, a rise in blood sugar and, rarely, infection or bleeding.

How do I know if my pain is from the SI joint?

SI joint pain is usually on one side, below the belt line, and worse with standing up, climbing stairs or lying on that side. An injection that relieves the pain helps confirm it.

What if SI joint injections stop working?

Radiofrequency ablation or a minimally invasive SI joint fusion may provide longer-lasting relief. Dr. Grunch will discuss which option fits you.

If you have neck pain, back pain or nerve pain and want to know which treatments make sense for you, call 470-293-9800 or contact us to schedule a visit with Dr. Grunch or one of her physician assistants. You can also ask general questions any time through our “Ask Us Anything” chat.

Related: All non-surgical treatment options · SI joint fusion · SI joint dysfunction

This information is for educational purposes only and is not medical advice. It does not replace individualized care from a licensed physician. Please talk to your provider about your symptoms and treatment options.