Sacroiliac Joint (SIJ) Pain & Dysfunction

Low back and buttock pain that worsens on sitting and transitional movements

Conditions Treated

Neck Pain
Trigeminal Neuralgia
Back Pain
Knee pain
Buttock Pain
Shoulder Pain
Pain Due To Vascular Diseases
Hip Pain
Cancer Pain And Palliative Care

Overview

Sacroiliac joint (SIJ) pain is responsible for 15–25% of all chronic low back pain. The SIJ transfers load between the spine and the lower limbs, and is a complex synovial joint stabilised by powerful ligaments. SIJ dysfunction causes pain in the buttock, lower back, groin, and posterior thigh — often misdiagnosed as lumbar disc disease or piriformis syndrome. At Vedant Pain Clinic, precise SIJ-targeted treatment offers lasting relief when the diagnosis is confirmed.


Symptoms & Causes

Common Symptoms

  1. Pain in the buttock and lower back, usually unilateral
  2. Pain worsened by transitional movements — sit-to-stand, rolling in bed
  3. Positive FABER / FADIR / Gaenslen's tests
  4. Pain referral into groin, posterior thigh, or lateral hip
  5. Worsened by prolonged sitting on hard surfaces
  6. Post-pregnancy pelvic girdle pain
  7. Pain after spinal fusion surgery at L4-S1 (adjacent segment)
Common Causes

  1. Pregnancy and postpartum ligamentous laxity
  2. Inflammatory sacroiliitis (ankylosing spondylitis, psoriatic arthritis)
  3. Degenerative joint disease (osteoarthritis)
  4. Post-lumbar fusion — increased SIJ load (adjacent segment disease)
  5. Leg length discrepancy and altered gait
  6. Trauma — fall directly onto the buttock
  7. Hip or lumbar spine pathology altering pelvic mechanics

Conservative & First-Line Treatment

  • Physiotherapy — SIJ stabilisation, core strengthening, gluteal activation
  • Pelvic support belts for pregnancy-related SIJ pain
  • NSAIDs and analgesics for acute pain
  • Manipulation and manual therapy (osteopathy / chiropractic)
  • DMARDs for inflammatory sacroiliitis

How Vedant Pain Management Clinic Can Help

Our interventional pain specialists offer the following evidence-based procedures, all performed with real-time ultrasound guidance for precision and safety:

  • Image-guided Sacroiliac Joint Injection (fluoroscopy / ultrasound) — diagnostic and therapeutic
  • Cooled Radiofrequency Ablation (Cooled RFA) of lateral branch nerves — offering 12–24 months of significant pain relief, the most durable non-surgical treatment for SIJ pain
  • Prolotherapy injections for SIJ ligamentous laxity (particularly effective in postpartum cases)
  • Differentiation from piriformis syndrome, lumbar facet pain, and hip joint pathology through systematic diagnostic blocks
  • PRP injection for SIJ ligamentous instability

Newer Diagnostic Concepts & Advances

Cooled Radiofrequency Ablation of the sacral lateral branches represents a major advance over conventional RFA — the cooled probe creates a larger, more spherical ablation zone ensuring coverage of the anatomically variable SIJ sensory nerves. Multiple randomised controlled trials support Cooled RFA providing >50% pain reduction for 12–24 months in confirmed SIJ pain.

Frequently Asked Questions

SIJ pain typically does not extend below the knee, worsens with transitional movements, and is reproducible with specific provocation tests (FABER, Gaenslen's). Disc pain often has a dermatomal distribution below the knee. A definitive diagnosis is made by a diagnostic SIJ injection — if more than 75% pain relief, the SIJ is confirmed as the source.

Cooled RFA uses cooled electrodes that allow delivery of more energy without tissue charring, creating larger ablation volumes. This is critical for SIJ nerves (S1–S3 lateral branches + L5 dorsal ramus) which are anatomically variable. Cooled RFA ensures all relevant nerve branches are captured, producing more complete and durable pain relief than conventional RFA.

Yes — pregnancy-related pelvic girdle pain (PGP) affecting the SIJ is extremely common, affecting 20% of pregnancies. Most cases resolve postpartum, but 7–8% develop chronic SIJ pain. For these patients, prolotherapy or low-dose SIJ injection with ultrasound guidance is safe and effective.

In the majority of cases, yes. SIJ fusion is a significant procedure with its own complications. Cooled RFA is a reversible, minimally invasive procedure that provides duration of relief comparable to fusion in many patients. Dr. Rakhi Goyal will counsel you on the evidence and your specific case.

Most patients return to desk work within 24–48 hours. After Cooled RFA, we recommend avoiding strenuous physical activity for 1–2 weeks and typically advise a 2–4 week physiotherapy programme to maximise the benefit.
Meet Our Specialist

Dr. Mohit Gupta

Interventional Pain Physician & Pain Specialist

Dr. Mohit Gupta is a highly experienced Interventional Pain Physician dedicated to helping patients overcome chronic pain and regain a better quality of life. He combines advanced, minimally invasive pain management techniques with compassionate, personalized care.

10+ Years Experience
Advanced Pain Therapies
Patient-First Care
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Dr Mohit Gupta