Hi everyone!
In my recent posts, I’ve been talking about lidocaine and cortisone injections for the SI joints– the various risks and benefits your doctor should tell you up front.
However, I wanted to address a larger question I had when I first looked into them, and why I, personally, decided not to proceed.
And again– this blog is based mainly on my own experience as a patient, and the opinions various medical professionals gave me at the time. I can’t promise that what turned out to be true for me will be true for you. However, my goal is to share the answers that I found, to save you the time I spent looking for them.
So why, ultimately, did I decide not to pursue lidocaine or cortisone injections?
A few reasons:
I was confident that I had a problem with SI joint dysfunction, so I didn’t feel I needed a diagnostic lidocaine injection.
I had previously had a bad reaction to a cortisone injection in my knee, and didn’t want to risk the same thing happening again.
However, there’s another overarching reason: neither I, nor the orthopedist I saw, were confident the injections would really help.
Why?
To answer this question, we need to first remember that the hip bone and the sacrum are meant to fit together in a certain way. That’s why the surface of one has a bump where the other will have a groove. It’s sort of like a lock and key.
When the joint is out of alignment, these bumps and grooves don’t line up. Instead, you can end up with a bump on a bump, which can create a lot of pain. It also affects the mechanics of how you walk– if your hip bone is stuck in a weird position, it also means your hip socket and therefore your leg bone are stuck in a weird position.
So, for me, when my joints would get stuck, I’d have a lot of pain and it would be hard to walk.
And then, when my chiropractor would put the joint in place– boom! All the pain would be gone.
So, the question that I asked my orthopedist at the time was: If the pain I feel is from the joint being misaligned, and the pain goes away immediately when my joint is put into place… will an injection that’s meant to reduce inflammation really help me?
His answer was no. Cortisone wouldn’t work to cancel out that type of pain “bump on bump” pain, because it wasn’t primarily being caused by inflammation. It was caused by the two bones being misaligned, which, biologically speaking… should cause pain. It wasn’t a case of chronic inflammation that had been going on for weeks, which is what cortisone is used to treat.
Because I could get immediate pain relief when my chiropractor adjusted the joint, my orthopedist and I concluded that I probably didn’t have much lingering inflammation in the area– not that was causing pain, anyway– because when my joints were in place I was pretty much pain-free. So trying to target that type of pain with an injection just didn’t seem to make sense.
However, I do know people who say they’ve found cortisone injections in the SI joints to be helpful.
As I always say, everyone is different. I do think there is a big range, from person to person, in terms of what type of dysfunction they actually have, and how much inflammation is present. (Check out my post on the four types of SI joint dysfunction for more on this!).
If you have significant inflammation or degeneration, it would stand to reason that cortisone might help you.
And on the other hand, if you and your doctor are having trouble telling where, exactly, your pain is coming from, a lidocaine injection might make complete and total sense.
But here, I’ve explained to the reasons why I, personally, chose not to receive these injections.
My goal on this blog is to provide you with all the information to help you make the best decision for you. I hope this helps!
My Sacroiliac Joint Saga 
Thanks Christine for the useful information. My doctor has done a prolotherapy injection (sugar water) into the SI joint area, which causes inflammation and causes healing to the tendons and ligaments. It did help for a few months, but because the underlying issues weren’t addressed, didn’t last. Now that I finally found a therapist to do the MET (third practitioner was the charm) and another to do the aquatic therapy, we probably will try more prolotherapy injections in the future. It helps to tighten up the ligaments.
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That’s awesome that you found someone who does MET! I bet you’re right about the prolotherapy being able to help more when you’re also actively correcting your alignment. Let me know how it goes!
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I have just recently been diagnosed to have a sacroiliac problem. My PA said I had sciatica but the chiropractor I saw diagnosed it as sacroiliac. I have not received any other treatment than the Chiropractic adjustment. I am trying to figure out how to proceed. I recently had hip replacement in my right hip which left me about three quarters of an inch shorter on my right side. That was 6 months ago. In moving a plant which was rather heavy I received a sharp pain in my left buttock. After 3 weeks of being careful I reinjured it by stepping into my motorhome with my left leg on the first step and my right foot catching on the step as I proceeded up. It produced a very sharp pain again in the left buttock. My PA has scheduled me with a physical therapist however I have no idea if they have the proper training with sacroiliac and I do believe it is a sacroiliac problem rather than sciatica as the PA had indicated. The Chiropractic adjustment did not help nor harm me. I have been seeing him for a number of years and he has yet to harm me in any way. I consider him to be a holistic chiropractor and therefore he is very gentle about what he does. I am scheduled to see the PA however I have no idea how proficient that person will or may be. I did see her for hip physical therapy after my operation. So what type of doctor do you see who has the experience to treat a sacroiliac problem?
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Hi Mary, thanks for your comment! It can be hard to find the right person to treat you, for sure. A really good place to start is with a physiatrist. (It’s a weird name, I know). Their specialty is Physical Medicine and Rehabilitation. Basically, they specialize in non-surgical treatments for musculoskeletal pain. Not ALL physiatrists will necessarily be familiar with the SI joint, but I think your chances of finding someone who is will be higher, within this specialty.
I think that if your legs really are 3/4″ different in length, that can definitely lead to SI joint problems. I think it could be a good idea to wear a lift in your right shoe, but I’d definitely check with a medical professional about that!
Here’s a post that explain more about physiatrists:
https://sijointsaga.com/2017/09/29/sacroiliac-joint-doctor/
And here’s a really great video which shows a physiatrist talking about how he treats SI joint dysfunction, just to give you an idea of some of the options that are out there:
https://sijointsaga.com/2017/07/24/physiatrist-si-dysfunction/
Unfortunately, you are right– there’s no guarantee that the PT you end up seeing will have experience treating the sacroiliac joint. If you feel comfortable, you could just call ahead and ask– has this person treated patients with SI joint dysfunction before? Because it isn’t a subject that everyone seems to learn about equally in PT school– a lot of PT’s develop their expertise either through working with patients, or through continuing education courses. If you go to the Physical Therapy section of this page, you’ll see my own story with PT as well as my suggestions for how to find the right person to help you:
https://sijointsaga.com/site-guide/
Hope this helps!
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Hi there, thank you for posting this. I have been dealing with SI joint pain for 4 years and it all started when I was pregnant with my son After treating the symptoms for years through yoga, acupuncture and osteopathic therapy, I finally figured out it was my SI joint causing all of the trouble and I went to see an orthopedic doctor. Who recommended a spine specialist and SI joint injection. The first injection I had was successful- however at the time when I got it, I wasn’t having a flare up so I just assumed the injection did it’s job as I was pain free for 6 weeks! Unfortunately the pain returned and it was intense (usually on my right side but it can switch to the left on occasion ) so I went back to the spine specialist who recommended I get another SI injection. This time I went in right away while I had a significant amount of pain. Here I am the next day and the pain is still so intense, maybe even worse. I’m wondering if this is similar to your experience with the shot you had in your knee? Anyway, I am at a loss as to how to proceed. I do think hyper mobility may be an issue so maybe I should see a chiropractor next? I’ve been trying to do PT in between the painful flare ups as the doctors I’ve seen seem to think I need to stabilize and strengthen but if hyper mobility is the issue, will that ever help? Also I am hoping to have another child in the near future, I just can’t seem to get my body to recover. Thanks again for your post and insight. I would be interested to hear more about your journey.
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Hi Emily, I think it definitely could be similar to my experience with the knee where, since you already have a lot of inflammation in the area, injecting extra fluid can make things feel worse. I would definitely ask the doctor who did the injections what they think– they should be able to give you an idea of how common it is, whether other people react the same way, etc. It may still get better in the next day or so– so you may not want to totally write off injections just yet, if it still turns out to be helpful.
Also, if hypermobility is the issue, chiropractic adjustments may not really be the best thing. I’m not sure which of my posts you’ve seen, but I found them to actually be de-stabilizing to my SI joint ligaments. I did better once I switched to using the Muscle Energy Technique, as shown to me by a physical therapist. https://sijointsaga.com/physical-therapy/
And yes– strengthening will ABSOLUTELY help with hypermobility! Basically, right now the structures of your joint allow it to move too far, so strong muscles– particularly core muscles– are what help to hold it within a more normal range of motion. When you strengthen, you aren’t trying to move the SI joint at all– in fact, the opposite– you want to find ways that strengthen the muscles while having the *least* impact on the joint. I do have an exercise e-book that I hope to release in the next few months! But a good PT should also be able to help you, and you can check out my posts on the Strengthening page: https://sijointsaga.com/strengthening/
Hope this helps!
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