Sacroiliac (SI) Joint Dysfunction
SI Joint Dysfunction
SI joint dysfunction is pain caused by abnormal motion or alignment of the sacroiliac joint, where the lower spine connects to the pelvis. It causes pain in the lower back, buttock, hip, or groin and is often mistaken for sciatica or lumbar disc pain. At Aptiva Health, board-certified orthopedic spine surgeons Dr. Michael Casnellie, Dr. Jaideep Chunduri and Dr. David McConda diagnose and treat SI joint dysfunction with physical therapy, fluoroscopy-guided SI joint injections, and minimally invasive SI joint fusion at locations across Louisville, Lexington, Northern Kentucky, Elizabethtown, Mt. Washington, and Indianapolis.
Medically reviewed by Michael Casnellie, MD, Jaideep Chunduri, MD, David McConda, MD, and Steven Ganzel, DO. Last reviewed: May 2026.
What is SI joint dysfunction?
The sacroiliac joint — usually called the SI joint — is the strong, weight-bearing joint where the bottom of your spine (the sacrum) meets your pelvis (the iliac bones). You actually have two SI joints, one on each side of your lower back, just below the dimples above your buttocks.
The SI joint is built to be stable, not flexible. Strong ligaments hold the bones together and allow only small amounts of motion. When that motion becomes abnormal — too much, too little, or in the wrong direction — or when the joint becomes inflamed, the result is SI joint dysfunction.
SI joint dysfunction is a leading cause of chronic low back pain. Research suggests that 15 to 30 percent of chronic lower back pain originates in the SI joint, but it is one of the most under-diagnosed sources of back pain because the symptoms closely mimic lumbar disc pain and sciatica.
What are common SI joint symptoms?
SI joint dysfunction usually causes pain in one specific location — the lower back, buttock, or hip on one side. The most common symptoms our spine team evaluates are:
Pain in the lower back, buttock, or upper back of the thigh — usually on one side, occasionally both.
Pain that radiates into the groin or down the back of the leg, but usually does not extend below the knee.
Pain that gets worse with prolonged sitting, prolonged standing, climbing stairs, or rolling over in bed.
A feeling that the lower back is "locked" or "giving way" when bearing weight.
Pain when transitioning from sitting to standing or vice versa.
Pain when standing on one leg (e.g., putting on pants).
Pain that is reproduced when pressure is applied directly over the dimple at the top of the buttock on the affected side.
What causes SI joint dysfunction?
SI joint dysfunction is most commonly caused by either a specific traumatic event or by gradual degenerative changes:
Traumatic Causes
Motor vehicle accident - especially t-bone impact crashes
Fall on buttocks or lower back
Lifting and/or twisting
Sports injuries with sudden twisting motions or hard impact to the pelvis
Degenerative and biomechanical causes
Pregnancy and childbirth — pregnancy hormones loosen pelvic ligaments to prepare for delivery, and the SI joint may not regain stability afterward. SI joint pain after pregnancy is sometimes called pelvic girdle pain.
Prior lumbar fusion surgery — a fusion in the lower spine transfers extra mechanical stress to the SI joint, which over years can cause dysfunction in 30 to 40 percent of fusion patients.
Leg-length discrepancy — even small differences in leg length put asymmetric stress on the SI joints.
Inflammatory arthritis — conditions such as ankylosing spondylitis or psoriatic arthritis directly inflame the SI joint (called sacroiliitis).
Repetitive stress — occupations or activities that involve repetitive bending, twisting, or heavy lifting.
How is SI joint dysfunction diagnosed?
SI joint dysfunction is one of the harder spine diagnoses to confirm because no single test reliably identifies it. The Aptiva spine team uses a structured, multi-step evaluation:
A focused history. Your provider will ask about exactly where the pain is, what triggered it, what makes it worse (sitting, stairs, rolling over), and any history of pregnancy, prior spine surgery, or trauma.
A pattern-of-pain mapping. Patients often place a single finger over the affected SI joint when asked to point to where it hurts most — this is called the Fortin finger sign and is one of the most useful clinical clues.
Provocative physical exam tests. Your provider will perform several tests designed to reproduce SI joint pain — including the FABER, thigh-thrust, distraction, compression, and Gaenslen tests. Three or more positive tests significantly increase diagnostic confidence.
Imaging to rule out other causes. X-ray and MRI are not used to diagnose SI joint dysfunction directly (the joint often looks normal on standard imaging) but they are used to rule out lumbar disc herniation, spinal stenosis, hip arthritis, and other conditions that mimic SI joint pain.
A diagnostic SI joint injection. The most reliable way to confirm SI joint dysfunction is a fluoroscopy-guided injection of local anesthetic directly into the joint. If your typical pain is dramatically reduced or eliminated for the duration the anesthetic is active, the SI joint is confirmed as the source. Dr. Steven Ganzel performs these diagnostic injections at Aptiva Health.
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SI joint pain vs. sciatica vs. low back pain - how to tell the difference
The most common reason SI joint dysfunction goes untreated for years is that patients and providers mistake it for sciatica or general lumbar back pain. Here is how the patterns typically differ.
SI joint dysfunction typically has a pain location in the lower back, buttock, hip, or occasionally groin or upper thigh that is almost always on one side. There is typically no radiating pain. It is typically made worse by prolonged sitting or climbing stairs and rarely creates numbness or tingling in the leg. It is confirmed by a diagnostic SI joint injection.
Sciatica (lumbar radiculopathy) is typically located in the lower back radiating down the buttock and back of the leg, often past the knee. It’s almost always on one side and can radiate into the foot. It is made worse by sitting and bending forward and sometimes with climbing stairs. It is often accompanied by numbness or tingling in the leg and is confirmed with an MRI and medical examination.
Lumbar facet or muscle pain is often centrally located or paraspinal in the lower back with minimal leg involvement. It can be on either or both sides and does not radiate below the knee. It can sometimes be made worse with sitting and climbing stairs but rarely is accompanied by numbness or tingling in the leg. It is confirmed by a medical examination and medial branch block if the facet joint is involved.
Many patients have more than one source of pain — for example, both SI joint dysfunction and a herniated disc — which is why a thorough evaluation by a fellowship-trained spine team is the most reliable way to identify everything contributing to your pain.
Aptiva Health treats SI joint dysfunction with a stepped-care approach. Most patients get significant relief from non-surgical care; the patients who do not respond after several months of high-quality conservative treatment are candidates for SI joint fusion. If you have been diagnosed with SI joint dysfunction, which can lead to one or both of the SI joints becoming painful, your doctor will first recommend exploring conservative treatment options.
STEP 1 EARLY TREATMENTS
Medications may include:
Analgesics and NSAIDS
Opioid medications prescribed by a physician (opioids should be used only for a short period of time and under a physician’s supervision, as opioids can be addictive, aggravate depression, and have other side effects)
Anticonvulsants—prescribed drugs primarily used to treat seizures—may be useful in treating people with sciatica
Antidepressants such as tricyclics and serotonin, and norepinephrine reuptake inhibitors have been commonly prescribed for chronic low back pain (prescribed by a physician)
Self-management:
Hot or cold packs
Resuming normal activities as soon as possible may ease pain; bed rest is not recommended
Exercises that strengthen core or abdominal muscles may help to speed recovery from chronic low back pain. Always check first with a physician before starting an exercise program and to get a list of helpful exercises.
STEP 2 Additional CONSERVATIVE TREATMENT OPTIONS:
Transcutaneous electrical nerve stimulation (TENS) involves wearing a battery-powered device which places electrodes on the skin over the painful area that generate electrical impulses designed to block or modify the perception of pain
Physical therapy programs to strengthen core muscle groups that support the low back, improve mobility and flexibility, and promote proper positioning and posture are often used in combination with other interventions
Spinal manipulation and spinal mobilization are approaches in which doctors of chiropractic care use their hands to mobilize, adjust, massage, or stimulate the spine and the surrounding tissues. Manipulation involves a rapid movement over which the individual has no control; mobilization involves slower adjustment movements. The techniques may provide small to moderate short-term benefits in people with chronic low back pain but neither technique is appropriate when a person has an underlying medical cause for the back pain such as osteoporosis, spinal cord compression, or arthritis.
Traction involves the use of weights and pulleys to apply constant or intermittent force to gradually “pull” the skeletal structure into better alignment. Some people experience pain relief while in traction but the back pain tends to return once the traction is released.
Dry needling is moderately effective for chronic low back pain. It involves inserting thin needles into precise points throughout the body and stimulating them (by twisting or passing a low-voltage electrical current through them), which may cause the body to release naturally occurring painkilling chemicals such as endorphins, serotonin, and acetylcholine.
Behavioral approaches include:
Biofeedback involves attaching electrodes to the skin and using an electromyography machine that allows people to become aware of and control their breathing, muscle tension, heart rate, and skin temperature; people regulate their response to pain by using relaxation techniques
Cognitive therapy involves using relaxation and coping techniques to ease back pain
STEP 3 INJECTION THERAPY OPTIONS:
Interventional pain management injections to include:
SI Joint Injections. Sacroiliac (SI) joint pain is easily confused with back pain from the spine. Sometimes injecting the SI joint with lidocaine may help your doctor determine whether the SI joint is the source of your pain. If the joint is injected and your pain does not go away, it may be coming from a different source. During the procedure, a mixture of local anesthetic and steroid is injected into the SI joint. The local anesthetic will numb the area, and steroid may help lower the swelling. The steroid should reduce the pain and improve the motion in your hip or buttock.
Medial branch blocks injection used to determine if the facet joint is causing the patient's back pain. Facet joints are pairs of small joints between the vertebrae in the back of the spine.
Radiofrequency ablation involves inserting a fine needle into the area causing the pain through which an electrode is passed and heated to destroy nerve fibers that carry pain signals to the brain. Also called a rhizotomy, the procedure can relieve pain for several months.
STEP 4 minimally invasive si joint fusion
SI joint fusion is the surgical treatment for SI joint dysfunction that has not responded to several months of conservative care. The procedure stabilizes the joint by fusing the sacrum and ilium together, eliminating the abnormal motion that causes pain.
Aptiva Health's board-certified orthopedic spine surgeons Dr. Michael Casnellie, Dr. Jaideep Chunduri and Dr. David McConda perform minimally invasive SI joint fusion through a small incision on the side of the buttock. Specialized titanium implants are placed across the joint under live X-ray and navigation guidance, locking the joint in proper alignment and allowing bone to grow across it over the following months.
Compared with traditional open SI joint fusion, the minimally invasive approach offers:
A smaller incision (typically 1 to 1.5 inches).
Less blood loss and less surgical trauma.
A shorter procedure — most cases are completed in about an hour.
Outpatient or short-stay surgery — most patients go home the same day or the next morning.
Faster return to non-strenuous activity — typically two to four weeks.
High patient satisfaction rates in published studies (around 80 to 90 percent of properly selected patients report significant pain relief).
step 5 recovery after si joint fusion
Recovery after minimally invasive SI joint fusion happens in stages. Specifics vary by patient, but a typical timeline at Aptiva Health is:
Week 1: Walking with a walker or cane is encouraged starting the day of surgery. Pain is managed with a multimodal regimen designed to minimize opioid use.
Weeks 2 to 4: Most patients transition off assistive devices and resume desk-based work. Driving usually resumes around week three to four.
Weeks 4 to 12: Structured physical therapy with Aptiva's in-house team focuses on restoring hip and pelvic mobility, building core and gluteal strength, and gradually returning to normal activities.
Months 3 to 6: Bone fusion progresses across the joint. Most patients return to full, unrestricted activity by three months.
Month 6 and beyond: Solid bony fusion is typically achieved. Long-term outcomes from the minimally invasive technique are excellent and have been documented in multiple peer-reviewed studies.
Why choose Aptiva Health for SI joint dysfunction?
SI joint dysfunction is one of the most under-diagnosed and under-treated causes of chronic lower back pain. Many patients spend years moving between primary care, chiropractors, and general orthopedic clinics without ever having the SI joint properly evaluated.
Aptiva Health is set up specifically to handle this:
Three board-certified orthopedic spine surgeons with explicit SI joint expertise — Dr. Michael Casnellie, Dr. Jaideep Chunduri and Dr. David McConda — each of whom perform minimally invasive SI joint fusion.
A double board-certified pain management physician — Dr. Steven Ganzel — for diagnostic and therapeutic SI joint injections under fluoroscopic guidance.
On-site digital X-ray and MRI to rule out other causes of pain quickly.
In-house physical therapy with therapists experienced in SI-joint-specific stabilization protocols.
Same-day and walk-in spine appointments at most locations.
Transparent cash-pay pricing and broad in-network coverage.
Free 24/7 virtual access to an Aptiva orthopedic provider via the HURT! app.
We treat SI joint dysfunction across Kentucky & Indiana!
Spine Center of Excellence: 3615 Newburg Road, Louisville, KY 40218
Louisville - East: 10100 Linn Station Road, Suite 1A, Louisville, KY 40223
Concussion & Sports Medicine Institute: 3611 Newburg Road, Louisville, KY 40218
Elizabethtown: 529 Westport Road, Suite 2, Elizabethtown, KY 42701
Indianapolis: 6801 Gray Road, Indianapolis, IN 46237
Louisville - Downtown: 300 South 13th Street, Louisville, KY 40203
Louisville - Middletown: 401 N English Station Road, Suite 1A, Louisville, KY 40223
Lexington Physical Therapy: 152 W Tiverton Way, Suite 180, Lexington, KY 40503
Mount Washington: 737 N Hwy 31e Byp, Suite 2, Mt. Washington, KY 40047
Northern Kentucky: 2093 Medical Arts Drive, Hebron, KY 41048
Frequently asked questions about SI joint dysfunction
What does an SI joint flare-up feel like?
An SI joint flare-up typically feels like sharp, deep, one-sided pain in the lower back, buttock, or hip that gets dramatically worse with sitting, climbing stairs, getting in and out of a car, or rolling over in bed. Many patients describe a sense that the lower back is locked or giving way on the affected side.
What is the success rate of SI joint fusion?
Published peer-reviewed studies of minimally invasive SI joint fusion report patient satisfaction rates of approximately 80 to 90 percent in properly selected patients, with significant reductions in pain scores and meaningful improvements in disability scores at one, two, and five years after surgery. Outcomes are best in patients whose SI joint pain has been confirmed by diagnostic injection.
How is SI joint pain different from sciatica?
SI joint pain is typically located in the lower back, buttock, hip, or upper thigh on one side and rarely radiates below the knee. Sciatica typically radiates from the lower back down the back of the leg past the knee and often into the foot, and is more frequently associated with numbness or tingling. Many patients have both conditions at the same time, which is why a careful diagnostic evaluation matters.
Can SI joint dysfunction heal without surgery?
Most cases of SI joint dysfunction respond well to non-surgical treatment with physical therapy, anti-inflammatory medication, an SI joint belt, and one or more fluoroscopy-guided steroid injections. Surgery is reserved for the smaller subset of patients who do not get adequate or durable relief from conservative care.
Is SI joint fusion outpatient surgery?
At Aptiva Health, minimally invasive SI joint fusion is typically performed as outpatient or short-stay surgery. Most patients go home the same day or the next morning. The minimally invasive technique uses a small incision and specialized titanium implants placed across the joint under live X-ray guidance.
Why does my SI joint hurt after pregnancy?
Pregnancy hormones intentionally loosen the ligaments around the pelvis to prepare for delivery. In some patients, those ligaments do not fully tighten back after delivery, leaving the SI joint with abnormal motion. SI joint pain after pregnancy — sometimes called pelvic girdle pain — typically responds well to targeted physical therapy, an SI joint belt, and in some cases SI joint injections.
Why does my SI joint hurt after lumbar fusion?
A lumbar spine fusion eliminates motion at the fused segments, which transfers extra mechanical stress to the joints just above and below — including the SI joint. About 30 to 40 percent of patients with prior lumbar fusion go on to develop SI joint dysfunction, which is one of the most commonly missed sources of persistent pain after back surgery.
How do I sleep with SI joint pain?
Most patients with SI joint dysfunction find side-lying with a pillow between the knees the most comfortable position, because it keeps the pelvis level and reduces twisting forces across the joint. Sleeping on the unaffected side, on a firm mattress, with a small pillow under the waist for support is a common starting recommendation.
Does Aptiva Health perform SI joint fusion in Louisville?
Yes. Dr. Michael Casnellie, Dr. Jaideep Chunduri and Dr. David McConda — both board-certified orthopedic spine surgeons specializing in minimally invasive spine and SI joint procedures — perform SI joint fusion for patients from Louisville and the surrounding region.
How quickly can I be seen for SI joint pain at Aptiva Health?
Aptiva Health offers same-day and walk-in spine appointments at most locations across Louisville, Lexington, Northern Kentucky, Elizabethtown, and Mt. Washington. The HURT! app provides free, 24/7 virtual access to an Aptiva orthopedic provider for after-hours guidance.
If your lower back, buttock, or hip pain has been written off as "just back pain" — but it has not gotten better — it may be SI joint dysfunction. Aptiva Health's spine team can confirm the diagnosis with a focused evaluation and a fluoroscopy-guided injection, often within the same week.
Videos About SI Joint Dysfunction
Hear from Lorie in the video below about her SI-joint fusion with Dr. Casnellie!
Learn more about SI-joint fusions with Dr. David McConda!
Studies show that the SI joint is a source of pain in 15-30% of patients with chronic low back pain. Does this include you?
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