Sacroiliac joint injections at PHI are performed by board-certified physicians Dr. Faisal Lalani and Dr. Nadiv Samimi in our affiliated surgical suite at 455 N Roxbury Drive, Suite B, Beverly Hills, under fluoroscopic guidance. They diagnose and treat pain from the sacroiliac joint, a frequently missed source of chronic low back, buttock, and posterior thigh pain.
What the Sacroiliac Joint Is and Why It’s Often Missed
Your sacroiliac joints connect the base of your spine (the sacrum) to your pelvis. There are two of them, one on each side, and they bear significant load every time you stand, walk, or move. They have minimal movement but substantial responsibility for transferring force between your upper body and legs.
When the sacroiliac joint becomes inflamed, injured, or starts moving abnormally, it produces pain that is frequently mistaken for general low back pain or hip pain. Patients are often treated for years for back pain before anyone considers the sacroiliac joint as the source.
Systematic reviews indicate the sacroiliac joint is a source of pain in roughly 10 to 27 percent of suspected cases of chronic low back pain when evaluated with controlled diagnostic blocks. That is a substantial portion of patients whose pain is being treated as something else.
How Sacroiliac Joint Injections Work
A sacroiliac joint injection delivers a combination of local anesthetic and corticosteroid into the joint capsule. Like facet injections, the procedure serves two purposes at once.
Diagnostic. If your pain improves significantly after the injection, the sacroiliac joint is confirmed as a primary source of your symptoms. This is the most reliable way to identify SI joint pain, because there is no imaging finding or physical exam test that definitively diagnoses it.
Therapeutic. The corticosteroid reduces inflammation in the joint, which often produces pain relief lasting weeks to several months.
For patients whose injection confirms the diagnosis but whose relief is shorter than desired, sacroiliac radiofrequency ablation is typically the next step for longer-lasting relief. Some patients with severe or persistent SI joint dysfunction may eventually be candidates for sacroiliac joint fusion, a surgical procedure also performed at PHI.
How the Procedure Works
The injection is performed in our affiliated surgical suite under fluoroscopic guidance. Image guidance is essential because the SI joint is a deep, irregularly shaped structure that cannot be reliably accessed by feel alone; without imaging, the injection often misses the joint capsule and the diagnostic value is lost.
You are positioned face down, and the injection site is cleaned and numbed with a local anesthetic. The physician advances a thin needle into the joint capsule, confirms position with imaging, and delivers the medication. The procedure typically takes 15 to 20 minutes.
PHI offers a range of comfort options, from local anesthetic to nitrous oxide, conscious sedation (Versed), or deep sedation (Propofol). You leave the same day; patients who receive only local anesthetic typically drive themselves home, while patients who receive sedation arrange transportation.
Conditions We Treat with Sacroiliac Joint Injections
- Sacroiliac joint dysfunction
- Sacroiliac joint arthritis
- Post-traumatic SI joint pain, after falls, car accidents, or other injuries
- Pregnancy-related SI joint pain that has not resolved postpartum
- Post-fusion adjacent segment SI joint pain, a common cause of new pain after lumbar fusion surgery
- SI joint pain following hip replacement
- Sacroiliitis from inflammatory conditions, in coordination with rheumatology
- Persistent SI joint pain that has not responded to physical therapy and conservative treatment
If your condition is not listed but your pain pattern suggests SI joint involvement, your physician will evaluate you during consultation. The diagnostic injection itself often resolves uncertainty when other tests have not.
When Sacroiliac Joint Injections Are the Right Option
An SI joint injection fits when
- Your pain is in the lower back, buttock, or back of the thigh
- Your pain worsens with prolonged sitting, standing, or stair climbing
- Physical exam findings suggest SI joint involvement, with multiple provocation tests positive
- Imaging has ruled out a clear lumbar spine source for your symptoms
- Conservative treatments like physical therapy and anti-inflammatory medication have not provided adequate relief
Not the right starting option when
- Your pain pattern primarily suggests a lumbar spine source, with radiating leg pain or neurological symptoms
- You have a contraindication to corticosteroids
- Your imaging suggests mechanical instability that injection will not address
The diagnostic value of an SI joint injection is part of why it is recommended. Even when relief is short, the information it provides often unlocks the right longer-term treatment, whether that is radiofrequency ablation, regenerative options, or in selected cases sacroiliac joint fusion.
Why Patients Choose PHI for Sacroiliac Joint Injections
Convenient and affiliated surgery center
SI joint injections require image guidance and a proper procedural environment. PHI performs every injection in our affiliated surgery center at 455 N Roxbury Drive, Suite B.
Image-guided every time
The SI joint is one of the more challenging targets for accurate injection. Every injection is performed under fluoroscopic guidance; image guidance is not optional at PHI.
Two board-certified physicians
Dr. Faisal Lalani and Dr. Nadiv Samimi, both trained in interventional pain at Cedars-Sinai. You meet your physician at consultation and the same physician performs your procedure.
Diagnostic-to-therapeutic continuity
PHI does not perform SI joint injections in isolation. Your physician tracks your response, evaluates whether RFA or fusion fits as a next step, and performs those procedures in the same facility.
SI joint pain treated as a distinct entity
Many practices treat all low back pain as a single condition. PHI’s physicians evaluate the sacroiliac joint specifically when your pain pattern suggests it.
Concierge, coordinated care
Single-physician continuity from consultation through treatment and return to activity. Patients receive clear guidance and transparent pricing at consultation.
What to Expect: Before, During, and After
Consultation and prep
Your physician reviews your imaging, history, and current medications at consultation. Some medications, including certain blood thinners, must be paused; you will receive specific instructions.
The injection
You are positioned face down, and the injection site is cleaned and numbed with a local anesthetic. The injection typically takes 15 to 20 minutes. PHI offers a range of comfort options, from local anesthetic to nitrous oxide, conscious sedation (Versed), or deep sedation (Propofol).
Recovery
You rest in our recovery area for about 20 to 30 minutes. Patients who receive only local anesthetic typically drive themselves home, while patients who receive sedation arrange transportation.
The diagnostic window
The local anesthetic often produces immediate relief; this is the diagnostic window your physician will ask you to track. The corticosteroid then takes effect. We tell patients it can take 7 to 10 days to feel relief.
Lasting relief
Most patients experience relief lasting weeks to several months. Patients who respond well but find the relief shorter than desired are typically candidates for sacroiliac radiofrequency ablation, which can extend relief to 6 to 18 months.
Frequently Asked Questions
You usually do not, until a properly placed diagnostic injection confirms it. There is no imaging test or physical exam finding that definitively diagnoses SI joint pain. The pattern that suggests SI joint involvement includes pain in the lower back or buttock that may worsen with prolonged sitting or standing, sometimes radiating into the back of the thigh but not below the knee. Your physician will evaluate this pattern at consultation.
Injections are spaced and monitored rather than repeated without limit. If you require more frequent injections to control pain, your physician will discuss longer-lasting options including radiofrequency ablation or, in selected cases, fusion.
Duration varies. Some patients experience months of relief from a single injection. Others experience shorter relief that confirms the diagnosis but suggests RFA or fusion as the next step. The duration of your response is itself useful information for your physician.
It depends on the option you choose. PHI offers local anesthetic, nitrous oxide, conscious sedation (Versed), and deep sedation (Propofol). Your physician helps you choose the right level of comfort for your procedure.
Most patients describe the procedure as briefly uncomfortable rather than painful. The local anesthetic numbs the skin and tissue along the needle path.
If you receive only local anesthetic, most patients drive themselves home. If you receive sedation, arrange transportation, as you should not drive the same day.
SI joint injections are well-established procedures with strong safety profiles when performed under image guidance. Risks include temporary increase in pain, bleeding or infection at the injection site, and rare complications related to needle placement. Image guidance significantly reduces these risks. Your physician will review the full risk profile at consultation.
This is one of the most useful outcomes a diagnostic SI joint injection can produce. A clear positive response with shorter-than-desired duration confirms the SI joint as the source of your pain and identifies you as a candidate for sacroiliac radiofrequency ablation, which targets the small nerves carrying pain signals from the joint and can provide relief lasting 6 to 18 months.
If a properly placed SI joint injection does not produce meaningful relief, this is diagnostic information. It tells your physician the SI joint is likely not the primary source of your pain. The next step is to revisit imaging and consider whether a different treatment approach fits.
SI joint fusion is reserved for patients with confirmed SI joint pain who have not responded to non-surgical approaches including injections and RFA. It is a more definitive intervention for severe, persistent SI joint dysfunction. Most patients do not need fusion. Your physician will discuss whether it is appropriate for your situation.
Insurance coverage and payment options may vary. We provide documentation for you to seek reimbursement through your out-of-network benefits, which may apply to certain services. All pricing is disclosed at consultation.
Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations.