There are several factors that can predispose someone to pain from the SIJ, most of which include forces that place an extraordinary amount of stress of the joint (increased axial load or a sudden rotation of the joint, for example).[4] These include disruption of the lining of the joint, ligament injury, muscle pain, shearing forces, cysts, etc.
Reasons for saroiliitis are typically divided into those that affect either the inside of the joint (intra-articular) or the outside of the joint (extra-articular).

Intra-articular sources include:

1. Arthritis
2. Spondyloarthropathy
3. Trauma
4. Infection
5. Cystic disease

Extra-articular sources include:

1. Trauma/fractures
2. Ligament injury
3. Myofascial pain
4. Pregnancy
5. Cystic disease
6. Enthesopathy

Extra-articular causes of pain are more likely to result in pain being one-sided. What’s more they occur in younger people, have greater associated tenderness to palpation, and are associated with a trauma or some other inciting event. It becomes important to determine whether the source is intra-articular or extra-articular when determining a treatment plan.

Increased stress from the SIJ can be from:
 Obesity
 Spinal deformities
 Previous spinal surgery
 Leg length discrepancy
 Ligament weakening leading to changes in structural support (i.e. pregnancy).[8]
About 40-50% of people with sacroiliac joint dysfunction report a history of trauma or some inciting event, with the leading causes being motor vehicle accidents, falls, cumulative strain, and pregnancy.[9]

Sacroiliac Joint Block – This injection is considered to be the gold standard in diagnosing SIJ pain and is the first line of treatment.[10]  Typically performed under fluoroscopic guidance, your physician will insert a small needle into the bottom portion of the SIJ and inject a small amount of local anesthetic (sometimes with the addition of cortisone). In the case of true sacroiliitis, pain relief will be immediate and dramatic.
Neurolysis & Ablation – In cases where the block provides only temporary relief, neurolysis or neuroablation can be utilized to increase the duration. There are several different methods that can be used to this end.[11]

• Radiofrequency Ablation (RFA) – Radio waves are applied to a nerve or plexus, preventing the transmission of pain.
• Cooled RFA (Coolief™) – This is a highly advanced form of RFA that allows for a higher likelihood of successfully blocking the pain transmitting nerves with less post-procedural discomfort.[12]

***The Ainsworth Institute is one of only a handful of centers in the tristate area capable of performing Cooled RFA

• Simplicity™ – This is a variation of traditional RFA where a small device called a Simplicity Probe™ is inserted under X-ray guidance along the SIJ. This allows strip lesion of radiofrequency energy to be delivered along the joint.

The initial goal in treating SIJ pain is addressing the underlying cause. For example, in the case of a leg length discrepancy causing SIJ pain, a shoe lift and physical therapy should be considered to potentially alleviate the cause and prevent further damage.

Physical Therapy & Conservative Measures – Particular exercises can be useful to stabilize the joint, such as transversus abdominis muscle contractions. There have not been studies done looking at pharmacologic treatment specifically of sacroiliac joint pain. Evidence is therefore drawn from studies looking at nonspecific lower back pain.

Medication Management & Pharmacologic Therapy – In patients who do not have a correctable cause, pharmacotherapy may be used as an adjunct to treatment. Anti-inflammatories, namely NSAIDs, and muscle relaxants may be of some benefit. There is only weak evidence for the benefit of tricyclic antidepressants.[13]