Diagnosing the Cause of SI Joint Pain

In diagnosing the cause of SI joint pain, your doctor will consider all the information you provide, including any history of injury, location of the pain, and problems standing or sleeping. A variety of diagnostic tests may help determine whether the SI joint is a source of your symptoms.

How is SI Joint Pain Diagnosed?

Though SI joint pain can be difficult to diagnose for some physicians, a few physical tests that manipulate the leg and hip combined with a thorough history and physical, X-ray and/or MRI imaging studies to rule out other possible causes, can help to determine if the pain is coming from the lower back or the sacroiliac joint.

SI Joint Pain Diagnosis

At BASIC, our skilled spine experts are extensively trained and highly qualified in the accurate and definitive diagnosis of SI joint pain. To accomplish this, we begin with history and physical, followed by supporting imaging studies and/or diagnostic epidural injections to validate the need to proceed with an SI joint pain diagnosis and treatment plan.

The History and Physical

When it comes to accurately diagnosing SI joint pain, the most important information you can give your doctor is the exact location of your pain and level of your functionality. Try to notice when the pain occurs and how intensely you feel it in various locations, including your low back, buttocks, and legs. Also, be sure to tell your doctor about any previous injury that may have either directly affected your pelvis, or caused you to walk with an altered gait, or may relate in any way to your functionality.

Upon completion of this discussion, the physician will then perform a physical examination aimed at pinpointing whether the SI joint is the cause of the low-back pain. The physical exam helps the doctor rule out other causes of low-back pain, while honing in on those related to the SI joint in order to properly diagnose the SI joint as the pain source. While the low-back will be a feature of the physical exam, other parts of the body may also be examined depending on the SI joint pain symptoms that are being experienced by the patient.  In addition, your doctor may perform a series of “provocative tests” to manipulate the SI joint in an attempt to “recreate” the pain or tenderness you are experiencing in that area. These tests can help further establish an SI joint pain diagnosis.

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X-rays can be helpful in SI joint pain diagnosis accuracy. It is also important to remember that more than one condition (like a disc or hip problem) can co-exist with SI joint conditions and these types of imaging studies are a way for your doctor need to check for other factors that may be causing your symptoms.


An MRI (Magnetic Resonance Imaging) is usually ordered once your physician has a suspicion as to what is causing the SI joint pain, based on the history questions, physical exam and any other imaging exams performed. The MRI can be helpful because its detailed images can show any changes to the soft tissues surrounding the SI joint in a way that x-rays, historical pain discussions and external physical exams cannot. For this reason, MRIs are frequently used to visualize whether there is damage to a lumbar disc, lumbar spinal stenosis, nerve problems or SI joint tumors, among other possible SI joint pain causes.

SI Joint Epidural Steroid Injection

The most widely used method to accurately determine the cause of SI joint pain is to inject the SI joint with painkillers. If, following the injection, the SI joint pain is decreased a significant amount, then it can be concluded that the SI joint is either the source, or a major contributor, to the low-back pain being experienced by the patient. If the level of pain does not change after the SI joint injection, then the SI joint is ruled out as the primary cause of the pain.

Accurately diagnosing SI joint pain is crucial to an effective treatment plan. While this diagnosis may require multiple steps in order to determine exactly what’s causing the SI joint-back pain, it is important to seek help from a spine expert who is skilled and experienced in effectively diagnosing SI joint pain and then expertly treating it using the least invasive methods first.

Health Tips For SI Joint

  • Perform SI joint stretches – these help prevent injury & increase mobility
  • Maintain a healthy body weight – extra pounds can worsen SI joint pain
  • Quit smoking – it seriously restricts nutrient rich blood flow to the spinal discs and joints

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