What is Sacro-Iliact Joint Pain?

The sacroiliac joints are located at the bottom of the spine, where the sacrum joins the pelvis. There is one joint on each side. These strong, weight-bearing joints help transfer force between the upper body and the legs and provide stability during standing and walking.

Sacroiliac joint pain is common and may account for up to one in three cases of persistent low back pain.

SIJ pain occurs when one or both joints, or the surrounding ligaments, become irritated or inflamed. Possible causes include:

  • Wear-and-tear changes
  • Pregnancy or childbirth
  • Previous injury or a fall
  • Uneven loading of the pelvis
  • Previous lumbar spinal fusion
  • Inflammatory conditions such as axial spondyloarthritis
  • Sometimes, no specific cause is identified

What are the symptoms?

SIJ pain is usually felt very low in the back, commonly on one side. Symptoms may include:

  • Pain over the upper buttock or close to the “dimples” of the lower back
  • Pain spreading into the buttock, groin or back of the thigh
  • Discomfort when standing up from a chair
  • Pain when climbing stairs, walking or standing for prolonged periods
  • Pain when turning in bed or lying on the affected side
  • Increased pain when standing mainly on one leg
  • Unable to sit in a bucket seat / car seat.

How is it diagnosed?

Diagnosis is primarily clinical, based on:

  • A detailed medical history and physical examination
  • Identification of characteristic movement-related pain
  • Imaging (such as MRI or CT scans) may be used to rule out any serious or structural causes of back pain. However, it is important to note that imaging findings often do not correlate with pain levels in facet joint-related problems.
  • A diagnostic Sacro-Iliac joint injection is often used to confirm SI joint as the pain source

What Treatments Do We Offer?

We provide a stepwise, evidence-based approach tailored to your individual needs. Treatment is considered after a detailed clinical assessment and is usually combined with physiotherapy, exercise and rehabilitation.

1. Image-Guided Sacroiliac Joint Injection
  • A small amount of local anaesthetic, usually combined with a corticosteroid, is injected into or around the sacroiliac joint.
  • The procedure is performed using ultrasound or X-ray guidance to improve accuracy.
  • It may help determine whether the sacroiliac joint is contributing to your pain.
  • The steroid may reduce inflammation and provide temporary pain relief.
  • This is a minimally invasive day-case or outpatient procedure.

Pain relief varies considerably. An SIJ injection is not a cure, but temporary improvement may allow greater participation in physiotherapy and rehabilitation. NHS patient guidance

2. Sacroiliac Joint Radiofrequency Denervation
  • This may be considered when an SIJ injection provides meaningful but temporary pain relief.
  • Special needles are positioned near the small nerves carrying pain signals from the sacroiliac joint.
  • Controlled radiofrequency heat is applied to reduce the nerves’ ability to transmit pain signals.
  • The aim is to provide longer-lasting relief and improve mobility and participation in rehabilitation.

3. Trigger Point Injections

  • For pain caused by muscle tension or spasm, especially in the upper trapezius or paraspinal muscles, we may offer trigger point injections
  • These are especially useful when muscle tightness is a major contributor to pain

4. Medication Optimisation

  • We review your current medications and help tailor a safe and effective plan
  • We support reducing unnecessary or ineffective medication use
  • Our clinic does not prescribe opioids or pregabalin; these must be managed by your GP

5. Self-Management & Rehabilitation Advice

  •  We support and guide you towards physiotherapy, activity pacing, and core strengthening
  • These are essential for long-term improvement once pain is better controlled
  • We strongly recommend water-based rehabilitation, including hydrotherapy and pool walking, as a safe, low-impact, and sustainable form of long-term exercise for people with facet joint pain.

What to expect from treatment

  •  Most patients report significant improvement in pain and function following the right combination of diagnostic and interventional care
  • Treatments are minimally invasive and done as day procedures
  • Repeat treatments may be considered depending on the response and recurrence of symptoms