Pain in the lower back, buttock, hip, or pelvic region can sometimes come from the sacroiliac joints, which connect the sacrum at the base of the spine to the pelvis. When the SI joint is suspected as a source of pain, a sacroiliac joint injection may be used to help confirm the diagnosis and, in some cases, provide temporary symptom relief.
SI joint injections are performed with image guidance so medication can be placed accurately within the joint. Depending on the purpose of the procedure, the injection may include local anesthetic, corticosteroid medication, or both.
At Regenerative Spine and Pain Specialists, Dr. Zwade Marshall and Dr. Jennifer Xiong evaluate your symptoms, examination findings, imaging, previous treatment, and response to diagnostic procedures to determine whether an SI joint injection or another treatment may be appropriate.
Request an Appointment or call (404) 618-0995 to schedule an evaluation at our Fayetteville, Marietta, or Atlanta office.
What Is a Sacroiliac Joint Injection?
A sacroiliac joint injection is an image-guided procedure in which medication is placed directly into the SI joint. The sacroiliac joints sit on each side of the lower spine where the sacrum connects with the pelvis.
These joints transfer forces between the upper body and the legs and move only a small amount. Irritation, inflammation, degeneration, trauma, altered biomechanics, or other changes around the joint can contribute to pain in some patients.
An SI joint injection may be used for two related purposes. Local anesthetic can temporarily numb the joint and provide diagnostic information about whether the SI joint is contributing to your usual pain. Corticosteroid medication may also be used to reduce inflammation and potentially provide temporary relief.
The injection does not permanently repair the joint or guarantee long-term pain relief. Instead, the response to the procedure can help your physician understand the likely pain source and guide the next step in your treatment plan.
Who May Be a Candidate for an SI Joint Injection?
Your pain management provider may consider an SI joint injection when your symptoms and physical examination suggest that the sacroiliac joint could be contributing to your pain.
You may be evaluated for an SI joint injection if you have:
- Pain concentrated near one side or both sides of the lower back, buttock, or posterior pelvis
- Pain that may extend toward the hip, groin, or upper thigh
- Symptoms that worsen with prolonged standing, stair climbing, transitioning from sitting to standing, or certain weight-bearing activities
- Tenderness or positive examination findings around the SI joint
- Persistent symptoms that have not improved enough with conservative treatment
- A need for diagnostic information before considering another SI joint treatment
SI joint pain can resemble pain from the lumbar spine, hip, muscles, or spinal nerves. Your provider will consider these other potential sources before recommending an injection.
Your medical history, medications, examination findings, imaging when appropriate, previous treatment, and overall health are reviewed before the procedure.
What Conditions Can SI Joint Injections Help Evaluate or Treat?
SI joint injections are most commonly considered when the sacroiliac joint is suspected of contributing to lower back, buttock, or pelvic-region pain.
Sacroiliac Joint Dysfunction
Sacroiliac joint dysfunction describes pain thought to arise from abnormal or painful motion, irritation, or mechanical stress involving the SI joint. Symptoms can overlap with other causes of low back pain, which is why a focused examination and diagnostic process are important.
Sacroiliitis
Sacroiliitis refers to inflammation involving one or both sacroiliac joints. The cause can vary, and treatment depends on the clinical context. An image-guided injection may be considered in selected patients as part of diagnosis or symptom management.
Degenerative or Mechanical SI Joint Pain
Age-related degeneration, altered movement patterns, previous injury, or changes in how forces are transmitted through the pelvis may contribute to SI joint symptoms in some patients.
Pain After Changes in Spinal or Pelvic Mechanics
Some patients develop SI joint symptoms after significant changes in spinal or pelvic mechanics, including after certain spine procedures or other musculoskeletal changes. The injection is considered only when the clinical evaluation points to the SI joint as a likely pain source.
Because similar symptoms can arise from lumbar discs, facet joints, spinal nerves, hips, muscles, and other structures, determining the likely source of pain is an important part of deciding whether an SI joint injection is appropriate.
Diagnostic vs. Therapeutic SI Joint Injections
An SI joint injection can have a diagnostic role, a therapeutic role, or both depending on the clinical plan.
Diagnostic SI Joint Injection
For diagnostic purposes, local anesthetic is placed within the SI joint. Your physician then evaluates whether your typical pain changes during the expected anesthetic period. A meaningful temporary response can support the conclusion that the SI joint is contributing to your symptoms.
Therapeutic SI Joint Injection
When corticosteroid medication is included, the goal is to reduce inflammation in or around the joint and potentially provide temporary symptom relief. The response varies from patient to patient.
The amount of relief, how quickly it occurs, how long it lasts, and whether function improves can all help guide future treatment decisions. Insurance requirements and clinical criteria for additional procedures can vary.
How Does an SI Joint Injection Work?
Before the procedure begins, you will be positioned so your physician can safely access the sacroiliac joint. The skin is cleaned, and local anesthetic is used to numb the injection site.
Your physician uses fluoroscopy, a form of real-time X-ray guidance, to direct a thin needle into the SI joint. Contrast material may be used when appropriate to help confirm that the needle is positioned within the joint.
Medication is then injected. Depending on the purpose of the procedure, this may include local anesthetic, corticosteroid medication, or both.
If the injection is being used diagnostically, your care team may ask you to compare your pain before and after the procedure and note how activities that normally trigger symptoms feel during the expected anesthetic window.
After the injection, the needle is removed and you are monitored before discharge.
What to Expect During an SI Joint Injection
The procedure is generally performed with you lying on your stomach so the physician can access the joint from the back of the pelvis.
After the skin is cleaned and numbed, fluoroscopic imaging is used to guide the needle toward the SI joint. You may feel pressure, a brief pinch, or temporary discomfort during needle placement or injection.
Contrast may be used to verify positioning before medication is administered. The injection itself is usually brief, although the total appointment takes longer because of preparation, positioning, monitoring, and discharge instructions.
If you experience intense or unusual symptoms during the procedure, tell your physician immediately.
What to Expect Before, During, and After an SI Joint Injection
Before the Procedure
Your care team will provide instructions based on your health history and the specific procedure being performed.
Before your appointment, tell your provider if you:
- Take blood-thinning or antiplatelet medications
- Have diabetes
- Have an active infection, fever, or illness
- Have allergies to medications, contrast material, or other substances
- Are pregnant or may be pregnant
- Have experienced a previous reaction to an injection or corticosteroid medication
- Have had recent changes in your health
Do not stop prescription medications, including blood thinners, unless the prescribing or treating clinician specifically instructs you to do so.
Follow any instructions provided by the office regarding eating, drinking, medications, and transportation. If you are preparing for an upcoming visit, our patient forms are available online.
During the Procedure
You may feel a brief pinch or burning sensation when local anesthetic is administered. During needle positioning or injection, some patients notice pressure or temporary discomfort.
Fluoroscopic imaging allows the physician to view the relevant anatomy while guiding the needle into the SI joint.
After the Procedure
Some soreness, tenderness, or temporary numbness around the injection site can occur. If local anesthetic is used, you may notice a temporary change in your usual pain shortly after the procedure.
If corticosteroid is included, any anti-inflammatory effect may take longer to develop. Your care team will provide specific instructions regarding driving, medications, activity, and return to exercise or your usual routine.
If the injection is being used diagnostically, you may be asked to track your pain and function after the procedure. Contact the office if you develop symptoms that concern you.
Risks, Side Effects, and Safety Considerations
SI joint injections are commonly performed in interventional pain management, but every injection procedure involves potential risks and side effects.
Temporary effects may include:
- Soreness or bruising at the injection site
- A temporary increase in pain
- Temporary numbness or weakness
- Dizziness or lightheadedness
- Flushing or temporary blood sugar changes when corticosteroid is used
Less common complications can include:
- Bleeding
- Infection
- Allergic or medication-related reactions
- Unintended injection outside the joint or into a blood vessel
- Nerve irritation or injury
- Other injury to a nearby structure
The risks vary depending on your anatomy, medications, allergies, medical conditions, and the medications used during the procedure.
Your physician will review the potential benefits, limitations, alternatives, and risks that apply to your individual situation before recommending the injection.
How Soon Can an SI Joint Injection Start Working?
Results vary depending on the purpose of the injection and the medications used.
If local anesthetic is included, you may notice a temporary change in pain soon after the procedure. When the injection is being used diagnostically, this early response helps your physician evaluate whether the SI joint is contributing to your usual symptoms.
If corticosteroid is used, any anti-inflammatory effect generally takes longer to develop. Some patients notice improvement within several days, while others may take longer.
It is also possible to experience temporary soreness or an increase in pain before any improvement occurs. An SI joint injection does not provide meaningful relief for every patient.
How Long Can Relief From an SI Joint Injection Last?
The duration of relief after an SI joint injection varies considerably.
Some patients experience improvement lasting several weeks or months, while others experience shorter relief or little change in symptoms. The response may depend on factors such as:
- Whether the SI joint is actually the primary pain source
- The underlying cause of the joint irritation or inflammation
- The medications used
- How long symptoms have been present
- Your overall health and activity level
- Your response to previous treatment
An SI joint injection does not permanently correct joint mechanics or cure the underlying condition. Temporary symptom reduction may help some patients participate more comfortably in rehabilitation, exercise, work, or daily activities.
Can SI Joint Injections Be Repeated?
Repeat SI joint injections are not automatically appropriate for every patient.
Your provider may consider another injection based on factors such as the amount and duration of relief, improvement in function, diagnosis, medications used, overall health, and the broader treatment plan.
If an injection does not provide the expected benefit, your provider may recommend reassessing the likely source of pain rather than simply repeating the same procedure.
Depending on your response and diagnosis, other options may include physical therapy, changes in rehabilitation strategy, radiofrequency treatment for selected SI joint pain, or surgical evaluation when clinically appropriate.
Insurance plans may also have specific requirements regarding repeat injections and related procedures.
What Happens If an SI Joint Injection Does Not Work?
Not responding to an SI joint injection does not mean that there are no other treatment options.
If you do not experience meaningful improvement, your provider may reconsider whether the SI joint is the primary source of your symptoms and review your examination findings, imaging, and response to previous treatment.
Depending on your condition, the next step could include:
- Physical therapy or rehabilitation focused on pelvic and core mechanics
- Changes to medications
- Additional diagnostic testing or imaging review
- Evaluation of the lumbar spine, hips, muscles, or other potential pain generators
- Radiofrequency treatment for selected SI joint pain when clinically appropriate
- Other interventional pain management options
- Surgical evaluation, including consideration of SI joint fusion, when appropriate
The goal is to identify the structure most likely responsible for your symptoms and adjust treatment based on that diagnosis rather than relying on one procedure for every type of lower back or pelvic pain.
Why Choose Regenerative Spine and Pain Specialists?
Regenerative Spine and Pain Specialists provides comprehensive interventional pain management for patients with spine-related and chronic pain conditions.
Our physicians, Dr. Zwade Marshall and Dr. Jennifer Xiong, are Harvard-trained, double-board certified anesthesiologists and interventional pain management specialists.
Dr. Marshall is the founder and chief medical officer of Regenerative Spine and Pain Specialists and completed his anesthesiology residency and interventional pain management training at Harvard-affiliated Brigham and Women’s Hospital.
Dr. Xiong completed her anesthesiology residency and fellowship training in interventional pain management at Harvard Medical School’s Brigham and Women’s Hospital. Her approach emphasizes compassionate, patient-centered care focused on function and quality of life.
Our approach to SI joint injections includes:
- Individualized evaluation before recommending a procedure
- Fluoroscopic image guidance
- Careful differentiation of SI joint pain from lumbar spine, hip, and other pain sources
- Diagnostic and therapeutic use when clinically appropriate
- Review of your response to guide future treatment decisions
- Access to additional interventional options when an SI joint injection is not the right treatment
- Care focused on function and quality of life rather than promising a specific outcome
SI Joint Injection Care in Fayetteville, Marietta, and Atlanta
Regenerative Spine and Pain Specialists offers SI joint injection evaluation and treatment through our offices in Fayetteville, Marietta, and Atlanta.
Fayetteville
Our Fayetteville pain management clinic is located at:
874 West Lanier Ave., Suite 250
Fayetteville, GA 30214
Marietta
Our Marietta pain management clinic is located at:
3939 Roswell Road, Suite 240
Marietta, GA 30062
Atlanta
Our Atlanta pain management clinic is located in Buckhead at:
371 E Paces Ferry Rd NE, Suite 802
Atlanta, GA 30305
Evaluation, follow-up, and procedure scheduling may vary by location. Our team will let you know where your appointment or procedure will take place based on your treatment plan.
For questions about scheduling, call (404) 618-0995 or contact Regenerative Spine and Pain Specialists.
Frequently Asked Questions About SI Joint Injections
An SI joint injection is an image-guided procedure that places medication directly into the sacroiliac joint. It may be used diagnostically to help determine whether the joint is contributing to pain and therapeutically to reduce inflammation and provide temporary symptom relief.
SI joint pain may be felt in the lower back, buttock, hip, groin, or upper thigh and may worsen with standing, stair climbing, transitioning between sitting and standing, or other weight-bearing activities. These symptoms can overlap with other conditions, so an examination is important.
It can be either or both. Local anesthetic can provide diagnostic information by temporarily numbing the joint, while corticosteroid medication may be used to reduce inflammation and provide temporary relief.
Local anesthetic is used to numb the skin, but you may still notice a brief pinch, pressure, or temporary discomfort during needle positioning and injection. Experiences vary, and you should tell your physician about intense or unusual symptoms.
The injection itself is generally brief. Your total appointment takes longer because of preparation, positioning, image guidance, the procedure, monitoring, and discharge instructions.
If local anesthetic is used, you may notice a temporary change in pain soon after the procedure. If corticosteroid is included, any anti-inflammatory effect may take several days or longer to become noticeable.
Relief varies considerably. Some patients experience improvement for several weeks or months, while others have shorter relief or little change. The response depends on the underlying condition, the medications used, and whether the SI joint is actually the primary pain source.
Repeat injections may be considered depending on the amount and duration of relief, improvement in function, diagnosis, medications used, overall health, and insurance requirements. They are not automatically scheduled as a predetermined series.
Potential effects include temporary soreness, bruising, increased pain, numbness, weakness, dizziness, or medication-related effects. Less common complications include bleeding, infection, allergic reactions, unintended injection outside the joint or into a blood vessel, nerve injury, or injury to a nearby structure.
Some soreness or temporary numbness is common. Follow the activity, driving, medication, and recovery instructions provided by your care team. If the injection is being used diagnostically, you may also be asked to track changes in your usual pain and function.
Your provider may reassess the likely source of your pain and consider other options such as rehabilitation, medication changes, evaluation of another pain generator, radiofrequency treatment in selected cases, or surgical evaluation when appropriate.
Regenerative Spine and Pain Specialists offers SI joint injection evaluation and treatment at our Fayetteville, Marietta, and Atlanta, Georgia locations. Our scheduling team will confirm the appropriate location for your evaluation and procedure.
Schedule an Appointment for an SI Joint Injection Evaluation
Lower back, buttock, hip, or pelvic pain can interfere with work, sleep, walking, exercise, and everyday activities. If your symptoms may be coming from the sacroiliac joint, an SI joint injection may help clarify the pain source and may also provide temporary symptom relief.
Dr. Zwade Marshall and Dr. Jennifer Xiong can evaluate your symptoms, review your previous treatment and imaging when appropriate, and help determine whether an SI joint injection or another treatment better fits your condition.
Request an Appointment online or call (404) 618-0995 to schedule with Regenerative Spine and Pain Specialists.
Patients can also review our financial options or contact our office with questions before scheduling.