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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.
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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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.
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.
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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 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 →
Realistic expectations.
SI joint pain is highly treatable when correctly identified. The greatest barrier to recovery for most patients has been the years of unsuccessful treatment for the wrong diagnosis. Once the SI joint is identified as the source and an appropriate treatment plan is followed, meaningful improvement is realistic for most patients. Like other chronic pain conditions, recovery is typically progressive over weeks to months rather than instant.
Our approach.
At Timeless Interventional of Naples, Dr. Chaturani Ranasinghe, MD, is a double board-certified anesthesiologist and interventional pain physician with extensive experience in image-guided lumbar and cervical procedures. We serve patients across Naples, Marco Island, and the broader Southwest Florida region, with coordination with spine surgical colleagues when appropriate.
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