SI Joint Injections, Part 1: Lidocaine

Hi everyone!

Here’s a subject I’ve been meaning to write about for a long time.  It’s been coming up a lot in messages from readers recently, which I always take as a sign it’s time to get an official post up!

What I wanted to talk to you about today is the topic of lidocaine and cortisone injections for the SI joints.

These are the injections that a specialist, such as an orthopedist or a physiatrist, will typically offer you.  (They’re much more widely available, and better understood, than prolotherapy.   This is because they’re a much older form of treatment, and have been around for a lot longer).

There are two main formulas a doctor will offer you.  In this post, we’re going to focus on the first one:

1) Lidocaine only. 

Lidocaine is a numbing chemical– similar to the novacaine you’d get at the dentist.

A lot of doctors will tell you that a lidocaine injection is the “gold standard” for diagnosing SI joint problems.

Now, before I go on, let me explain that a physical therapist, or a chiropractor, might give you a different answer– it sort of depends on profession, and training.

However, according to the training that a medical doctor receives on the SI joint, the best, and only *true* way, to know if pain is coming from the SI joint is to inject it with lidocaine.  This will “turn off” the nerves sending pain signals from the SI joint.

If the pain disappears, that’s how you know the pain was coming from the SI joint itself, and not from several other causes that can seem like SI joint pain.  (For example, pain from a pinched or irritated nerve in the lumbar spine can often feel identical to SI joint dysfunction).

From a doctor’s perspective, this is the only true and reliable way to know if it makes sense to proceed with treating the SI joint, rather than other causes, such as the spine.  That’s why lidocaine injections are sometimes referred to as diagnostic injections, because they’re used to diagnose.

Now, as with any complex medical condition, I think that sometimes each profession looks at things through their own lens, and all of those lenses are “accurate” in their own way.  Different approaches can lead to healing for different people.  For some patients– particularly those who also have pathologies in the lumbar spine– a lidocaine injection may be completely necessary to tell what’s going on.

On the other hand, I personally never received any type of injection at all in my SI joints.  I had confidence in my chiropractor, who was able to identify a clear cause and effect in the way my pelvis was rotating, which in turn made it hard to move my legs.  I could clearly see the results each time when I limped in to his office for an adjustment, and came out walking normally.  To me, it was clear he knew what he was talking about.  (With this being said, I did later come to have mixed feelings about chiropractic adjustments, which make up an important part of story if you’re new to my blog).

The purpose of this post is not to tell you whether or not to get a lidocaine injection– it’s to present you with information.  

My goal is to present both sides of the issue to you, and to explain why some medical professionals might consider a lidocaine injection to be completely necessary, while others will be happy to treat you without it.

As with everything related to the SI joints, you have to decide if something makes sense for you personally.   If you, and the medical professionals you’re working with, are already confident that your SI joints are the issue, it might not be necessary to go for a diagnostic lidocaine injection.

But if you’re having a hard time figuring out if your pain is coming from the SI joints in the first place, a lidocaine injection might be a good idea.

Here is a really great video I wanted to leave you with, where a physiatrist talks about the different treatment approaches for SI joint dysfunction.  At the 2:45 mark, you can see how he mentions lidocaine adjustments as the “gold standard” for diagnosing SI joint problems.

(This talk is one of my favorite resources to share with people, and I even wrote a separate post where I took notes on it here).

In my next post, I’ll be discussing the other main type of injection a pain specialist might off you– lidocaine and cortisone combined.  Stay tuned!

If you have any questions in the meantime, remember you can always comment below or email me at  Thanks!


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