Out-of-state? Free MRI review + telehealth consult before you travel4.9 ★ · 619 Google reviewsBoard-certified — American Board of Orthopaedic SurgeryMinimally invasive, same-day spine surgery in Beverly HillsCall (424) 217-7463
Out-of-state? Free MRI review + telehealth consult before you travel4.9 ★ · 619 Google reviewsBoard-certified — American Board of Orthopaedic SurgeryMinimally invasive, same-day spine surgery in Beverly HillsCall (424) 217-7463
SI joint pain is one of the great imposters of the lower back — frequently blamed on a disc, when the real trouble is the joint where the spine meets the pelvis.
The sacroiliac (SI) joints sit where the base of the spine, the sacrum, joins the pelvis on either side. They are built for stability and move only slightly, transferring load between your upper body and legs. When one of these joints becomes irritated or moves abnormally, it can produce a deep, one-sided pain low in the back that spreads into the buttock and sometimes the groin or thigh.
SI joint dysfunction is easy to miss. Its pain sits close to the lower spine and can mimic sciatica or a disc problem, so patients are often treated for the wrong thing for months. A telling feature is that the pain flares with transitions — standing up from a chair, rolling over in bed, climbing stairs, or getting out of the car — and usually stays on one side.
✓Pain that spreads into the groin, hip, or back of the thigh
✓Sharp flares when standing up, climbing stairs, or rolling over in bed
✓Discomfort from sitting or standing too long on one side
✓A sense of instability or the leg wanting to give way
✓Relief when the load is taken off the affected side
Some patients also notice:
Numbness or weakness in legs
What causes SI Joint pain?
Wear and arthritis of the sacroiliac joint
Pregnancy and the ligament changes that follow it
A fall or impact directly onto the buttock or pelvis
Uneven leg length or gait that overloads one joint
Prior lumbar fusion that shifts stress onto the SI joint
Repetitive lifting or twisting under load
Trauma
A car accident, sports injury or a fall on your backside can cause SI joint pain. You can also damage it lifting heavy objects and twisting in such a way that you stress the joint that connects the two bones.
Pregnancy
Pregnancy is another cause of SI Joint pain. The body naturally prepares for childbirth by loosening the SI joint ligaments by producing a hormone called, appropriately, relaxin. This relaxation allows the pelvis to enlarge as the uterus grows and the baby develops. The core muscles that surround the pelvis become stretched and can begin to ache. The mother-to-be will gain weight which also stresses the newly relaxed joints. Often, in the last trimester, the mother-to-be’s walking pattern is altered. All of these factors contribute to SI joint pain during pregnancy.
Pregnancy can cause hyper-mobility of the joint which is high movement or looseness. There may be more friction in the joint, uneven wear and improper alignment that can generate a sharp pain at the rear of the pelvis.
Long-term Stress
Long-term stress on the SI joint such as uneven leg length, scoliosis or hip replacement can aggravate or loosen the SI Joint and cause pain. Any prior infection of the SI joint can contribute to SI joint pain, as can recent lumbar back surgery or using the iliac crest bone as a source for bone graft material.
Osteoarthritis
SI joints are susceptible to the degenerative effects of osteoarthritis. Due to wear over the years, the cartilage of the SI joints will weaken. The loss of cushioning and flexibility and the persistent rubbing of the iliac and the sacrum bones will eventually impede movement, generate pain and promote the growth of bone spurs.
Osteoarthritis causes hypo-mobility of the SI joint. Hypo-mobility simply means low movement. Due to the degenerative action of arthritis, the ligaments connecting the two bones lose elasticity. The SI joint can become very stiff and even lock-up, causing pain and irritation of the surrounding soft tissues.
Confirming the Pain Comes From the SI Joint
Because the SI joint hides among other causes of low back pain, Dr. Melamed diagnoses it deliberately. He combines a focused history with hands-on provocation tests that stress the joint and reproduce the pain, and rules out the disc and hip as the source. When the picture points to the SI joint, an image-guided diagnostic injection of local anesthetic into the joint is the most reliable confirmation — if the pain drops sharply for the duration of the numbing medicine, the joint is the culprit.
How is SI Joint pain treated?
Most SI joint pain responds well to non-surgical care, so that is where Dr. Melamed starts. Targeted physical therapy to stabilize the pelvis and core, activity changes, anti-inflammatory measures, and a supportive belt can settle the joint. When inflammation is stubborn, an image-guided steroid injection into the joint often provides lasting relief and doubles as confirmation of the diagnosis.
If pain keeps returning despite an honest trial of conservative care, the least-invasive next steps are considered before anything larger. Radiofrequency treatment of the small nerves supplying the joint can quiet the pain, and only when a joint is truly unstable and unresponsive does minimally invasive stabilization enter the conversation. Dr. Melamed's rule holds here as everywhere: the smallest intervention that solves the problem is the right one.
Women who are pregnant should consult a physical therapist for specialized exercises and procedures for their SI joint pain.
For patients whose SI joint injury is related to trauma or osteoarthritis, Dr. Melamed will develop a nonsurgical treatment that treats the causes of the SI joint pain. Rest and relaxation for a few days can help. If your SI joint pain is mild, over the counter nonsteroidal anti-inflammatory drugs (NSAID) such as aspirin, naproxen, and ibuprofen may relieve pain, and reduce inflammation.
For intense pain, some doctors may prescribe opioid-based pain relievers and muscle relaxants. Dr. Melamed may suggest using less addictive treatments such as TENS systems which can reduce localized pain in the SI joint region. Epidural corticosteroid injections may be recommended.
Dr. Melamed’s holistic treatment programs combine the best of traditional medicine with the best of integrative medicine. A typical program may feature physical therapy sessions that include range-of-motion and stretching exercises to tone the SI joints. He may recommend alternative treatments such as acupuncture, Tai-Chi and yoga to reduce pain, improve balance and stretch muscles near the pelvis.
The two overlap in location and both can send pain into the buttock and leg, so an MRI that shows a normal-looking disc bulge often gets the blame while the real source is missed. The way to tell them apart is a targeted diagnostic injection into the SI joint — if numbing the joint erases the pain, the joint is the problem, not the disc.
Is a diagnostic injection just for pain relief?
It does two jobs. The anesthetic tells us whether the SI joint is truly the pain source, and the steroid can calm the inflammation for weeks or months. Because the SI joint is so often misdiagnosed, that confirmation is one of the most valuable steps in getting you the right treatment.
Will I need surgery for SI joint dysfunction?
Usually not. The large majority of cases settle with focused therapy, injections, and load management. Surgery is reserved for the small number of joints that are genuinely unstable and have failed everything else, and even then it can be done through a minimally invasive approach.
