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Sacroiliac (SI) Joint Pain Treatment in Naples & Marco Island
Sacroiliac (SI) joint pain is one of the most commonly missed causes of chronic low back and buttock pain. Estimates suggest the SI joint is the primary source of pain in 15 to 30 percent of patients with chronic low back pain, yet it is rarely identified early in the workup. If you have been told your imaging is normal, or you have been treated for disc or facet pain without relief, the SI joint is worth a careful look. This page describes how we evaluate and treat SI joint pain at Timeless Interventional of Naples.
SYMPTOMS
How SI joint pain typically presents.
The classic SI joint pain pattern is unilateral low back or buttock pain that is worse with prolonged sitting, prolonged standing on one leg, getting in and out of a car, or rolling over in bed. Patients often point with one finger to the area just below the dimple at the lower back as the spot where the pain lives — the so-called Fortin finger sign. Pain may be triggered or worsened by transitions (sit to stand), stairs, or specific postures.
Common triggers and risk factors include pregnancy and postpartum biomechanical changes, prior lumbar fusion (which increases load on the SI joints), traumatic injury such as a fall onto the buttock or a motor vehicle accident, leg-length discrepancy, and inflammatory conditions such as ankylosing spondylitis.
OVERVIEW
What the sacroiliac joint is.
The sacroiliac joint connects the sacrum (the triangular bone at the base of the spine) to the ilium (the large pelvic bone). You have one on each side. The joint is unusual in that it is partly synovial and partly fibrous, with very limited motion in normal physiology. Its main job is to transfer load between the spine and the lower extremities and to provide stability through the pelvis.
Because it sits at the base of the spine, SI joint pain is often felt as low back pain, buttock pain, or pain just to the side of the spine. It is typically unilateral (one-sided) but can be bilateral. Pain may radiate into the upper posterior thigh, but rarely below the knee.
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THE OVERLOOKED JOINT
Why SI joint pain is so often missed.
Several factors contribute. Standard lumbar MRI does not image the SI joint directly, and even when SI joint changes are noted, they often do not correlate with pain. The exam findings can mimic disc, facet, or hip pain. And the joint is anatomically unusual — many primary care physicians and even some specialists are not familiar with its specific clinical patterns. As a result, patients often spend years being treated for the wrong source before SI joint involvement is identified.
EVALUATION
How SI joint pain is diagnosed.
Diagnosis is largely clinical. A focused exam uses specific provocation tests that mechanically load the SI joint — the Fortin finger test, FABER (Patrick's) test, Gaenslen's test, distraction and compression tests, and the thigh thrust test. The combination of multiple positive provocation tests substantially increases the likelihood that the SI joint is involved.
The diagnostic SI joint injection remains the gold standard. Under fluoroscopic guidance, local anesthetic is delivered precisely into the joint. If the patient's typical pain substantially decreases for the duration of the local anesthetic, the SI joint is confirmed as the dominant pain generator. This both establishes the diagnosis and often provides therapeutic relief at the same time.
TREATMENT
Treatment of SI joint pain
Treatment is matched to the specific findings and the patient's history.
Conservative care includes targeted physical therapy emphasizing pelvic stabilization, gluteal strengthening, and movement re-education; SI joint belts in selected patients; and nerve-modulating medications when appropriate. Many patients improve with this layered conservative approach over weeks to months.
Intra-articular SI joint injections with corticosteroid provide both diagnostic confirmation and therapeutic benefit, often lasting weeks to months. They can be repeated as part of a long-term plan.
Sacral lateral branch radiofrequency ablation is the longer-term interventional option for patients who respond well to diagnostic injections but find the relief too short-lived. The sacral lateral branches carry pain signals from the posterior SI joint. By interrupting these nerves with radiofrequency, relief can extend nine to eighteen months, and the procedure can be repeated as the nerves regenerate.
Minimally invasive SI joint fusion is appropriate in selected patients with confirmed SI joint pain who have failed appropriate non-surgical care. Modern fusion techniques use small implants placed through tiny incisions under image guidance, and have substantially better outcomes than older open approaches.
Treatment of central sensitization is layered in patients with longstanding SI joint pain, since the nervous system component contributes meaningfully once the pain has persisted for years.
For patients with chronic sacroiliac joint pain that has not responded to conservative care or has had only short-lived benefit from steroid injection, we offer image-guided PRP injection as a regenerative alternative. Learn more about our SI joint PRP approach →
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WHAT TO EXPECT
Realistic expectations.
SI joint pain is highly manageable for most people once the joint is correctly identified as the source — which is often the hard part after years of it being treated as a disc or hip problem. Conservative care and a well-placed injection resolve many cases, and for those whose relief runs short, sacral lateral branch radiofrequency ablation commonly extends it to nine to eighteen months and can be repeated. Improvement usually builds over weeks as the joint calms and the surrounding muscles re-stabilize, rather than switching off overnight. The honest goal is durable control of your pain and a return to the activities that matter — reserving fusion for the small number of patients a thorough non-surgical plan hasn't helped.
GOOD TO KNOW
Frequently asked questions
WHAT DOES SI JOINT PAIN FEEL LIKE?
SI joint pain is usually felt low and to one side — over the dimple of the low back, deep in the buttock, sometimes radiating into the groin or the back of the thigh. It's often worse with standing up from sitting, rolling over in bed, climbing stairs, or standing on one leg. Because it sits right where the spine meets the pelvis, it's frequently mistaken for a disc or hip problem.
HOW DO YOU KNOW IF PAIN IS COMING FROM THE SI JOINT?
The most reliable way is an image-guided diagnostic injection into the joint. If numbing the SI joint significantly relieves your pain, it confirms the joint as the source — and that same injection often provides lasting therapeutic relief.
CAN SI JOINT PAIN BE TREATED WITHOUT FUSION SURGERY?
In most cases, yes. Targeted physical therapy, image-guided SI joint injections, and — for the right patient — sacral lateral branch radiofrequency ablation can control the pain for many months to years. Fusion is a last resort, considered only when a thorough non-surgical plan hasn't helped.
WHAT CAUSES SACROILIAC JOINT PAIN?
Common causes include arthritis of the joint, prior lumbar fusion that shifts load onto the SI joint, pregnancy-related ligament changes, injury or a fall, and asymmetric movement patterns. Identifying the driver is part of building a plan that lasts.
THE NEXT STEP
Our approach.
Dr. Chaturani Ranasinghe, MD is a double board-certified anesthesiologist and interventional pain physician with deep experience in image-guided spine procedures, serving Naples, Marco Island, and greater Southwest Florida. If low-back or buttock pain has been dismissed or mistreated as a disc problem, the best next step is a simple conversation about whether a precise, image-guided approach can pinpoint and calm the true source.
Already get these injections, or here for the season? With recent imaging, we can often evaluate and treat you the same day or next — no insurance pre-authorization wait.