FACT SHEETS
Sacroiliac Joint Injection (SIJ)
Sacroiliac joint injections are diagnostic and/or therapeutic procedures for pain originating from the sacroiliac joints. The procedure consists of injecting local anesthetic and anti-inflammatory medication (usually a corticosteroid) into the sacroiliac joint where the sacrum connects with the ilium bones of the pelvis.
If the patient experiences significant pain relief while the medication is active, this suggests that the sacroiliac joint is the source of pain. This confirms the diagnosis and provides therapeutic benefit simultaneously.
This injection procedure targets the sacroiliac joint directly, delivering medication to the site of inflammation. The approach requires precise needle placement into the joint space, which is guided by fluoroscopic (X-ray) or ultrasound imaging to ensure accuracy.
Should a sacroiliac joint injection provide significant but temporary pain relief, repeated injections may be recommended, typically limited to three to four times yearly. For some patients, this may be followed by other interventions such as physical therapy, specific stabilization exercises, or consideration of radiofrequency ablation or minimally invasive fusion if conservative treatments fail to provide adequate long-term relief.
THE DIAGNOSIS FOR SACRO-ILIAC JOINT INJECTIONS
Low back pain commonly manifests as pain in the buttock, lower lumbar region, or posterior hip area with or without referred pain radiating into the groin or lower extremities. Dysfunction of the sacroiliac joint can result from trauma, pregnancy, inflammatory conditions, degenerative changes, or biomechanical stress, and these conditions may not always be clearly visible on standard imaging studies.
To confirm if a sacroiliac joint is the source of pain, we inject a combination of local anesthetic and anti-inflammatory medication (usually a corticosteroid) directly into the joint. We access this joint under fluoroscopic (X-ray) or ultrasound guidance to ensure accurate placement—this is why these procedures are called sacroiliac joint injections.
Research indicates that sacroiliac joint injections can provide significant pain relief for patients with sacroiliac joint dysfunction or inflammation. The diagnostic value is determined by the level of pain relief following the anesthetic portion of the injection, with significant relief suggesting the sacroiliac joint as the pain generator.
For persistent sacroiliac joint pain, injections can be used as part of a comprehensive treatment plan that may include physical therapy focused on core and pelvic stability, medication management, and in some cases, consideration of radiofrequency denervation or minimally invasive fusion if conservative treatments fail to provide adequate relief.
INJECTION PROTOCOL
The primary purpose of the injection is to diagnose and potentially reduce inflammation and alleviate pain in the sacroiliac joint. Consequently, implementing a consistent pain measurement method is essential. The Visual Analog Scale (VAS) is commonly used, rating pain from 0 to 10—where 0 represents no pain and 10 indicates extreme pain that completely inhibits thinking, movement, and normal functioning.
Patients should continue their regular medication schedule prior to the procedure, except for blood thinners which may need to be temporarily discontinued (only after consultation with your physician). For the procedure to be appropriately evaluated, patients should keep track of their pain levels before and after the injection, particularly noting how their typical pain-producing activities are affected following the procedure.
THE PROCEDURE
The injection requires inserting a needle through the skin under fluoroscopic (X-ray) guidance. The needle is carefully guided into the sacroiliac joint, which has a narrow and often irregular joint space. Contrast dye is typically used to confirm proper placement within the joint before the medication is injected.
It's perfectly normal to feel anxious about the procedure. However, you can be reassured that these injections are performed routinely, generally involve minimal discomfort due to local anesthetic use, and usually take less than 30 minutes to complete. Some patients may experience temporary soreness at the injection site, referred pain, or a temporary increase in their usual pain symptoms, but these effects typically resolve within 24-48 hours as the anti-inflammatory medication begins to take effect.