Sacroiliac joints connect your spine to your hip bone. They connect the bottom of the spine, called the sacrum, to the outer part of the hip bone, called the ilium. You have two sacroiliac joints. One is found on each side of the sacrum. Sacroiliac joints help control your pelvis when you move. They help transfer forces from your lower body to your upper body. Each sacroiliac joint has several ligaments to help strengthen it.
You may feel pain if a sacroiliac joint is injured. At times it may feel like simple muscle tension, but at other times the pain can be severe. Sometimes the cartilage inside the joint is injured, but at other times only the ligaments around the joint are affected. You usually feel sacroiliac joint pain in an area from your low back down to your buttocks. But sometimes, if a joint is very inflamed, pain may even extend down the back of the leg. The diagram shows where sacroiliac joint pain usually is felt.
If you have pain in one or more of these areas you may have sacroiliac joint pain. Common tests such as x-rays or MRIs may not always show if a sacroiliac joint is causing pain. Your pain doctor can perform other tests to find out if you have sacroiliac joint pain.
In a sacroiliac joint injection, a local anesthetic and a corticosteroid are injected into one or both of your sacroiliac joints, or into the ligaments surrounding the joints. The local anesthetic, a numbing medicine, lessens your pain temporarily. The corticosteroid reduces inflammation that may be causing pain. The injection can be used for diagnosis and treatment. If the injection immediately lessens your pain and helps you move better, it tells the doctor that the sacroiliac joint is causing the pain.
An IV is inserted to administer intravenous medication(s) to help you relax. A local anesthetic may be used to numb your skin. The doctor will insert a thin needle directly into the sacroiliac joint. Fluoroscopy, a type of x-ray, may be used to ensure a safe and proper position for the needle. A dye may also be injected to help make sure the needle is at the correct spot. Once the doctor is sure the needle is correctly placed, the medicine will be injected.
You will be monitored for up to 30 minutes after the injection. Before you leave, you will be given discharge instructions. Keeping track of your pain helps the doctor know what the next steps will be. It may help to move in ways that hurt before the injection, to see if the pain is still there, but do not overdo it. You may feel immediate pain relief and numbness in your back for a brief period of time after the injection. This means the medication has reached the right spot. Your pain may return after this short pain-free period, or may even be a little worse for a day or two. This is normal. It may be caused by needle irritation or by the corticosteroid itself. Corticosteroids usually take two or three days to start working, but can take as long as a week. You can usually return to work the day after the injection, but always check with your doctor.
The amount and duration of pain relief varies from person to person and is dependent on many factors including underlying pathology and activity level. Some can have relief that lasts for years, while others have short-term relief. Usually a series of injections, often three, each spaced a week or two apart, are given. It is important to discuss with your physician your response to the sacroiliac joint injection in order to plan future treatment options.
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