SI Joint Pain

If you’ve been experiencing pain in your lower back or hips, it could be due sacroiliac (SI) joint instability. The SI joint is the joint where the sacrum (the triangular bone at the base of the spine) meets the ilium (the large pelvic bone). This joint is held together by many ligaments travelling in different directions. These ligaments provide the first layer of stability for your SI joints. The SI joint plays an important role in supporting the weight of the upper body and transferring it to the legs. It moves each time you take a step, bend over, or move your torso. When this joint becomes unstable, it can cause pain that affects your daily activities.

In my experience, SI joint instability is a cause of pain that is often overlooked and under-diagnosed. X-rays do not show a detailed picture of the SI joint due to overlapping bones in the area. MRI, which provides the most detailed imaging for the SI joint, take images while patients lay on their back without moving. MRIs can show degeneration, arthritis, or inflammation in the SI joints, but it does not effectively measure the stability of SI joints. All of the patients I have successfully treated have had normal x-rays and MRIs because our current technology does not allow us to measure the dynamics of a person’s SI joints. We must rely on a patient’s symptoms and physical examination to diagnose SI joint instability.

At White Oak Pain Clinic, we have provided many patients with regenerative injections (prolotherapy or platelet rich plasma) to treat SI joint instability. These injections are a safe and effective alternative to surgery. The patients we have successfully treated had all already tried many other therapies such as medications, physiotherapy, chiropractic, massage therapy, and more. These other treatments can provide temporary pain relief because it addresses painful muscles caused by the joint instability, or temporarily puts the joint back in place only to have it go out of place again shortly after.


Symptoms of SI joint instability can vary from person to person, but they often include:

  1. Pain in the lower portion of the lower back or in the hips
  2. Difficulty sitting or standing for long periods of time
  3. Sensation of something being out of place in your low back, which improves once it is put back in place
  4. Clicking in the low back
  5. Pain that worsens with certain movements, such as walking, twisting, or bending
  6. Numbness or tingling in the legs or buttocks
  7. Muscle weakness in the legs or buttocks


SI joint instability can be caused by a number of factors:

I have met patients whose SI joint became unstable for a variety of reasons. The most common reason are traumas such as falls or car accidents. Pregnancy is another common cause because hormones released during pregnancy purposefully make the joints of the pelvis looser to allow babies to pass through the birth canal. I have even met patients whose SI joints became unstable due to repetitive bending and lifting.


There are treatments for SI joint instability that DO correct the instability.

  1. Physical therapy: Strengthens muscles around the SI joint to provide additional stability, but does not change the instability of the ligaments holding the joint together. Sometimes, SI joint pain is caused by muscle imbalance, which pulls the joint out of alignment. Once muscle balance is restored through rehabilitation of weak muscles and releasing of overly tight muscles, the joint can be in the ideal alignment again. In more severe cases, this is not enough to fully treat the pain. 
  2. Regenerative injections: These injections triggers your own body to repair damaged ligaments and restore the most fundamental layer of stability to your joints. The regenerative injections available in Canada are prolotherapy and platelet rich plasma (PRP). Stem cell therapy in Canada is only available under research settings.
  3. SI joint fusion surgery: In most severe cases of SI joint instability, surgery is required to completely fuse the joint.


There are treatments for SI joint pain that does NOT change the stability of the joint.

  1. Medications: Pain medications and muscle relaxants can help alleviate pain temporarily, but does not address the underlying instability.
  2. SI Joint Belt: This belt compresses your SI joints to provide stability. Once the belt is taken off, the instability returns.
  3. Steroid or local anaesthetic injections: Even injections for the SI joint with just local anesthetic can provide months of pain relief for some patients. Others require cortisone injection for longer term relief. For some, neither provide more than a few days of pain relief. Cortisone injections are a good option for causes of SI joint pain other than instability, such as inflammatory pain due to ankylosing spondylitis, psoriatic arthritis, or other rheumatologic conditions.
  4. Radiofrequency ablation: This is a needle-based procedure that uses heat to destroy the nerves that send pain signals from the joint to the brain. When the nerves cannot transmit pain, your brain cannot feel the pain. Although it sounds invasive, this can be a very good option for patients who have pain despite trying other treatments.


At White Oak Pain Clinic, we provide a balanced treatment approach for SI joint pain.

We start by listening to your symptoms and performing a thorough physical examination. With an experienced physician, this alone can provide a fairly good accuracy of diagnosis for SI joint instability. To further increase the accuracy of our diagnosis, we perform injections targeting the SI joint using only local anaesthetic and see how much pain reduction you have. Sometimes, this alone will permanently reduce your pain, or provide significant pain relief for several weeks to months. If the pain reduction is significant but temporary, we move onto regenerative injections with the intent of creating long-term improvements. If you do not improve with regenerative injections, we refer you onto other pain programs that can perform radiofrequency ablation.


Author: Dr. Xiao Yuan MD CCFP D-CAPM

1 thought on “SI Joint Instability and How Regenerative Injections Can Help

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