Lower back pain is one of the most common complaints among adults, and for many, the pain can be both puzzling and persistent. While people often think of bulging discs or muscle strains as the main culprits, the sacroiliac joint (SIJ) is another possible source of lower back discomfort. Though it might be less well-known, the SIJ plays a crucial role in bearing and transferring weight between your upper body and legs. When something goes wrong here—through arthritis, inflammation, or injury—it can cause significant pain that may radiate from your lower back into your buttocks and hips.
This blog will help you understand how the SIJ can become painful, what sorts of conditions may affect it, how doctors diagnose SIJ-related problems, and what treatment options are available. We will also look closely at sacroiliac joint injections as a potentially effective method for pain relief. We’ll focus on a patient-friendly, one-stop clinic approach, showing you how you can get assessed, scanned, and treated (if needed) in a single visit.
Understanding the Sacroiliac Joint
The sacroiliac joints are located where the sacrum (the triangular bone at the bottom of the spine) meets the iliac bones (the wing-like bones of the pelvis). You have two SIJs—one on either side of your spine. The primary job of these joints is to help stabilise your pelvis and spine, as well as to absorb the shock and stresses that come from everyday activities like walking, running, or lifting objects.
Because the SIJ doesn’t move much compared to other joints like the hips or knees, you might not even notice it—until problems arise. When the SIJ becomes inflamed or worn down, pain can manifest in different ways, including a dull ache in the lower back, a sharp pain around the buttocks, or even discomfort that spreads to the hip. For some people, everyday tasks like getting in and out of a car or climbing stairs can become an ordeal if the SIJ is acting up.
Common Conditions Affecting the SI Joint
Several conditions can contribute to sacroiliac joint pain, but two particularly common issues are:
Arthritis (Osteoarthritis): Over time, the protective cartilage that lines your joints can wear down, leading to osteoarthritis. When it affects the SIJ, you may notice aches, or tenderness in the lower back and pelvis. Osteoarthritis is generally a degenerative condition, but injuries, obesity, and chronic repetitive strain can all contribute to earlier onset.
Inflammation (Sacroiliitis): It simply means inflammation of the sacroiliac joint. This inflammation can sometimes be part of a broader condition, such as an autoimmune disorder (for example, ankylosing spondylitis) or it may be triggered by infections, previous injuries, or strain. Inflammation often comes with pain and swelling, which might be more pronounced when you move or put weight on the affected side.
While arthritis and inflammation are the primary focus here, other factors—like pregnancy-related pelvic changes or an injury from a fall—can also aggravate your SIJ. If you’re experiencing lower back pain, it’s important to consider all possible causes, especially if it’s persistent or worsening.
Diagnosing SI Joint Pain
Your journey toward understanding and treating SIJ pain usually begins with a thorough examination by a doctor. During your initial visit, you will be asked about your symptoms—when they started, what makes them worse or better, and whether the pain spreads to other parts of your body.
Your doctor will perform simple tests, such as gently pressing on your lower back or asking you to move or stretch in certain ways. One common manoeuvre is the FABER test (Flexion, ABduction, and External Rotation), though the specific name might not always be mentioned in a routine check-up. These tests help pinpoint the location of your pain and rule out other causes like disc issues or hip joint problems.
Because lower back pain has a range of potential sources, your doctor might also discuss how to rule out issues such as herniated discs, spinal stenosis, or hip arthritis. If these or other conditions are suspected, they might suggest imaging to get a clearer picture of what’s happening inside your body.
Imaging Modalities
Imaging helps confirm whether the sacroiliac joint is inflamed or otherwise damaged. The main types of imaging used include:
X-ray: Quick, widely available, and great for seeing bony changes. Doctors can spot signs of wear or misalignment around the SIJ.
MRI: More detailed than an X-ray, especially for early onset of SIJ pain and for visualising soft tissues and inflammation. An MRI can show swelling and other subtle changes linked to conditions like sacroiliitis.
CT Scan: Provides a more precise look at the bones if an X-ray isn’t clear enough. It’s particularly useful for detecting small fractures or subtle deformities.
Not everyone needs every type of scan. Your doctor will recommend the most appropriate imaging based on your symptoms and medical history. The goal is to confirm a diagnosis while making sure tests are both necessary and beneficial for your care.
The One-Stop Clinic Approach at ACTIVATE
ACTIVATE Musculoskeletal clinic offers a “one-stop” approach, streamlining your patient journey. This method allows you to have:
A Comprehensive Assessment: You’ll discuss your medical history, symptoms, and daily challenges. The appropriate imaging will be requested and often performed on the same day.
Immediate Injection (If Indicated): If your clinical and radiological assessment shows that an injection could help, it can often be done during the same visit. This immediate intervention can save you time and reduce the need for multiple appointments.
This one-stop model offers clear benefits to patients: quicker diagnoses, prompt relief, and a personalised plan without the hassle of going to multiple locations or waiting for separate appointments.
Treatment Options for SI Joint Pain
Before going down the route of injections, many patients try (and often benefit from) conservative treatments:
Pain Relief Medication: Over-the-counter anti-inflammatory drugs (like ibuprofen) or prescription medications can reduce pain. Always consult your doctor before starting any new medication.
Physiotherapy: Targeted exercises help strengthen muscles around the pelvis and lower back, improving stability and reducing stress on the SIJ. At ACTIVATE, we offer a personalised digital physiotherapy programme to all out patients.
Lifestyle Changes: Sometimes, small adjustments—like losing excess weight, using proper lifting techniques, or improving posture—can make a big difference over time.
Heat or Ice Therapy: Applying a hot compress or an ice pack to the painful area can offer temporary relief and is easy to do at home.
Once a diagnosis is confirmed, We recommend trying these conservative measures first, unless your symptoms are severe or rapidly worsening. If you’re not getting sufficient relief, your doctor might suggest moving on to more advanced options.
Sacroiliac Joint Pain Injections: The Basics
If conservative methods aren’t working well enough, sacroiliac joint injections can be an excellent option for relief. These injections typically consist of two main components:
Corticosteroid: A powerful anti-inflammatory medication that helps reduce swelling and pain in the SIJ.
Local Anaesthetic: Provides quick pain relief and confirms that the SIJ is the source of your discomfort. If your pain decreases immediately after the injection, it’s a strong sign you’ve targeted the right area.
In many private MSK clinics, imaging guidance—either ultrasound or fluoroscopy—is used to ensure the injection goes exactly where it’s needed. This approach increases the accuracy of the procedure, minimises discomfort, and enhances the effectiveness of the treatment. At ACTIVATE, Dr Alnaib performs SIJ injections using ultrasound guidance.
Most people are pleasantly surprised by how quick and straightforward SIJ injections can be. You’ll usually lie down comfortably while the injection area is sterilised. Then, using imaging guidance, the injection is administered directly into the joint space. Some feel relief almost immediately, while for others, full benefits might take a few days to appear.
Potential Side Effects and Risks
Like any medical procedure, SIJ injections carry some potential risks, but serious complications are rare—especially when the injections are carried out by an experienced doctor with image guidance
Mild Soreness or Bruising: Around the injection site, you might feel tender for a short time.
Infection: Very rare, as healthcare providers use sterile techniques to minimise this risk.
Nerve Irritation: Occasionally, nerves near the SIJ can become irritated, causing temporary pain or tingling.
Expected Outcomes and Long-Term Management
Many people experience significant pain relief after a sacroiliac joint injection. The duration of relief varies: some enjoy weeks or even months of reduced pain, while others might need repeat injections.
It’s also crucial to maintain any progress you’ve made. In addition to injections, doctors often recommend physiotherapy to keep the surrounding muscles strong and supportive. Watching your weight, staying active, and sticking to a healthy lifestyle can all play a role in preventing future flare-ups.
If your pain returns after a while, your doctor may suggest further evaluation to decide whether another injection is appropriate or if you might benefit from a referral to a specialist spinal or pelvic surgeon.
Conclusion
The sacroiliac joint might not get as much attention as other parts of the spine, but it can have a huge impact on your overall comfort and mobility. For those struggling with persistent lower back pain, identifying the SIJ as the underlying cause can offer real hope for relief. Arthritis and inflammation are two key offenders, but the good news is that there are effective ways to diagnose and treat these issues.
A one-stop clinic approach—where assessment, imaging, and ultrasound guided injections can happen all in a single, convenient visit—has streamlined the patient experience significantly. If conservative treatments like medication, physiotherapy, and lifestyle adjustments aren’t providing enough relief, sacroiliac joint injections can offer targeted, long-lasting comfort.
Above all, remember that each person’s experience with SIJ pain is unique. If you suspect your sacroiliac joint might be causing your discomfort, don’t suffer in silence. Seek professional advice from a trusted healthcare provider or a private MSK clinic. With the right diagnosis and a personalised treatment plan, you can reclaim an active, pain-free life.
Ready to Find Relief?
If you’re experiencing ongoing sacroiliac joint pain, ACTIVATE Musculoskeletal Clinic is here to help with a one-stop clinic approach.
Don’t let SIJ pain hold you back. Book your appointment today by contacting us or visiting our website.
About the Author: Dr. Mustafa Alnaib MBChB, MRCS, MSc, FEBOT is an orthopaedic surgeon, musculoskeletal doctor and Clinic Director at ACTIVATE Musculoskeletal Clinic in Kent and London
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