---
title: "Sacroiliac Joint Dysfunction"
---
## You May Have Been Misdiagnosed for Years
If you have been treated for lower back pain for months or years without finding meaningful relief, there is a real possibility your pain is not actually coming from your back at all. It may be coming from your sacroiliac joints.
Sacroiliac joint pain is one of the most under-recognized causes of chronic lower back, buttock, and hip pain. Studies suggest the SI joints are the source in roughly 10 to 27 percent of suspected cases of chronic low back pain. That is a substantial group of patients whose pain is being treated as something else. If you have cycled through epidural injections, physical therapy, chiropractic adjustments, and pain medications without lasting relief, your sacroiliac joints may be the source nobody has evaluated yet. We do.
## What the Sacroiliac Joints Are and Why They Matter
Your sacroiliac joints connect the base of your spine to your pelvis. There are two of them, one on each side of your tailbone, where the sacrum meets the iliac bones. Despite their small size, they bear significant load: every time you stand, walk, climb stairs, or lift something, the SI joints transfer force between your upper body and your legs.
When the SI joints become inflamed, injured, or start moving abnormally, they produce pain that often gets blamed on something else. Standard lumbar MRI often does not capture the SI joints clearly, physical exam tests for SI joint pain are not always part of a standard back exam, the pain pattern overlaps with lumbar and hip pain, and many providers were trained when SI joint pain was considered rare. The result is a population of patients treated for years for general back pain when their actual source is the SI joints.
## What Sacroiliac Joint Pain Feels Like
The pain pattern is often distinctive once you know what to look for:
- Pain in the lower back, buttock, or back of the upper thigh, often on one side more than the other
- Pain that worsens with prolonged sitting, prolonged standing, or stair climbing
- Pain that worsens when rolling over in bed or getting out of a car
- Pain that may radiate into the back of the thigh but typically not below the knee
- Pain that often does not respond to traditional back treatments like epidural steroid injections
If your pain pattern matches any combination of these, SI joint involvement is worth evaluating. Many patients are surprised to learn their pattern points clearly to the SI joints once a physician familiar with the condition examines them.
## Why SI Joint Pain Develops
The most common causes include pregnancy and childbirth, which loosen the ligaments around the SI joints; previous back surgery, especially lumbar fusion, which changes how forces transfer through the lower spine and increases load on the SI joints; trauma such as falls or car accidents; arthritis, particularly in inflammatory conditions like ankylosing spondylitis; repetitive stress from athletic activity; and hip replacement, which changes how forces transfer through the pelvis. In many patients no specific cause is identified; the joints simply begin generating pain, often gradually, often in middle age.
## How PHI Diagnoses SI Joint Pain
Diagnosis is the most important step. Standard imaging often shows nothing definitive, and physical exam tests can suggest SI joint involvement but cannot confirm it alone.
The most reliable diagnostic tool is a sacroiliac joint injection performed under image guidance. The injection delivers local anesthetic into the SI joint capsule, and if your typical pain pattern significantly improves in the hours immediately after, the SI joint is confirmed as a primary source. This dual diagnostic-and-therapeutic approach is part of why SI joint injections are usually the first interventional treatment we recommend; they confirm the diagnosis and often provide therapeutic relief simultaneously.
## How PHI Treats SI Joint Pain
Once SI joint involvement is confirmed, treatment follows a typical sequence based on response. Sacroiliac joint injections are usually first, delivering local anesthetic and corticosteroid into the joint, often producing relief lasting weeks to several months. Sacroiliac radiofrequency ablation is the natural next step for patients whose injections confirm the diagnosis but produce shorter-than-desired relief; RFA targets the small nerves carrying pain signals from the joint and can extend relief to 6 to 18 months.
Regenerative options including PRP, A2M, stem cell therapy, and exosome therapy may be appropriate for patients seeking to support the underlying joint tissue. Sacroiliac joint fusion is reserved for patients with confirmed SI joint pain who have not responded adequately to non-surgical treatments; modern minimally invasive fusion is meaningfully different from older approaches and is performed at our affiliated surgery center as an outpatient procedure. Most patients begin with diagnostic injections and progress to longer-lasting treatments only as needed.
## Why PHI for Sacroiliac Joint Pain
## Frequently Asked Questions
**Q: How do I know if my pain is from the SI joint or my lower back?**
The pain patterns can overlap, which is part of why SI joint pain is often missed. SI joint pain is typically felt in the lower back and buttock, often more on one side, and worsens with prolonged sitting, standing, stair climbing, or rolling over in bed. Lumbar spine pain often radiates further down the leg with numbness or tingling. The most reliable way to distinguish them is a diagnostic injection.
**Q: Why hasn't anyone diagnosed this before?**
SI joint pain is genuinely under-diagnosed in primary care and even in some pain practices. Standard imaging often does not capture SI joint involvement clearly, and lumbar causes are more commonly evaluated first. Many patients see multiple providers before someone evaluates the SI joints specifically.
**Q: Will an MRI show SI joint pain?**
MRI sometimes shows changes in the SI joints, including arthritis or inflammation, but many patients with significant SI joint pain have relatively normal-appearing imaging. The diagnosis often relies more on the pain pattern, physical examination, and response to a diagnostic injection than on imaging alone.
**Q: How effective are SI joint injections?**
For patients whose pain is genuinely coming from the SI joints, injections often produce significant relief. The duration varies. Some patients experience months of relief from a single injection. Others experience shorter relief that confirms the diagnosis but suggests radiofrequency ablation as a longer-lasting next step.
**Q: Will I need fusion?**
Most patients with SI joint pain do not need fusion. The vast majority find meaningful relief through injections, radiofrequency ablation, and regenerative options. Fusion is reserved for the subset of patients whose pain has not responded to non-surgical care.
**Q: What if I had back surgery and now have SI joint pain?**
This is one of the most common scenarios we see. SI joint pain frequently develops after lumbar fusion because the fusion changes how forces transfer through the lower spine. Patients who had successful back surgery and then developed new pain in a different location should be evaluated for SI joint involvement.
**Q: Will treatment cure my SI joint pain?**
Cure is not always the right word for chronic joint conditions. Many patients experience long-term relief through a combination of treatments and lifestyle modifications. Some require periodic repeat treatment as relief diminishes. The goal is durable, meaningful improvement in your symptoms and function.
**Q: Can I exercise with SI joint pain?**
In most cases yes, often with modifications. Specific exercises that strengthen the muscles supporting the SI joints can help significantly. Activities involving repetitive impact or asymmetric loading may need temporary modification. Your physician will provide specific guidance.
**Q: Do you take insurance?**
PHI is a concierge practice and is out-of-network with all insurance plans. We provide detailed invoices that patients may submit to their insurer for potential out-of-network reimbursement. All pricing is disclosed at consultation.
**Q: Do you accept international patients?**
Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations.
## Treatments We Offer for Sacroiliac Joint Pain
PHI offers the full range of evidence-based treatments for sacroiliac joint pain. Your physician will recommend the right option, or combination, based on the severity of your symptoms, your treatment history, and your response to the initial diagnostic injection.
- Sacroiliac Joint Injections, diagnostic and therapeutic
- Radiofrequency Ablation, extends relief when injections confirm the source
- Sacroiliac Joint Fusion, minimally invasive
- PRP Therapy
- Stem Cell Therapy
- A2M Therapy
- Exosome Therapy
> Consensus practice guidelines on sacroiliac joint complex pain from a multispecialty, international working group. Peer-reviewed via PMC, 2025.
— [McCormick ZL, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC12681192/)
> Systematic review of the diagnostic accuracy and therapeutic effectiveness of sacroiliac joint interventions. Pain Physician, 2015.
— [Simopoulos TT, et al.](https://pubmed.ncbi.nlm.nih.gov/26431129/)
> Systematic review and meta-analysis of effectiveness of therapeutic sacroiliac joint injections. Pain Physician, 2023.
— [Janapala RN, et al.](https://pubmed.ncbi.nlm.nih.gov/37774179/)
> Two-year outcomes from a randomized controlled trial of minimally invasive sacroiliac joint fusion vs. non-surgical management for sacroiliac joint dysfunction. Peer-reviewed via PMC, 2016.
— [Polly DW, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC5027818/)
## Schedule Your Sacroiliac Joint Consultation
A 60-minute consultation will evaluate whether your pain is coming from the SI joints, walk through the treatment options that match your situation, and give you a clear plan. Call (310) 856-9488 or book online now.
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