Sacroiliac (SI) joint pain originates from the two joints connecting the base of your spine (the sacrum) to your pelvis (the ilium). This condition is often confusing because its symptoms frequently imitate other common problems, leading to delayed or incorrect diagnoses. The deep ache in the lower back, buttocks, or groin can easily be mistaken for sciatica, hip arthritis, or a lumbar disc issue. Identifying the correct medical professional is the first major step toward finding lasting relief.
The Initial Consultation
The first step should be a consultation with a Primary Care Physician (PCP). Your PCP performs an initial physical exam and gathers a detailed history of your pain patterns. They will perform basic provocative tests, which involve specific movements to reproduce your pain, helping to isolate the SI joint as the likely source.
The PCP will often order basic imaging, such as an X-ray, to rule out fractures, tumors, or severe joint degeneration that might suggest a different underlying condition. Initial, short-term management involves conservative measures like non-steroidal anti-inflammatory drugs (NSAIDs) or muscle relaxers to control acute symptoms. If the pain persists despite this initial treatment, the PCP will facilitate a referral to a specialist for advanced evaluation.
Specialists Focused on Diagnosis and Non-Surgical Management
Once the initial consultation suggests an SI joint problem, a specialist in non-surgical musculoskeletal care is the next step. Physiatrists, who specialize in Physical Medicine and Rehabilitation (PM&R), focus on restoring function and treating the whole person. They develop comprehensive, non-surgical treatment plans that integrate multiple modalities like medication, targeted therapy, and bracing.
Pain Management Specialists, often trained in Anesthesiology or PM&R, focus on interventional techniques that directly target the pain source. These specialists perform the most definitive diagnostic tool for SI joint pain: the diagnostic injection, or SI joint block. This procedure involves injecting a numbing agent, such as a local anesthetic, directly into the joint under fluoroscopic (X-ray) guidance. If the injection provides at least 50% short-term pain relief, the diagnosis is confirmed. Following confirmation, they may administer therapeutic corticosteroid injections to reduce local inflammation and provide longer-lasting relief.
The Role of Physical Therapy and Rehabilitation
Physical therapy (PT) is nearly always a necessary component of successful long-term recovery. Physical Therapists focus on addressing the biomechanical issues that caused the SI joint to become symptomatic. They use manual therapy techniques, such as soft tissue mobilization and Muscle Energy Techniques (METs), to improve joint mechanics and correct pelvic alignment imbalances.
The core of the rehabilitation program involves therapeutic exercise focused on stabilizing the pelvis and strengthening the supportive musculature. Specific exercises target the deep abdominal muscles, gluteal muscles, and hip stabilizers, which maintain joint stability during movement. For symptom reduction, a PT might also use modalities like dry needling to target trigger points in tight muscles surrounding the pelvis and lower back.
When Surgical Intervention is Necessary
Surgical intervention is reserved for a small percentage of patients whose severe pain persists after at least six months of intensive non-operative management. The decision to proceed is usually made by a PM&R or Pain Management specialist who refers the patient to a surgical specialist. These surgeons are typically Orthopedic Surgeons or Neurosurgeons specializing in the spine or complex joints.
The standard procedure is minimally invasive SI joint fusion, which aims to stabilize the painful joint by fusing the sacrum and ilium together. This percutaneous approach uses image guidance to place transfixing devices across the joint, leading to a shorter recovery time compared to traditional open surgery. This procedure is often categorized by the CPT code 27279, representing the placement of a transfixing device to eliminate motion and the source of chronic pain.