The sacroiliac (SI) joint connects the sacrum, the triangular bone at the base of the spine, to the ilium, the large bones of the pelvis. This joint primarily absorbs shock and transfers the weight of the upper body to the legs. Although its motion is minimal, dysfunction or inflammation can cause intense discomfort. Pain is frequently centered in the lower back and buttock, often radiating down the leg, which can be confused with conditions like sciatica or hip arthritis. Successfully treating this condition requires identifying the correct medical professional who can accurately pinpoint the SI joint as the source of pain and guide a targeted treatment strategy.
Initial Assessment and Primary Care
The first consultation for persistent low back or buttock discomfort should involve a Primary Care Physician (PCP), Family Doctor, or Internist. The primary function of this initial visit is differential diagnosis—systematically ruling out other frequent causes of pain, such as issues originating from the lumbar discs or hip joint arthritis. The PCP will perform a thorough physical examination, including specific provocative maneuvers that stress the SI joint to reproduce the patient’s familiar pain pattern.
The PCP will often order standard imaging, typically X-rays of the pelvis, to look for structural irregularities or signs of advanced arthritis. While imaging alone cannot confirm SI joint pain, it helps exclude fractures or other severe spinal pathologies. If the pain persists and the physical exam strongly suggests SI joint involvement, the PCP serves as the gateway for referral to a specialist for advanced diagnostic procedures or specialized management.
Specialists Focused on Non-Surgical Pain Management
For patients whose pain is confirmed or highly suspected to originate from the SI joint, the next step involves consulting specialists focused on non-surgical interventions. Physiatrists (Doctors of Physical Medicine and Rehabilitation, or PM&R) specialize in musculoskeletal diagnosis and non-operative spine and joint care, focusing on restoring function. They are trained to manage complex pain problems and often lead the multidisciplinary treatment team.
Pain Management Specialists, often anesthesiologists or physiatrists with additional training, focus on interventional techniques for pain reduction. Both types of specialists perform the definitive diagnostic test for SI joint dysfunction: the diagnostic injection. This procedure involves injecting a local anesthetic into the joint, often guided by fluoroscopy or ultrasound. A significant, temporary reduction in pain confirms the SI joint as the source.
Once the diagnosis is confirmed, these specialists offer advanced non-surgical therapies. Therapeutic injections, combining a corticosteroid with a local anesthetic, can provide temporary relief by reducing inflammation inside the joint. For long-term pain control, they may recommend radiofrequency ablation (RFA), a procedure that uses heat energy to temporarily interrupt the function of the small nerves transmitting pain signals from the joint.
Rehabilitation and Manual Therapy Providers
While medical specialists manage pain, rehabilitation providers address the underlying mechanical instability and muscle imbalances contributing to SI joint dysfunction. Physical Therapists (PTs) are fundamental to long-term recovery, focusing on restoring proper movement mechanics and strengthening supporting musculature. A primary goal of physical therapy is teaching patients specific exercises for core and pelvic stabilization to minimize excessive strain on the joint.
These strengthening programs focus on the deep core muscles, gluteal muscles, and hip abductors, which create a stable foundation for the pelvis. Physical therapists also employ manual techniques and posture correction to improve body awareness and movement patterns during daily activities. A complementary approach is provided by Chiropractors or Osteopathic Doctors (DOs) who specialize in manual therapy.
These professionals use hands-on manipulation and adjustments to restore appropriate alignment and motion to the SI joint and surrounding structures. Manual therapy aims to correct excessive stiffness or looseness that can cause pain. It is often recommended that manual therapy be coordinated with strengthening exercises to ensure that restored alignment is maintained by improved muscle support.
Consulting a Surgical Specialist
Surgery for SI joint pain is considered a measure of last resort, reserved only for patients whose pain is severe and has not responded to a comprehensive, six-month trial of conservative treatments. The specialists who perform SI joint surgery are typically Orthopedic Surgeons focused on spine or complex joint disorders, or sometimes Neurosurgeons. They are consulted to evaluate the patient’s candidacy for a stabilizing procedure.
The most common surgical intervention is minimally invasive SI joint fusion, which involves inserting small titanium implants across the joint to encourage the bones to grow together. The goal of fusion is to eliminate movement and instability in the joint, thereby stopping the pain signals. Consulting a surgeon who specializes in this specific procedure is important, as their experience with the technique can significantly influence the outcome.