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Chronic SI Joint Pain
I’m a 25M suffering from chronic pain in my left SI joint. The problem started when I was sledding on a hill, lost control, and I ended up crashing into a tree when I was 17. The impact caused my left knee to hit my face, but I was able to stand up and walk afterwards with sharp pain in my left glute. Over time, I ignored it and didn't think much of it. During the meantime, I was doing physical therapy for about 2-3 months, but was sent to see an orthopedic surgeon, who then ordered a hip arthrogram. According to the report, there was a stress fracture in the left iliac bone parallel to the sacroiliac joint, and nothing could be done about it treatment-wise. Later on, I went to see a pain management doctor who ordered an MRI of the lumbar that came back normal, and then proceeded with a bilateral SI joint injection with no relief.
The pain and discomfort that I feel on a daily basis feels like when you make a fist, and you use your knuckle and press it into your SI joint, and it is always there constantly like a dull or aching pain. I feel it the most when I lie on it or sit too long. Most days, I would experience sharp glute pain in either the left or right. Some days I would feel sharp pain in both my front hips or the lower back L4-L5 area. (And every time the doctor asks where the pain is, I am pointing directly to the left SI joint.)
A few months go by, and I ended up moving to another state. I saw a new orthopedic surgeon who ordered blood work, and it turns out I was positive for HLA-B27 with normal ESR and CRP (never has been elevated) markers, and was referred to a rheumatologist. The rheumatologist started by giving me biologic medications for approximately 4 months each. The rheumatologist referred me to a new pain management doctor and ordered a CT scan of my pelvis. The rheumatologist declared that I have ankylosing spondylitis, but here is the CT report.
“Skeletal System: Both sacroiliac joints show articular cortical
erosions and subchondral sclerosis suggestive of bilateral inflammatory
sacroiliitis. HLA-B27 correlation is suggested. Both hip joints are
normal. Pelvic bones are otherwise normal.“ (they can see that stress fracture has healed)
And here is my most recent CT of the lumbar imaging report findings done this year.
“No acute osseous abnormality. An L4-L5 Disc bulge results in mild bilateral neural foraminal stenosis. L5-S1 Disc bulge.
Here are the procedures/medications that I have done in the past to present that have not worked.
Feb 2018: Bilateral SI joint Injection (Pain Doc #1)
May 2022: Bilateral SI joint injection (Pain Doc #2)
May 2023: Bilateral Ischial Bursa Injection (Pain Doc #3)
June 2023: L3-L5 Medial Branch Blocks (Pain Doc #3)
July 2023: Caudal Epidural Steroid Injection (Pain Doc #3)
August 2023: Left Hip Injection (Pain Doc #3)
September 2023: Trigger Point Injection in the Piriformis Muscle (Pain Doc #3)
October 2023: Left SI joint Injection again (Pain Doc #3)
November 2025: Bilateral Cluneal Nerve Block of the Superior and Medial (Pain Doc #4)
December 2025: Radiofrequency Ablation of the SI joint (Pain Doc #4)
January 2026: Bilateral Hip injection under X-ray (Pain Doc #4)
March 2026: Acupuncture
April 2026: Bilateral sacrospinous ligament, sacrotuberous, and iliolumbar trigger point injection (Pain Doc #4)
July 2026: Epidural of T12/L1 Bilateral (Pain Doc #4)
Biologic Medications
Cimzia, Rinvoq, Avsola, and Humira.cosentyx
Anti-inflammatory Medications
Meloixcam, Celebrex, Diclofenac, Naproxen, Nabumetone, and Ibuprofen
Other Medications
Tramadol, Cyclobenzaprine, Prednisone, Gabapentin, Cymbalta, and Pregabalin
Not sure what to do anymore, would like other people’s input. I was suggested to do a trial of the spinal stimulator, but I've read more horror than good stories about them. I was going to consider PRP but the problem is the fact that we aren't able to find where the actual pain generator is. Whether it's in my SI joint or somewhere else.
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@artemis1886 No surgeon will perform an SI joint fusion if I don't get relief from an SI joint injection or radiofrequency ablation—and no insurance company will cover it without a positive response to those standard treatments.
I am going through the same thing. My left glute is on fire and every step hurts. I am currently convinced I tore my iliolumbar ligament trying to do hamstring curls only 2 weeks after a minor lumbar decompression surgery. What an idiot! I actually felt the overstretched pain when I did it. It sounds like your knee being forced to your face would be a logical assumption of a ligament tear somewhere in there. My neurosurgeon has tried an Si joint injection, S1 nerve block, and L5-S1 steroid injection with minimal relief. Now he is talking lumbar fusion and I am talking about a new doctor. No way!
It sounds like your pain is a little lower than mine. There are Si joint ligaments I believe that you may have torn. I see you had a trigger point injection in the iliolumbar ligament already. I also had a trigger point injection somewhere in my glute that did nothing. Is your pain any better in the morning? I usually get about 5 minutes of walking around my house before it starts hurting with every step forvthe restbof the day. Plus, i have been still working out like a goof for the past year not giving it time to heal. I’m 58 now and really missing playing baseball in my 43+ league. It sucks that you are going through this at your age. Good luck in finding an answer. Keep us updated.
Oh one more thing. I am seriously starting to look at trying either prolotherapy, PRP injections, or if I can find a suitcase full of cash flying to mexico to try some stem cell therapy.
@closer0043 My pain remains the same regardless if it's morning or night. Certain activities is what causes it to flare up, for example excerises that physical therapy has taught me to do, or sitting on the solid ground for a few minutes. What makes my case difficult is, I've pretty much done every injection available to me in my pelvis and lower back with no significant reduction in pain relief. That is why I am heistant in getting PRP because if there is nothing that can numb my pain for even 20-30 minutes, how can I know that we are targeting the pain generator with PRP? It would be an expensive diagnostic since PRP is typically not a one time thing.
Usually an MRI can detect torn ligaments, but every MRI I've done in my pelvis has came back as remarkable (normal), which is strange because on my CT scan they can see sacroiliitis in my SI joints. My current pain management doctor wants to repeat another bilateral si joint injection, but I have very low expectations. To be honest, I've been reading more and more about cluneal nerve entrapment and would rather have that procedure repeated again. But I'm not sure how rare it is for my doctor to miss one of the nerves if she is using ultrasound as guidance.
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