Back Pain Causes & Treatments

SI Joint Pain Treatment

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How is SI joint pain treated?

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Sacroiliac joint pain can be treated in a number of ways. Treatment for SI joint pain is typically done first with conservative treatments and tend to be really effective. Conservative treatment for SI joint pain may include:

• Anti-inflammatory medications

• Physical therapy

• Osteopathic manipulation

• Electroacupuncture

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It is important to note that it is estimated that 80% of patients with back pain caused by SI joint dysfunction may get adequate relief with physical therapy alone. If conservative treatments fail to provide relief, other treatment options can be added to or used in place of conservative treatments. These treatments include:

• Injections

  • Corticosteroids

  • Prolotherapy

  • Platelet rich plasma (PRP) and platelet rich fibrin (PRF)

• Prescription medications​

  • Corticosteroids​

  • NSAIDs

  • Opioid medications (pain medicine)

• Nerve ablation (destruction of the nerve)​

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Currently, surgical intervention for SI joint pain is rare. Therefore, if your back pain is caused by SI joint pain, it is unlikely that surgery will relieve the pain. In fact, a review published in Journal of Neurosurgery: Spine concluded that "evidence for the efficacy of SIJ fusion itself lacking, serious consideration of the cause of pain and alternative treatments should be given before performing the operation". 

 

So instead of surgery for your SI joint pain, get a second opinion from a licensed physician.

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PRP for SI Joint Pain

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Platelet rich plasma, or PRP, is a regenerative medicine treatment method that uses the patients own blood as the source. It involves the removal and concentration of platelets which are then injected into the area of injury. PRP has been studied as a potential treatment for back pain that is caused by pain in the sacroiliac.

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A prospective randomized open blinded end point (PROBE) study published in Pain Practice in 2016 compared treating chronic back pain using corticosteroid injections with platelet rich plasma. The study evaluated 40 patients that were randomized to being treated with either methylprednisolone (the steroid) or platelet rich plasma. The patients' pain was then tracked for 3 months.

 

The corticosteroid injections were only 25% effective 3 months after treatment. On the other hand, PRP was found to be 90% effective in those who received PRP for SI joint pain. The study tracked 3 different standardized pain scores over the 3 months, the visual analog scale (VAS), the Modified Oswestry Disability Questionnaire (MODQ), and the Short Form (SF-12) Health Survey. All 3 scores appeared to favor PRP over the use of corticosteroids for sacroiliac joint pain. The MODQ and SF-12 scores were lower in the patients treated with steroids than the patients treated with PRP. Essentially, 3 months after treatment, patients treated with PRP for SI joint pain had significantly less pain. The authors concluded that the use of PRP in treating low back pain due to the SI joint was effective.

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Prolotherapy for SI Joint Pain

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Prolotherapy has also been studied for the treatment of SI joint pain. Prolotherapy typically involves the injection of more natural substances into an injured area in an effort to stimulate the body's ability to heal itself. Prolotherapy has been around for decades, but for a number of reasons has not become a more common treatment.

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A prospective, randomized, controlled trial published in The Journal of Alternative and Complementary Medicine in 2010 compared the efficacy of prolotherapy versus corticosteroid injections for the treatment of sacroiliac joint pain. The authors concluded that not only were the effects of prolotherapy equivalent to using steroids, but the effects of prolotherapy on SI joint pain lasted longer than corticosteroid injections. 

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A retrospective cohort study published in Complementary Therapies in Medicine in 2018 evaluated the effectiveness in treating SI joint pain with prolotherapy. The 103 patients diagnosed with back pain secondary to SI joint instability were treated with a series of 3 prolotherapy injections, each injection separated a month. The researchers found that prolotherapy can have clinically meaningful effectiveness on a select group of patients with SI joint pain. They also found that relief after the first injection in the series was a good indicator of improvement later.

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Prolotherapy versus PRP for SI Joint Pain

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A study published in the Journal of Prolotherapy in 2018 compared the effectiveness of platelet rich plasma with prolotherapy in treating SI joint pain. The study treated 45 patients with either PRP or prolotherapy and assessed the patients at 3 months and at 12 months. The researchers reported that PRP for SI joint pain was superior overall. In summary, PRP was more effective in reducing pain as 100% of all patients treated with PRP reported better function and an improvement in pain. In addition, the patients treated with PRP required fewer injections that the patients treated with prolotherapy.

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It is important to note that although PRP was found to be superior to prolotherapy, both treatments can be done together and during the same visit. Also, although PRP takes fewer treatments to get superior results, PRP typically costs more than prolotherapy.