Sacroiliac Joint Injections

Are sacroiliac joint injections useful for our patient population? A 2013 review article, available here, concludes that current literature "…is unable to fully conclude the effectiveness of the modality and provide adequate comparison against surgical treatment." The above linked article provides a description of fluoroscopy-guided sacroiliac joint injections that can be used for both diagnostic and for therapeutic purposes.

According to the article, a guided injection may be indicated in a patient who has known sacroiliac joint pathology, a history of trauma, or referred symptoms into the buttock or lower extremity. Contraindications can include pathology of coagulation, pregnancy (due to radiation effects), systemic or local skin infection, or patient allergies to medication. During the procedure, a local anesthetic is utilized, and the patient is minimally sedated so that he or she is able to answer questions about pain. Both a pain-reducing medication and an anti-inflammatory are typically utilized; however, in patients who have received a maximum level of steroids, only an analgesic may be injected.

Results of an injection may include provocation of symptoms and/or immediate relief, which provides diagnostic value, i.e., that the structures injected may have, in fact, been causative to the patient's symptoms. For many patients, pain relief occurs within 24 hours. The long-term benefits of sacroiliac joint injections is not well-documented, so the ability to predict length of benefit is challenging.

In regards to rehabilitation of the patient who has undergone a sacroiliac joint injection, following a procedure, the patient is usually instructed to rest for 3-4 days and to follow-up with the referring medical provider within 2-3 weeks. The level at which a patient should resume physical activity, therapeutic exercises, and participation in physical therapy is determined by the medical provider. Level of activity in rehabilitation should therefore be coordinated with the patient's medical provider and potentially with the interventionist who performed the injection.

For more information about sacroiliac joint injections, check out this MedScape article about the topic, or clickhereto view a video of an SIJ injection. To learn clinical information about SIJ evaluation, mobilization, and stabilization activities, check out the next Sacroiliac Joint & Pelvic Ring Dysfunctioncontinuing education course taught by Pelvic Rehabilitation Institute faculty member Peter Philip. This course will be offered two times this year; coming up in early February on the West coast (Santa Barbara, CA) and in July on the East coast (Baltimore, MD.) Click here to learn more about the course objectives and schedule.