Understand your SI diagnosis and how treatment works

Diagnosis and treatment of SI joint pain are, unfortunately, a little complicated. But when you understand the process, you can find the path that’s right for you.

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Why SI pain diagnosis is difficult

There are a lot of different things that can cause low back pain, and that means finding the real cause can be a challenge.

Low back pain that comes from the SI joint can feel very similar to lots of other kinds of low back pain. In addition to that, SI joint dysfunction is a relatively recent medical diagnosis, though it’s well-supported by data, and some doctors aren’t as familiar with it as others. There’s no one test that gives a diagnosis of SI joint pain – instead, there are several steps involved to pinpointing the SI joint as the true source of your pain. Luckily, once you do identify it, there are several treatment options to help relieve your pain.

Tests for SI joint pain

There are a few tests that can help determine if your SI joint is the problem:

Physical tests

When you visit your doctor, they’ll ask you to point to where it hurts, and they’ll do some tests called “provocative tests,” where they’ll move your legs and hips and see how your body feels in response. Based on the results, they’ll be able to tell whether the SI joint is a likely culprit for your pain.

Imaging tests

Your doctor might also want to take an MRI or an x-ray to get a better look at the structure of your pelvis. Internal images like these can help diagnose things like osteoarthritis or sacroiliitis, or even small fractures.

Injections as tests

If you have an injection in the SI joint and it relieves your low back pain, even if only for a short time, then it can be a clear indicator that your pain may be coming from an SI joint problem.

Treatment for SI joint pain

Once you’ve got a diagnosis of SI joint pain, there are options for treating it. Remember, pain isn’t normal, and you shouldn’t have to live with it.

You’ll probably start with the most conservative treatment and stop when you find something that works for you. You’ll start by trying simple treatments like rest, ice, over-the-counter medication, or a belt that supports the joint. If those don’t work, you may move on to some of the following options:

Physical therapy

Physical therapy for the SI joint can be passive – things that the therapist does, like massage, ice, or heat – or active – things that you do, with the guidance of the therapist, like stretches, exercises, and strengthening. You’ll probably need to do therapy for several months to see an effect.


If other therapies haven’t worked, your doctor may try injecting a combination of local anesthetic (like lidocaine) and anti-inflammatory medication (commonly corticosteroids) into your SI joint. For some people, this provides relief, but it’s not a permanent solution, and is not recommended to be done more than three times a year. Even a little bit of relief from injections can be a clear indicator that the SI joint is the source of your pain, and that makes these injections an important step to take before moving on to other types of treatment.

SI joint fusion surgery

When nothing else works for SI joint pain, it might be time to think about surgery. SI joint fusion surgeries, like the SImmetry procedure, fuse the joint together so it doesn’t move and therefore can’t cause pain. SImmetry surgery is a new kind of fusion surgery that’s minimally invasive, usually only requires a 1 – 2 day hospital stay – and results in an average 59% reduction in average low back pain after 12 months.*

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*Araghi, A et al, Symmetry Sacroiliac Joint Fusion System — Differentiated Technologies for Your Patients. Think Tank Symposium June, 2019

Although SI joint fusion surgery isn’t right for everyone, it can benefit those patients who are appropriate candidates. As with any type of surgical procedure, there are risks associated with SI joint fusion surgery. Be sure to discuss these with a spine specialist who is skilled in diagnosing and treating patients with SI joint dysfunction.