Spine, Neck & Back

Sacroiliac Joint Dysfunction

Sacroiliac (SI) joint dysfunction is a frequently overlooked cause of low back and buttock pain, responsible for an estimated 15–30% of chronic low back pain cases. Because its symptoms often overlap with lumbar disc herniation, radiculopathy, and hip pathology, SI joint pain is commonly misdiagnosed and undertreated. At Maryland Orthopedic Specialists, we use a systematic clinical examination combined with diagnostic injection techniques to confirm the SI joint as the pain generator, and we offer targeted interventions — including corticosteroid injections and lateral branch radiofrequency ablation — that provide durable relief.

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What is sacroiliac joint dysfunction?

Sacroiliac joint dysfunction is pain arising from the joint that connects the base of the spine (the sacrum) to the pelvis. Too much or too little motion, or inflammation, can irritate the joint. Symptoms include lower back and buttock pain that may radiate into the hip or groin.

The sacroiliac joint connects the sacrum (the triangular bone at the base of the spine) to the iliac bones of the pelvis on each side. It is a true synovial joint surrounded by strong ligamentous support. The SI joint transmits substantial forces between the spine and lower extremities and is capable of generating pain through mechanical dysfunction (altered joint movement) or inflammatory/degenerative changes of the joint surfaces.

The joint is heavily innervated by branches of the L4–S3 dorsal rami (lateral branches), which is why SI joint pain is responsive to lateral branch radiofrequency ablation (RFA) when other treatments provide insufficient durability.

Common contributing factors:

Leg length discrepancy
Prior lumbar fusion (increased SI joint stress — "adjacent segment" effect)
Pregnancy and peripartum ligamentous laxity
Inflammatory arthropathies (ankylosing spondylitis, psoriatic arthritis)
Degenerative osteoarthritis of the joint

Treatment options

SI joint dysfunction responds well to targeted physical therapy and, when needed, image-guided injections.

Physical Therapy

Pelvic stabilization exercises — gluteal, hip abductor, and core strengthening — are the foundation of treatment. Manual therapy and SI joint mobilization address acute pain and restore normal movement patterns. A home exercise program maintains gains long-term.

Medications

NSAIDs manage inflammation and are the first-line medication for SI joint pain. A short oral steroid course helps during acute flares.

SI Joint Corticosteroid Injection

A fluoroscopic-guided injection of corticosteroid directly into the SI joint confirms the diagnosis and provides meaningful pain relief. This approach is effective in 70 to 90% of appropriately selected patients. Relief typically lasts weeks to months, and injections can be repeated based on clinical response.

Lateral Branch Radiofrequency Ablation

For patients with confirmed SI joint pain who respond to injections but have short-lived relief, cooled radiofrequency ablation interrupts the nerve supply to the joint. The procedure provides 6 to 12 months of durable pain relief and can be repeated when symptoms return.

Frequently Asked Questions

How do I know if my low back pain is from the SI joint and not the disc?

SI joint pain is typically well-localized to the PSIS region and does not follow a dermatomal pattern. Lumbar disc herniation more often produces leg pain below the knee in a specific nerve root distribution. Your MOS physician uses a structured clinical examination and, when needed, a diagnostic injection to make this distinction definitively.

What is lateral branch RFA and does it hurt?

Lateral branch RFA uses radiofrequency energy delivered through a needle to thermally ablate the small nerve branches that carry pain from the SI joint. The procedure is performed under local anesthesia with light sedation if desired. Most patients experience soreness for a few days followed by progressive pain relief over 2–4 weeks.

Can SI joint dysfunction occur during pregnancy?

Yes. Peripartum SI joint pain is common due to the ligamentous laxity effects of relaxin. A sacroiliac belt and pelvic floor PT are effective first-line treatments. Symptoms typically improve after delivery.

Can an injection make my diagnosis clear?

Yes — a diagnostic SI joint injection is the gold standard. If you receive ≥75% pain relief from a local anesthetic injection into the joint, the SI joint is confirmed as the primary pain source.

How long does SI joint RFA last?

Most patients experience 6–12 months of meaningful relief. The procedure can be repeated when the nerves regenerate and pain returns.

Meet the specialists

Christopher S. Raffo, MD

Orthopedic Surgery · Sports Medicine

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John J. Christoforetti, MD

Orthopedic Surgery · Sports Medicine · Hip Preservation Surgery

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James S. Gardiner, MD

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Peter G. Fitzgibbons, MD

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Medically reviewed by Christopher S. Raffo, MD

Last reviewed May 1, 2026

References

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Laslett M, Aprill CN, McDonald B, Young SB. "Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests." Manual Therapy 2005;10(3):207–218. https://doi.org/10.1016/j.math.2005.01.003
Szadek KM, van der Wurff P, van Tulder MW, Zuurmond WW, Perez RS. "Diagnostic validity of criteria for sacroiliac joint pain: a systematic review." Journal of Pain 2009;10(4):354–368. https://doi.org/10.1016/j.jpain.2008.09.014
Patel N, Gross A, Brown L, Gekht G. "A randomized, placebo-controlled study to assess the efficacy of lateral branch neurotomy for chronic sacroiliac joint pain." Pain Medicine 2012;13(3):383–398. https://doi.org/10.1111/j.1526-4637.2012.01328.x
Fortin JD, Dwyer AP, West S, Pier J. "Sacroiliac joint: pain referral maps upon applying a new injection/arthrography technique." Spine 1994;19(13):1475–1482. https://doi.org/10.1097/00007632-199407000-00011
OrthoInfo / AAOS. "Sacroiliac Joint Dysfunction (Sacroiliac Joint Pain)." https://orthoinfo.aaos.org/en/diseases--conditions/sacroiliac-joint-dysfunction/