Common causes
- Altered movement or load transfer across the pelvis after injury or pregnancy.
- Arthritis or wear affecting the joint surfaces.
- Leg-length differences or gait changes that shift pelvic loading.
- Previous lumbar fusion changing the forces across the joint.
- Inflammatory joint disease requiring rheumatology coordination.
How we evaluate
History explores the location of pain, aggravating positions, prior pregnancy or injury and previous spine care. A hands-on osteopathic and physiatric examination uses a cluster of provocative SI joint tests alongside hip, spine and nerve assessment, since no single test confirms the joint as the source. Prior imaging is reviewed, and diagnostic ultrasound may help assess nearby tendons or guide care, while EMG/NCS is considered when a nerve problem is suspected. A diagnostic injection may be discussed when examination and imaging leave the source uncertain.
Treatment options
we may discuss.
Performance Health / rehabilitation
Rehabilitation may address hip and trunk strength, pelvic control, gait and the movement habits that load the joint. A supportive belt may be discussed for selected situations, with progression guided by the examination. Most SI joint pain can be managed without surgery; a surgical opinion is sought only when confirmed joint pain persists despite a thorough nonsurgical program.
Regenerative & Cell-Based Medicine
When appropriate, PRP or prolotherapy may be discussed for selected SI joint or surrounding ligament problems, recognizing that evidence varies by target and technique. Cell-based and biologic options require a separate review of evidence, risks and applicable law. These approaches complement, and do not replace, rehabilitation that restores load transfer across the pelvis.
Targeted Pain Management
Medication review and precise, image-guided procedures may be discussed for a confirmed joint source. Diagnostic joint blocks can clarify the diagnosis, and radiofrequency ablation of the nerves supplying the joint may be considered after appropriate diagnostic assessment. When it's needed, an image-guided joint injection with steroid can also calm an inflamed joint. Procedures are image-guided, using ultrasound or X-ray guidance depending on the target.
Related treatments
From the Journal
Related conditions
Common
questions.
When to seek
care urgently.
Seek urgent medical care for a hot, swollen joint with fever, new bladder or bowel changes, inability to bear weight after injury, or back pain with unexplained weight loss.
This page is general information, not medical advice. Individual results vary. Medical Disclaimer