Do Sacroiliac Joint Injections Work?

Sacroiliac joint injection are us to reduce or eliminate back pain that occurs from injured inflamed sacroiliac (SI) joint. According to clinical studies, around 15% of adults suffer from some type of chronic lower back pain, which often develops due to SI joint problems. Research shows that corticosteroid joint injections are effective for this sort of pain. Injections into the surrounding tissue around the joint (extra-articular) or directly into the joint (peri-articular) provides patients with pain relief that is much greater than what is achieved with oral medications.

What is a sacroiliac joint?

The sacroiliac joint is positioned at the base of the spine cord, and there are one on each side of the lower hip region. SI joints connect the hips to the spine. The SI joint provides support for the upper body and limbs, enhances stability, and reduces occurrence of injuries by lowering the lower body’s range of motion.

The sacroiliac joint connects the bottom of the spine (sacrum) to the pelvic bone (ileum), and the region where these two structures meet is protected by cartilage. A small space between these two structures has clear, thick synovial fluid, which is joint material that cushions the area. The entire structure is enclosed in a fibrous capsule, which is protected by a tough membrane. The doctor injects the medication in the area right outside the membrane.

How does the corticosteroid work?

Most people who receive SI joint injections report immediate pain relief due to the local anesthetic. However, the corticosteroid starts to work after 2-3 days, providing long-lasting pain relief. The corticosteroid agent enters the body’s cells, where it combines with steroid receptors in the cytoplasm. Then, the substances enter the nucleus of the cell where it controls protein synthesis, including the enzymes that regulate cell activities and inflammation. The corticosteroid also acts on cell membranes to alter ion permeability and modify the production of neuro-hormones.

How is the sacroiliac joint steroid injection done?

When you arrive at the medical facility, a nurse goes over the procedure risks and benefits and has you sign a consent form. A local anesthetic is used to numb the skin and deeper tissues, and the doctor guides the procedure needle into the area using a fluoroscope (real-time x-ray). Once the correct position is confirmed, the corticosteroid agent is injected along with a local anesthetic. While the anesthetic numbs the tissue and reduces pain, the steroid alleviates inflammation. After the injection, the needle is removed, and a bandage is applied over the site.

Is the sacroiliac joint steroid injection effective?

In a recent clinical study, researchers analyzed the effectiveness of a SI injection for the treatment of SI joint pain over a 2-year follow-up period. The study participants had a CT-guided intraarticular steroid (triamcinolone acetonide 80 mg) and anesthetic (bupivacaine hydrochloride) joint injection. Afterwards, pain was evaluated using a visual analog scale (VAS). The overall efficacy rate of the SI injection was 89%, and some patients had pain relief that lasted for up to 2 years.

What can I expect after the SI joint injection?

After the sacroiliac joint injection, you will experience some soreness at the injection site(s). One or both joints are injected during the procedure. We recommend that you rest the remainder of the day, and gradually return to usual activities as tolerated. For site pain relief, we encourage use of an ice pack to the lower back region for 20-minute intervals several times each day.

Resources

Sahin O, Harman A, Akgun RC, & Tuncay IC (2012). An Intraarticular Sacroiliac Steroid Injection Under the Guidance of Computed Tomography for Relieving Sacroiliac Joint Pain: A Clinical Outcome Study with Two Years of Follow-Up. Rheumatology, 27(3), 165-173.