Sacroiliac joint injection
An X-ray or ultrasound-guided injection of local anaesthetic, often with a steroid, into or around the sacroiliac joint where the spine meets the pelvis, used to see whether that joint is causing your pain and to try to settle it for a while.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- A sacroiliac joint injection is used to test whether the joint is causing your pain and to try to settle it for a while; it is not a cure and relief is often short-term.
- It works best alongside physiotherapy and staying active, not as a stand-alone treatment.
- The evidence for lasting benefit is limited, and there is no single perfect test for sacroiliac pain, so the result is judged alongside your symptoms and examination.
- It is done with X-ray or ultrasound guidance under local anaesthetic, and serious problems are rare, though pain can feel worse for a few days first.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Can help work out whether the sacroiliac joint is contributing to your pain
Your pain does not fit a sacroiliac joint source and another cause seems more likely.
If local anaesthetic was used, your pain may drop noticeably for a short time. This early effect is useful information but wears off as the anaesthetic...
A named contact route and advice on where to get urgent help for red-flag symptoms: NHS 111 in England, Scotland or Wales; GP out-of-hours or your HSC...
If local anaesthetic was used, your pain may drop noticeably for a short time. This early effect is useful...
Pain can feel worse before it gets better as the steroid settles. Use simple pain relief, keep the area dry for 24...
Any steroid benefit usually starts to build. This is a good time to ease back into gentle movement and...
The fuller effect, if any, is clearer. Note how much relief you got and how long it lasted, as this guides what to...
What is a sacroiliac joint injection?
The sacroiliac joints sit at the base of the spine, one on each side, where the spine meets the pelvis. They can become a source of low back, buttock or hip pain through wear and tear, injury, pregnancy-related changes or inflammatory conditions. A sacroiliac joint injection puts a small amount of local anaesthetic, often with a steroid, into or around the joint using X-ray or ultrasound to guide the needle.
The injection has two roles. As a test, the local anaesthetic can show whether numbing the joint takes your pain away, which points to the joint as the source. As a treatment, the steroid is hoped to calm inflammation and settle symptoms for a while.
It is important to be realistic. A sacroiliac joint injection is not a cure. Relief is usually short-term, lasting from days to months, and some people get little benefit. It is best used as one step within a wider plan, especially physiotherapy and an active self-management programme, rather than on its own.
The published evidence for lasting benefit is limited and mixed, and there is no single perfect test for sacroiliac pain. That is why the injection is often used to help confirm the diagnosis as well as to treat, and why expectations should be modest.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Sacroiliac joint injection vs facet joint injection
| Feature | Sacroiliac joint injection | Facet joint injection |
|---|---|---|
| Where the pain is | Low back, buttock, sometimes groin | Back or neck, often midline |
| Target | The joint at the spine and pelvis | Small joints at the back of the spine |
| Main purpose | Test the joint and sometimes treat it | Test the joint and sometimes treat it |
| Often paired with | Physiotherapy and self-management | Physiotherapy; sometimes radiofrequency |
Both are image-guided injections that aim to find and settle a joint source of pain. Ask why this particular joint is suspected.
Preparing for your procedure
- See a pain or rheumatology specialist who explains why the sacroiliac joint is suspected and what the injection can and cannot do.
- Tell the team about all your medicines, especially blood thinners such as warfarin, clopidogrel or rivaroxaban, which may need adjusting.
- Mention diabetes, as the steroid can raise blood sugar for a few days, and any allergy to local anaesthetic or X-ray dye.
- Tell the team if you might be pregnant, as X-ray guidance is usually avoided in pregnancy.
- You can usually eat, drink and take your normal medicines unless told otherwise.
- Arrange a lift home, as you should not drive for the rest of the day.
- Plan a quiet day or two afterwards and keep up your physiotherapy as advised.
What happens
You lie face down on an X-ray table. The skin is cleaned and a small amount of local anaesthetic is injected, which stings briefly and then numbs the area. Using X-ray (or ultrasound) guidance, the specialist guides a fine needle to the sacroiliac joint. A little contrast dye may be used to confirm the position before the medicine is injected.
You stay awake and may feel pressure or a brief ache as the medicine goes in. The injection takes only a few minutes, with the whole appointment lasting about 15 to 30 minutes.
Afterwards you rest in a waiting area for a short time so the team can check you are well. You will often be asked to note how your pain behaves over the next hours and days, as this helps judge whether the joint is the source and whether the injection has helped.
Is this procedure right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Your pain does not fit a sacroiliac joint source and another cause seems more likely.
- You have an active infection, especially near the injection site, or are unwell.
- You take blood thinners that cannot be safely paused.
- An untreated underlying inflammatory arthritis needs assessment and treatment in its own right.
- You expect a permanent cure from an injection.
Delay or rearrange if…
- You have a current infection, fever or feel unwell.
- You might be pregnant, as X-ray guidance is usually avoided.
- Your blood thinners have not yet been reviewed and adjusted.
- You have new or worsening nerve symptoms that need urgent assessment first.
- Your diabetes is poorly controlled, as the steroid can raise blood sugar.
Alternatives to discuss
- Physiotherapy, targeted exercise and a structured self-management plan.
- Pelvic support, activity advice and pacing, especially for pregnancy-related pain.
- Treating an underlying inflammatory arthritis with the relevant specialist where present.
- Reviewing and optimising pain medicines rather than injecting, where appropriate.
- No injection if symptoms are mild or improving with conservative care.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Can help work out whether the sacroiliac joint is contributing to your pain
- May give a period of reduced pain that makes it easier to move and do physiotherapy
- Can support a wider plan of rehabilitation and self-management
- Done with image guidance under local anaesthetic, without a general anaesthetic
- May let some people reduce reliance on painkillers for a while
Risks & complications
- More pain for the first 2 to 3 days as the steroid settles, which then eases
- Bruising or tenderness where the needle went in
- Facial flushing or feeling warm for a day or two from the steroid
- A short-lived rise in blood sugar if you have diabetes
- Little or no improvement, so the injection does not help
- Temporary numbness or a heavy leg feeling if anaesthetic spreads to a nearby nerve
- Disturbed sleep, mood changes or a brief change in periods from the steroid
- A small skin dimple or pale patch where the steroid was injected
- Infection that may need antibiotics, very occasionally a deeper joint infection
- Serious nerve injury (extremely rare, reported as less than 1 in 10,000)
- An allergic reaction to the local anaesthetic or contrast dye
As with other spinal and pelvic injections, the main issue is usually limited or short-lived benefit rather than danger, and there is no single perfect test for sacroiliac pain. Ask your specialist what makes the sacroiliac joint the suspected source, what relief they expect, and how the injection fits with your physiotherapy. Be wary of any service that offers repeated injections as a cure.
Published figures to discuss
Reliable, comparable rates are hard to give because techniques and patient groups vary, there is no single perfect test for sacroiliac pain, and the evidence for lasting benefit is limited. Serious complications are rare; the more common issue is limited or short-lived relief. Quoted ranges should be treated as cautious estimates.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Serious nerve injury | Extremely rare; quoted by NHS sources as less than 1 in 10,000 | New or persistent weakness or numbness needs prompt review; ask for clear emergency instructions. | NHS (Guy's and St Thomas') — Sacroiliac joint injections to treat painguysandstthomas.nhs.ukPublished figure |
| Infection | Rare; a small risk that may need antibiotics, very occasionally a deeper joint infection | Watch for a hot, swollen, very painful joint, fever or feeling unwell, which need urgent review. | Use of diagnostic injections to evaluate sacroiliac joint pain — PMCpmc.ncbi.nlm.nih.govSource-linked context |
| Temporary blood-sugar rise after steroid injection | Common in people with diabetes for a few days | Glucose monitoring advice should be given before the injection. | Guide sourcesClinical context |
| Short-lived or absent pain relief | Common | Sacroiliac pain is difficult to diagnose; benefit should be measured against function and activity, not just immediate numbness. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is usually little physical recovery. Many people go back to normal activities the same day or the next, though the area can feel sore for a few days and any benefit takes time to show.
- A short spell of increased pain for 2 to 3 days after the injection
- Mild bruising or tenderness at the needle site
- Feeling flushed or warm for a day or two from the steroid
- Gradual, partial easing of pain rather than a sudden complete fix
- Relief that may fade after weeks to months
Aftercare
- Keep the injection site clean and dry for 24 hours.
- Do not drive for the rest of the day; arrange a lift home.
- Use simple pain relief such as paracetamol if the area is sore, unless told otherwise.
- Ease back into normal activity over a day or two; avoid heavy lifting or strenuous exercise for about 48 hours.
- Keep up your physiotherapy and stay as active as your pain allows.
- Keep a simple diary of your pain levels and how long any relief lasts.
- If you notice signs of infection or worsening symptoms, contact the clinic or your GP. For urgent advice when it is not life-threatening, use NHS 111 in England, Scotland or Wales; in Northern Ireland, contact your GP out-of-hours service or your HSC Trust's Phone First service. If symptoms are severe or life-threatening, call 999 or go to A&E.
- Someone to drive you home
- A note of your usual medicines, especially blood thinners
- Simple pain relief at home
- A quiet day or two planned
- Your physiotherapy plan to continue
- The clinic's contact number saved, plus your local urgent-advice number (NHS 111 in England, Scotland or Wales; GP out-of-hours or your HSC Trust's Phone First service in Northern Ireland)
⚠ Get urgent help if…
- Spreading redness, heat, swelling or discharge at the injection site
- Fever, chills or feeling generally unwell in the days after the injection
- New or worsening leg weakness, numbness or pins and needles that does not settle
- Loss of control of your bladder or bowels, or numbness around the back passage (seek emergency help)
- Severe, escalating pain that is not controlled by simple pain relief
- A hot, swollen, very painful joint with fever (possible joint infection; seek urgent help)
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A helpful result is a clear, time-limited drop in your usual pain after the injection. If local anaesthetic was used, an early improvement that matches how long the anaesthetic lasts suggests the joint is involved. If a steroid was used, any benefit builds over a few days.
A sacroiliac joint injection cannot prove a long-term cure, and there is no single perfect test for sacroiliac pain, so the result is judged alongside your symptoms and examination. A poor response does not mean your pain is imaginary; it suggests the joint is not the main source, or that an injection is not the right tool, and your specialist will discuss what to do next.
When a steroid injection helps, the relief is usually short-term, lasting from days to a few months, and sometimes longer. Some people get little benefit at all. Injections are not a permanent solution, and repeating them indefinitely is not advised. Lasting improvement usually depends on continued physiotherapy, activity and, where relevant, treating any underlying inflammatory condition.
Related tests, treatments or support
Sacroiliac joint injections are most useful alongside physiotherapy and an active self-management plan, and NHS services usually offer them this way. They may also sit alongside treatment of an underlying inflammatory arthritis if that is the cause. They are not a substitute for rehabilitation, and a responsible service will not offer them in isolation.
Follow-up & long-term care
You should have a review to discuss how much relief you got and how long it lasted, usually a few weeks later. This decides whether to repeat the injection, change approach or focus on rehabilitation, and whether further assessment for an underlying cause is needed. Report any signs of infection or new nerve symptoms straight away.
- Keep up physiotherapy and regular activity, which often matters more than the injection itself
- Track how long any relief lasts so repeat injections are only used when genuinely helpful
- Address any underlying cause, such as inflammatory arthritis, with the relevant specialist
Repeat, follow-on and what comes next
- Repeat injections are sometimes done, but indefinite repetition without clear benefit is not recommended.
- If relief is poor or very short-lived, the diagnosis or approach should be reconsidered.
- A poor response often means the sacroiliac joint is not the main source.
- Persistent sacroiliac pain may prompt assessment for an underlying inflammatory condition.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A named contact route and advice on where to get urgent help for red-flag symptoms: NHS 111 in England, Scotland or Wales; GP out-of-hours or your HSC Trust's Phone First service in Northern Ireland; and 999 or A&E if life-threatening.
- A planned review to judge how much relief you got and how long it lasted.
- Written advice on the normal 2 to 3 day sore spell and how to manage it.
- Integration with physiotherapy and a self-management plan rather than injections alone.
- Onward assessment for an underlying cause if sacroiliac pain persists.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The specialist's fee for assessing you and performing the injection
- The facility or imaging suite fee, including X-ray or ultrasound guidance
- Whether one or both joints are injected
- Contrast dye and the medicines used
- Any sedation, if offered (most are done with local anaesthetic only)
- Follow-up appointments to review the result
- Whether the same fee covers a repeat injection if needed
- The specialist's fee and who will perform the injection
- The facility and imaging (X-ray or ultrasound) fee
- Whether one or both joints are included in the price
- Medicines and contrast dye
- A follow-up review to assess the result
- What happens, and what it costs, if a repeat or different procedure is needed
- The policy if the injection gives little or no relief
On the NHS? Sacroiliac joint injections are available in some NHS pain and rheumatology services, usually alongside physiotherapy and when the joint is the suspected source; private access may be used for speed or choice.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Being promised a cure or lasting relief from a single injection.
- No discussion of physiotherapy and self-management as the foundation of care.
- No mention that there is no single perfect test for sacroiliac pain.
- Overlooking an underlying inflammatory arthritis that needs separate treatment.
- No written emergency instructions for signs of infection or new nerve symptoms.
Marketing red flags
- Promising a cure or permanent fix from injections.
- Selling a course of repeated injections up front.
- Describing it as a pain-free, no-risk or guaranteed treatment.
- Pushing injections without offering or encouraging physiotherapy.
- Pressure to commit on the day, with no cooling-off time.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- What makes you think the sacroiliac joint is the source of my pain?
- Is this injection mainly to diagnose, to treat, or both?
- What relief do you expect, and how long might it last?
- How does this fit with my physiotherapy and self-management?
- Could an underlying condition, such as inflammatory arthritis, be involved?
- What is the plan if the injection gives little or no relief?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my procedure, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this procedure not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Will a sacroiliac joint injection cure my pain?
Can I get this on the NHS?
Does it hurt?
How long will the relief last?
How many injections can I have?
What if it does not help?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS (Guy's and St Thomas') — Sacroiliac joint injections to treat pain NICE NG59 — Low back pain and sciatica in over 16s (recommendations) Faculty of Pain Medicine — Patient information leaflets Use of diagnostic injections to evaluate sacroiliac joint pain — PMC Fluoroscopically guided sacroiliac joint injections — systematic review (Pain Medicine) nidirect — Urgent and emergency care services (NI) nidirect — GP out-of-hours service (NI)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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