Treatment for sacroiliac joint pain typically starts with over-the-counter pain relievers and targeted exercises, then escalates to injections, nerve treatments, or surgery only if simpler approaches fail. The sacroiliac (SI) joint sits where your lower spine meets your pelvis, and it’s a surprisingly common source of low back pain. A 2023 systematic review in eClinicalMedicine found that among patients with persistent low back pain, more than half had pain originating from the SI joint.
Most people improve with conservative care. But if your pain lingers beyond a few weeks, a clear ladder of next steps exists, each more targeted than the last.
Pain Relief and Anti-Inflammatory Medication
The first line of treatment is straightforward: over-the-counter anti-inflammatory drugs like ibuprofen, along with acetaminophen for pain relief. These reduce both the inflammation inside the joint and the pain signals it produces. For most people with a new flare-up, this is enough to take the edge off while the joint calms down.
If your SI joint pain is caused by an autoimmune condition like ankylosing spondylitis, your treatment looks different. These conditions involve the immune system attacking the joint, so doctors use medications that dial down that immune response. The specific class of drug depends on the severity and type of autoimmune disease involved.
Exercise and Physical Therapy
Stretching and strengthening exercises are one of the first treatments recommended alongside medication. The goal is to stabilize the pelvis by building strength in the muscles that support the SI joint. Three muscle groups matter most here: your core (the deep abdominal muscles that act like a natural brace around your pelvis), your glutes, and your hamstrings.
Common exercises include bridging (lying on your back and lifting your hips while keeping your feet flat), the bird dog (extending opposite arm and leg from a hands-and-knees position), and specific stretches for the piriformis, a deep muscle in your buttock that can tighten and pull on the SI joint. Hamstring stretches also help by reducing tension on the back of the pelvis.
If pain doesn’t resolve well within the first two to three weeks of conservative care, it’s typically time to consider the next step rather than continuing to wait. Physical therapy may continue alongside more advanced treatments, but stalled progress is a signal to escalate.
SI Joint Belts
A sacroiliac belt is a narrow, firm band that wraps around your hips at the level of the SI joint, compressing the pelvis and providing external stability. It sits lower than a standard back brace, secured around the front of your body at the crease where your thigh meets your torso. In clinical trials, SI belts scored significantly higher in user satisfaction compared to standard lumbar braces. However, when researchers measured actual pain reduction and painkiller use, there was no statistically significant difference between the two types of support. An SI belt can be a useful tool for daily comfort, particularly during activities that aggravate your pain, but it won’t replace exercise or other treatments.
Corticosteroid Injections
When conservative care isn’t enough, a corticosteroid injection directly into the SI joint is the typical next step. The injection delivers a potent anti-inflammatory medication right to the source of pain, often guided by imaging so the needle is placed precisely inside the joint. Many people experience significant relief within days.
These injections also serve a diagnostic purpose. If the injection eliminates most of your pain, it confirms that the SI joint is actually the problem, which matters because low back pain can come from several overlapping sources. A reduction of at least 75% in pain after an image-guided injection is the benchmark most guidelines use to confirm the SI joint as the pain generator, and this confirmation is required before more advanced procedures are considered.
Radiofrequency Ablation
If injections confirm the SI joint as the source but the relief doesn’t last, radiofrequency ablation (RFA) offers a longer-term solution. This procedure uses heat to disable the lateral branch nerves, which are the specific nerves that carry pain signals from the SI joint to your brain. With those nerves interrupted, the pain signal simply stops reaching you.
Pain relief from RFA typically lasts six months to a year, and for some people it lasts several years. The nerves do eventually regrow, which means pain can return, but the procedure can be repeated. Before approving RFA, most practitioners require that diagnostic nerve blocks first confirm you’ll respond well. Some guidelines recommend at least 50% pain relief from a single diagnostic block, while several major spine societies advocate for stricter criteria: 75% or greater relief from two separate blocks.
SI Joint Fusion Surgery
Surgery is reserved for people who have exhausted all other options. Minimally invasive SI joint fusion uses small implants to permanently stabilize the joint, eliminating the movement that causes pain. The criteria for qualifying are specific and strict.
You’ll need to have tried at least six months of intensive nonsurgical treatment, including medication, activity changes, bracing, and a structured exercise program targeting the lower spine, pelvis, and hip. Your pain should be typically one-sided, located below the lowest lumbar vertebra and over the back of the SI joint. A physical exam must show tenderness specifically over the joint (not at other common pain points like the hip or tailbone), and at least three out of several standard provocation tests must reproduce your pain.
Imaging is required to rule out other causes like tumors, fractures, or nerve compression in the lumbar spine. You also need at least 75% pain relief from two separate diagnostic injections using different anesthetics, plus at least one therapeutic corticosteroid injection into the joint. These requirements exist because SI joint fusion is irreversible, and confirming the diagnosis beyond doubt protects against operating on the wrong source of pain.
How Diagnosis Shapes Your Treatment Path
One of the trickiest aspects of SI joint pain is confirming where the pain is actually coming from. The SI joint sits close to the lower spine, hip, and several other structures that can all produce overlapping symptoms. Doctors use a cluster of physical provocation tests (specific movements and pressures designed to stress the SI joint) to narrow down the source. Research has shown that having three or more positive provocation tests, combined with the absence of symptoms that shift during repeated movements (which would suggest a disc problem instead), provides strong diagnostic accuracy when compared against confirmatory injections.
This diagnostic process matters because it determines which treatments you’re offered. If provocation tests are inconclusive, you may start with general conservative care. If they clearly point to the SI joint, your doctor can move more quickly to targeted injections. And if injections confirm the joint as the source, the door opens to RFA or, eventually, fusion. Each step builds the diagnostic case while simultaneously treating the pain.