Sacroiliac (SI) joint injections are a common procedure used to help diagnose and treat lower back and pelvic pain originating from the sacroiliac joints. The injection typically contains a mixture of a long-acting corticosteroid, which reduces inflammation, and a local anesthetic, which provides immediate, temporary pain relief. While the procedure is quick, the post-injection period involves specific restrictions designed to ensure safety, maximize the therapeutic effect, and prevent complications. Following these guidelines is an important part of the overall treatment plan.
Critical Restrictions in the First 24 Hours
The most immediate restrictions are concentrated in the 24 hours following the procedure, primarily due to the local anesthetic administered. Patients must strictly avoid driving or operating heavy machinery for at least 12 to 24 hours after the injection. The local anesthetic can cause temporary numbness or mild weakness in the leg or foot, impairing the ability to safely control a vehicle. This temporary unsteadiness also increases the risk of a fall, requiring caution when walking or climbing stairs.
Strenuous physical activities and heavy lifting are also prohibited for the first 24 hours to prevent the medication from being displaced from the joint space. Patients should avoid lifting anything over 5 to 10 pounds. Activities involving excessive twisting, significant bending, or jarring motions should also be avoided on the day of the injection to allow the steroid to settle effectively.
Patients should also refrain from consuming alcohol for the first 24 hours post-procedure, especially if any form of sedation was used during the injection. Alcohol can interact with sedative medications and may also mask a patient’s perception of pain or any new neurological symptoms that could indicate a complication. Furthermore, patients who received sedation may be advised to avoid making important life or financial decisions for 24 hours, as their judgment may be temporarily impaired.
Monitoring the Injection Site and Managing Initial Discomfort
Direct care of the injection site focuses on preventing infection and managing the expected short-term discomfort following the needle placement. Patients should not take a bath, soak in a hot tub, or swim for at least 24 to 48 hours after the procedure to prevent bacteria from entering the injection site. While showering is generally permitted after a few hours, the area should be kept clean, and patients should avoid scrubbing the site for several days.
It is common to experience some localized soreness or an increase in pain once the temporary numbing effect of the local anesthetic wears off, which can happen within a few hours. Applying a covered ice pack to the area for about 15 to 20 minutes at a time can help reduce this discomfort and any localized swelling. Patients should avoid applying heat to the injection site for the first few days, as heat can sometimes increase inflammation or reduce the effectiveness of the medication.
Patients should be vigilant for signs of complication and seek immediate medical attention if they develop a fever greater than 101°F or new weakness or numbness in the leg lasting more than a few hours. Signs of infection at the site include spreading redness, warmth, excessive localized pain, or fluid discharge. Diabetics must also monitor their blood sugar levels closely for several days, as the corticosteroid can cause a temporary elevation in blood glucose.
Timeline for Resuming Physical Activities and Work
After the initial 24-hour period of strict rest, patients can typically return to their normal daily activities and light work the following day. The full anti-inflammatory effects of the corticosteroid medication are not immediate and may take between three and seven days to become noticeable. Until the steroid begins to work, some pain relief may be minimal or the original pain may return temporarily.
A gradual return to more demanding physical activities, such as regular exercise or physical therapy, is advised over the next few days to a week. Guidance for resuming these activities is highly individualized and should be discussed with the treating physician. The overarching principle is to listen to the body and avoid any activity that significantly increases pain or re-provokes the original SI joint symptoms.