Treating SI joint dysfunction starts with physical therapy and over-the-counter pain relief, which resolve symptoms for most people within several weeks to a few months. The sacroiliac joints sit where your lower spine meets your pelvis, and when they become irritated or move too much (or too little), the result is a deep, aching pain in the low back and buttock that can radiate down the leg. Treatment follows a step-by-step approach: conservative options first, then injections, and surgery only as a last resort.
Pain Relief With Medication
For most flare-ups, standard anti-inflammatory drugs like ibuprofen or naproxen are enough to bring pain down to a manageable level. They reduce the inflammation around the joint while also providing direct pain relief. If you can’t take anti-inflammatories because of stomach issues, blood thinners, or allergies, acetaminophen is the typical alternative.
Muscle relaxants are sometimes added during an acute episode, especially when the muscles around the pelvis and low back are spasming. These work mainly through sedation and general relaxation rather than targeting the joint itself, so they’re meant for short-term use only. For chronic SI joint pain, medications become less effective, and the focus shifts to physical rehabilitation and hands-on therapy.
Physical Therapy and Targeted Exercises
Physical therapy is considered the first-line treatment for SI joint dysfunction, and the exercises focus on two things: strengthening the muscles that stabilize the pelvis and improving the flexibility of the muscles that pull on it. Weak glutes and core muscles are common culprits because they force the SI joint to absorb forces it isn’t designed to handle alone.
A foundational exercise is the bridge. You lie on your back with both knees bent about 90 degrees and feet flat on the floor. Tighten your abdominal muscles by drawing your belly button toward your spine, then press through your feet and squeeze your glutes to lift your hips until your shoulders, hips, and knees form a straight line. Hold briefly, lower slowly, and repeat. This targets both the glutes and the deep core muscles simultaneously.
Other common exercises include clamshells (lying on your side and rotating your top knee open against resistance), bird-dogs (extending opposite arm and leg from a hands-and-knees position), and gentle hip stretches that release tension in the piriformis and hip flexors. A physical therapist will tailor the program based on whether your joint is hypermobile (moves too much) or hypomobile (too stiff), since the exercise approach differs. Hypermobile joints need more stabilization work, while stiff joints benefit from gentle mobilization alongside strengthening.
Manual Therapy and Hands-On Treatment
Physical therapists, chiropractors, and osteopaths often use hands-on techniques to treat SI joint dysfunction. These fall into two broad categories: mobilization (slow, gentle, repetitive movements applied to the joint) and manipulation (a quick thrust that sometimes produces an audible pop). Multiple studies, including a 2019 meta-analysis and a 2015 Cochrane review, have found no significant difference between the two techniques in terms of pain relief or functional improvement. Both outperform doing nothing, but neither is clearly superior to the other.
This means the choice between gentler mobilization and higher-force manipulation comes down to your comfort level and your clinician’s experience. If the idea of a thrust makes you uneasy, mobilization achieves comparable results. Most treatment plans combine hands-on work with the exercise program described above rather than relying on manual therapy alone.
SI Joint Belts
A pelvic compression belt can provide meaningful relief, especially during the early weeks of treatment. The belt should be worn low around the pelvis, just above the bony knobs you can feel on the outside of your upper thighs (the greater trochanters). It works by compressing the pelvis and reducing the amount the SI joint moves, which takes strain off the irritated ligaments.
Clinical protocols typically recommend wearing the belt during all waking hours for the first four weeks, then gradually weaning off as your muscles get stronger. The belt is a support tool, not a fix on its own. Wearing it indefinitely without strengthening the surrounding muscles can lead to further deconditioning.
SI joint dysfunction is particularly common during and after pregnancy, when hormonal changes loosen pelvic ligaments. Pelvic belts are one of the primary recommendations for postpartum patients because they help stabilize the joint while the ligaments gradually tighten back up.
Injections for Persistent Pain
When physical therapy and medication aren’t enough after several weeks, injections are the next step. The two main options are corticosteroid injections and platelet-rich plasma (PRP) injections.
Corticosteroid injections deliver a strong anti-inflammatory directly into or around the joint. They work quickly, but the results are often modest. One study found that only about 31% of patients who received injections around the joint (and just 12.5% of those who received them inside the joint) achieved at least a 50% reduction in pain. The relief also tends to fade within weeks.
PRP injections use a concentration of your own blood platelets, which contain growth factors that promote tissue healing. Head-to-head comparisons paint a more favorable picture for PRP. In one study, 90% of patients in the PRP group achieved at least 50% pain reduction, compared to just 25% in the steroid group. Other studies have found that while both approaches perform similarly in the first six weeks, PRP pulls ahead at the two-month and four-month marks, offering longer-lasting relief and better function scores.
PRP is generally more expensive and less likely to be covered by insurance, which is a practical consideration. Both injection types are considered short-to-medium-term solutions rather than permanent fixes, and physical therapy remains the backbone of treatment regardless of which injection you receive.
Radiofrequency Ablation
If injections provide temporary relief but the pain keeps returning, radiofrequency ablation (also called neurotomy) is an option. This procedure uses heat delivered through a needle to disable the small nerves that carry pain signals from the SI joint. It doesn’t fix the joint itself but interrupts the pain message.
A retrospective study of 128 patients found that about 54% achieved at least a 50% reduction in pain at three months, and half reported meaningful improvements in daily function. Those are respectable numbers for a population that has already failed other treatments. The nerves do eventually regenerate, which means the pain can return, but many people get several months to over a year of relief from a single procedure. Repeat treatments are possible.
Surgery as a Last Resort
SI joint fusion is reserved for patients who have tried conservative treatment, injections, and ablation without adequate relief. The procedure involves placing implants across the joint to eliminate motion entirely. Older open surgical techniques had high complication rates and long recoveries, so modern approaches use minimally invasive methods with smaller incisions.
However, the evidence supporting fusion is less convincing than you might expect. A double-blind, placebo-controlled trial published in The Lancet compared minimally invasive SI joint fusion to a sham (fake) surgery and found that the sham procedure produced results comparable to the real one. The authors raised the concern that much of the benefit patients experience after fusion may come from a placebo effect rather than the mechanical fixation itself, and questioned whether an irreversible procedure with surgical risks is justified when the measured benefit over placebo is so small.
This doesn’t mean fusion never helps anyone, but it does mean the decision deserves careful consideration. Patients selected for fusion should have a clear clinical diagnosis of SI joint pain confirmed by a diagnostic injection, no other likely source of pain (such as disc problems or spinal stenosis), and a realistic understanding of what the evidence shows.
Putting a Treatment Plan Together
Most people with SI joint dysfunction improve with the conservative approach: a few weeks of anti-inflammatories to manage the initial pain, a structured physical therapy program focused on glute and core strengthening, hands-on mobilization or manipulation based on your preference, and a pelvic belt for added support during the early phase. This combination addresses both the symptoms and the underlying mechanical problem.
If pain persists beyond six to eight weeks of consistent effort, injections are a reasonable next step, with PRP offering a potential advantage in durability over corticosteroids. Radiofrequency ablation is an effective option for people who respond to injections but can’t get lasting relief. Surgery sits at the end of the treatment ladder, and the current evidence suggests approaching it with caution. The majority of people never get that far.