General Principles

Although injections may be helpful in confirming a diagnosis, they should be used primarily after a specific presumptive diagnosis has been established. Injections should not be used in isolation, but rather in conjunction with a program stressing muscle flexibility, strengthening, and functional restoration. Proper follow-up after injections to assess the patient's treatment response and ability to progress in the rehabilitation program is essential. A limited number of injections can be tried to reduce pain, but careful monitoring of the response is required prior to a second or third injection.

These injections are an adjunct treatment, which facilitates participation in an active exercise program and may assist in avoiding the need for surgical intervention. All physiatrists who perform injections should be aware of the indications, contraindications, and complications of therapeutic injections, and fully inform patients of the potential risks.

Sacroiliac Joint Injection

Although not usually a primary pain generator, the sacroiliac joint is a common area of referred pain and can persist as the primary focus of pain. The typical pain referral pattern is to an area around and just caudal to the posterior superior iliac spine. The S-1 joint should therefore be treated within the context of the entire spine and kinetic chain, including the pelvis, hips, and lower extremities.

In patients who have failed four to six weeks of a comprehensive exercise program, local icing, mobilization/manipulation and anti-inflammatories, a sacroiliac joint injection can be helpful for both diagnostic and therapeutic purposes. In some patients, S-1 joint injections can provide significant pain relief.

When sacroiliac joint injections are employed, they should be performed with fluoroscopic guidance using contrast medium to ensure proper needle and medication placement. If helpful, they may be repeated; however, the frequency of these injections should be limited with attention placed on the comprehensive exercise program.
Sacroiliac Joint Injection