SI Joint Pain Treatment | Austin, TX

Sacroiliac Joint Pain

Precise diagnosis and interventional treatment of sacroiliac joint dysfunction — a commonly missed cause of low back pain.

Overview

The sacroiliac (SI) joint connects the sacrum (the triangular bone at the base of the spine) to the ilium (the large hip bone on each side of the pelvis). SI joint dysfunction is estimated to be responsible for 15–30% of chronic low back pain cases — yet it is frequently missed or misdiagnosed, sometimes even after spinal surgery that failed to address the true source of pain. Dr. Migdale evaluates and treats SI joint pain with both diagnostic and therapeutic precision, using image-guided injections, radiofrequency ablation, and minimally invasive SI joint fusion procedures.

Recognizing SI Joint Pain

SI joint pain characteristically presents as pain in the low back and buttock, often radiating into the groin or thigh — sometimes mimicking lumbar radiculopathy. It is typically one-sided (though can be bilateral), worsened by prolonged sitting or standing, transitioning from sitting to standing, walking, and sleeping on the affected side. Specific provocative tests during physical examination can help identify SI joint involvement.

Why SI Joint Pain Is Often Missed

The SI joint is not well visualized on routine lumbar MRI, which focuses on the intervertebral discs and nerve roots. Without specific imaging of the SI joint and careful physical examination, the SI joint can be overlooked as a pain source — leading to treatment directed at the wrong anatomy. Dr. Migdale's combination of chiropractic and interventional training gives her a heightened awareness of the SI joint as a pain generator.

Treatment Options

Dr. Migdale offers a full range of SI joint treatments. Diagnostic SI joint injections under fluoroscopic guidance confirm the SI joint as the pain source. Therapeutic injections can provide significant temporary relief. For patients with confirmed SI joint pain who respond to injections but experience only temporary benefit, cooled radiofrequency ablation of the lateral branch nerves supplying the SI joint provides longer-lasting relief. Minimally invasive SI joint fusion using the Liberty-SI system is available for patients with refractory SI joint pain.

Common Questions

Frequently Asked Questions

How is SI joint pain diagnosed?
Diagnosis involves a combination of clinical history, physical examination including specific SI joint provocation tests, and response to diagnostic injection. A fluoroscopically guided SI joint injection that provides significant temporary pain relief (typically >50% improvement) is considered the gold standard for confirming the SI joint as the primary pain source.
How long do SI joint injections last?
SI joint injections with corticosteroid can provide weeks to months of relief. The duration varies among patients. For those with good but short-lived response to injections, cooled radiofrequency ablation of the lateral branch nerves can provide more sustained relief — often lasting 12 months or longer.
Is SI joint fusion surgery required?
Minimally invasive SI joint fusion is a procedure, not open surgery — it is performed percutaneously through a small incision and typically allows same-day discharge. It is reserved for patients with confirmed SI joint pain who have not achieved adequate relief from injections and radiofrequency ablation. It is not the first line of treatment.

Medical Disclaimer: The information on this page is intended for general educational purposes only and does not constitute medical advice. It is not a substitute for professional medical evaluation, diagnosis, or treatment. Please consult Dr. Migdale or another qualified healthcare provider regarding your specific condition.

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