Doctor Knab, MD, Doctor Arora, MD and Physicians Assistant Anthony Gore Provide SI Joint Pain Relief and Treatment
The sacroiliac joint (SIJ) connects the hip bone to the triangular sacrum at the bottom of the lumbar spine. So there are two SI joints, one on either side of the pelvis. The SIJ is a large, S-shaped joint with strong ligaments and muscles to help keep it in place.
SIJ dysfunction is a common cause of pain involving the lower back, buttock, leg and groin. Patient suffering with SIJ pain may feel a deep aching in the buttock which radiates into the groin/hip region. Many patients suffering with SIJ dysfunction say that they have difficulty rolling over in bed and sitting for prolonged periods of time Some studies show that the SIJ is responsible for 15-40% of all low back pain complaints. Common factors that can lead to a painful SIJ include trauma (specifically stepping down onto the leg awkwardly such as stepping in a hole, etc.), history of lower lumbar fusion, scoliosis, and inflammatory arthritis. Occasionally, the ligaments surrounding the SIJ can become loose, causing chronic “micro-dislocations” of the joint which lead to chronic inflammation and pain.
SIJ injections can be both diagnostic (telling us where the pain is coming from) and therapeutic (helping to treat the pain and allowing the patient to return to activities such as physical therapy or exercise). Injections are best performed under x-ray or ultrasound guidance, depending upon whether the inner with our portion of the joint is being targeted. Typically the first step in treating SIJ pain involves using a local anesthetic or a combination of local anesthetic and steroid to reduce the pain and minimize inflammation. Sometimes the steroid injections provided only short-term relief, however. For longer lasting benefits, orthobiologic procedures such as prolotherapy (using dextrose or other therapeutic agents) or PRP (Platelet rich Plasma) injections may be recommended. These techniques promote the body’s own natural healing process and offer the potential for permanent improvement.
What to expect after an SIJ Injection:
Commonly performed SIJ injections contains a mixture of local anesthetic and a steroid medication.
The local anesthetic may provide partial pain relief within 10 to 15 minutes after the completion of the procedure but may only last for few hours. Temporary numbness or heaviness of an extremity may be experienced after an SIJ injection, however most patients are able to stand and walk immediately after the procedure without assistance. The steroid will usually start working within 24 to 72 hours. The pain relief and improvement in function may last for days, weeks, or even several months after the single injection, and sometimes a series of injections may help to prolong that benefit. Although uncommon, some patients will experience an increase in their usual pain for few days following the procedure.
Steroid injections are generally very well tolerated, however, some patients may experience side effects, including flushing of the face, anxiety, difficulty in sleeping, changes in mood or menstrual cycle, or temporary increase in blood sugar and water retention. These side effects are usually mild and will often resolve within a few days.
Serious complications are rare when the procedure is performed by an experienced physician using fluoroscopic or ultrasound guidance, and SIJ injections are usually well tolerated with the majority of patients doing well.
How much time do I need to take off work?
The procedure takes about 5-10 minutes. Following the injection, some patients need to be monitored briefly before being discharged home. It is typically recommended that the patient does not drive for 6-8 hours after an injection. Patients are usually instructed to take easy on the day of the SIJ injection. In most patients, normal activities may be resumed the following day.
How Frequently Can SIJ Injections be Performed?
In general, SIJ injections are done in 2-4 week intervals. If necessary, up to 3 injections may be performed in a six-month period.