Sacroiliac joint pain

What it is

How research defines it

A 2024 narrative review defines sacroiliac joint pain as pain localised in the anatomical region of the sacroiliac joint¹. The sacroiliac joint is where the sacrum meets the ilium⁷. The sacrum is the triangle-shaped bone at the base of the spine, and the ilium is the wide upper part of the hip bone.

A 2025 multispecialty guideline describes the sacroiliac joint complex as the joint together with its network of ligaments at the back and the front². A ligament is a tough band of tissue that holds bones together at a joint. In the guideline’s account, these parts contain nociceptors (nerve endings that sense possible harm to tissue) and can generate pain². The guideline concluded that the pain can come from different portions of the parts inside the joint and the parts outside it².

Some trials enrolled people described as having sacroiliac joint dysfunction^8,9.

How studies confirm the joint as the source

A systematic review looked at 18 studies of one international pain association’s criteria for sacroiliac joint pain¹⁰. A systematic review is a study that gathers the research on a question in a set, checkable way. The studies used an injection into the joint as their reference standard, the yardstick other tests are judged against¹⁰. No study had tested the validity of that injection, or of the criteria set as a whole¹⁰. The 2025 guideline committee found such injections valid for identifying pain that arises inside the joint, but not pain that arises outside it².

Two studies checked physical examination against an anaesthetic block, an injection of a numbing drug into the joint^4,11:

• A prospective study (one that follows people forward in time) tested 85 patients¹¹. No feature of the history showed worthwhile value for identifying the pain¹¹. Nor did any of 12 physical tests, or any combination of them¹¹.
• In a study of 48 patients, six provocation tests were used⁴. Its authors drew a conclusion for cases where all six fail to provoke the familiar pain⁴. In those cases, the joint can be excluded as a source of current low back pain⁴.

A systematic review of test accuracy turned such results into certainty³. Assuming 20% of those tested have sacroiliac joint pain, a positive cluster of provocation tests gave 35% certainty that the joint was correctly identified³. A negative result was correct with 92% certainty³. The same review pooled five studies of test clusters and rated its accuracy estimates as very low in certainty³. The 2025 guideline committee also found that negative tests have greater predictive value than positive ones².

Who it affects

Among people with low back pain

Counts vary with who was studied and how the joint was confirmed^2,12. Prevalence is the share of people in a group who have a condition at a given time.

Counts vary with who was studied and how the joint was confirmed.

Study	Who was counted	Share with sacroiliac joint pain
Study of 43 patients13	Consecutive patients with chronic (long-lasting) low back pain, worst below the L5-S1 level	30%, relieved by an anaesthetic block
Study of 54 patients14	Patients selected because their one-sided low back pain appeared sacroiliac in origin	18.5%, relieved by a first block and a confirming second block
Chart review, 170 cases15	Low back pain cases that had procedures to find the pain source at an academic spine centre	18%
Systematic review12	Varied with the setting	10% to 62%, with most of the studies analysed suggesting about 25%

L5-S1 is the joint between the lowest vertebra of the lower back and the top of the sacrum. The 2025 guideline reports figures of 29% to 63% from studies using a single joint injection, and 10% to 33% from studies using two². It notes that these figures apply to people already suspected of sacroiliac joint pain, not to the whole population of patients with low back pain². The same guideline concluded that sacroiliac joint complex pain affects 15% to 30% of patients whose axial pain is predominantly below the L5 level².

After spinal surgery

A systematic review and meta-analysis covered 12 observational studies (studies that watch people without assigning them to groups) of 3,570 spinal surgery patients¹⁶. A meta-analysis is a study that pools the results of several earlier studies. This one put the incidence of new sacroiliac joint pain after spinal surgery at 9.40%¹⁶. Incidence is how many new cases appear in a group over a set time.

The new pain was associated with female sex and with the number of segments (levels of the spine) operated on¹⁶. It was also associated with fusion down to the sacrum and with pelvic tilt (how the pelvis is tipped) after surgery¹⁶.

A second systematic review pooled 12 observational studies of moderate to low quality¹⁷. After lumbosacral spinal fusion (fusion of the lower back and the sacrum), it put the incidence at 15.8% overall¹⁷. The figure was 32.9% when the fusion extended to the sacrum, and the studies’ results differed widely¹⁷.

Athletes

A systematic review with meta-analysis covered 13 studies of 2,842 athletes¹⁸. Reported prevalence of sacroiliac joint pain or dysfunction varied widely¹⁸. It averaged 10.72% among the athletes as a whole and 32.39% among those who had low back pain¹⁸. The authors concluded that an accurate prevalence cannot be reported¹⁸. The review named years of experience, stress injuries and biomechanical movements as risk factors, from studies of low to moderate quality¹⁸.

What studies found

Exercise and manual therapy

The 2025 guideline found the evidence base for non-interventional approaches to be indirect². That evidence was extrapolated mostly from studies of low back pain².

A single-blind randomised trial enrolled 51 patients with low back or buttock pain from sacroiliac joint dysfunction⁹. In a single-blind trial, one party does not know who is in which group. An exercise group, a manipulation group and a combined group each improved in pain and disability⁹. There was no significant difference among them at 24 weeks⁹. The trial had no control group outside these three programmes⁹.

A meta-analysis of 16 randomised trials (421 adults) compared manual therapy (hands-on methods) of the joint mostly with exercise-based programmes¹⁹. Manual therapy did not significantly reduce pain, and had a moderate effect on disability¹⁹. Certainty was low for disability and very low for pain¹⁹. A 2025 meta-analysis of randomised controlled trials in sacroiliac joint dysfunction found statistically significant improvements with exercise in pain and disability²⁰.

Injections and radiofrequency

A 2023 systematic review and meta-analysis of injections into the joint included 11 randomised trials, five positive and six negative, and three observational studies²¹. It graded the evidence as Level III, or fair²¹. The 2025 guideline committee found that steroid injections inside and outside the joint both give at least four weeks of relief in well-selected patients².

Three sources report on radiofrequency denervation, also called radiofrequency ablation^2,22,23. It is a procedure that heats a small nerve, with the aim of stopping it carrying pain signals.

• The 2025 guideline committee found strong evidence for ablation of the sacral lateral branch nerves (small nerves at the sacrum)². The evidence was of relief for at least six months in people whose pain source lies outside the joint².
• A 2015 review with meta-analyses of randomised trials included two studies of sacroiliac joint pain²². It found low-quality evidence of no differences from placebo (a dummy version) in pain or function over the short term²². One study showed a small effect over the intermediate term²².
• A randomised trial enrolled 228 participants with chronic low back pain and a positive anaesthetic block at the sacroiliac joints²³. It was pragmatic (run as in everyday care) and non-blinded²³. Adding denervation to a three-month exercise programme changed pain at three months by −0.71 points on a 0–10 scale, against the control group²³. That was less than the 2 points set in advance as clinically important²³.

Fusion surgery

Fusion, also called arthrodesis, is an operation that fixes the bones of a joint together. In an open-label trial, the people taking part know which group they are in⁸. Three randomised trials compared fusion of the sacroiliac joint with something else^5,8,24:

• One compared it with non-surgical management in 148 people with sacroiliac joint dysfunction⁸. The implant’s maker sponsored this open-label trial and completed the statistical analyses⁸. The 46 assigned to non-surgical management had a mean six-month change in joint pain of 12.2 points on a 100-point scale⁸. That was 38.3 points smaller than in the 102 assigned to minimally invasive fusion with triangular titanium implants⁸. Crossover to surgery was allowed after six months⁸.
• One compared it with conservative management (care without surgery) in 103 adults with chronic sacroiliac joint pain²⁴. This trial was also open-label, and the maker of the implant system funded it²⁴. Subjects marked their own pain on a line (a visual analogue scale), which the 2025 guideline gives as 0 to 100^2,24. At two years, mean low back pain had improved by 45 points after fusion with triangular titanium implants and by 11 after conservative management²⁴.
• One, a double-blind trial, compared minimally invasive fusion with sham surgery in 63 patients with injection-confirmed sacroiliac joint pain⁵. Neither participants nor assessors knew who was in which group, and the trial describes itself as not sponsored by industry⁵. At six months, pain on a 0–10 scale had fallen by 2.6 points after fusion and 1.7 after sham surgery⁵. The difference was −1.0, with a 95% confidence interval (a range showing how precise a result is) from −2.2 to 0.3⁵. The trial could not show fusion to be superior to sham surgery⁵.

Once the sham trial was unblinded at six months, 26 of the sham group’s 31 patients crossed over to fusion²⁵. At two years, its authors could not determine the effect of fusion compared with sham surgery²⁵.

The sham trial’s authors noted that earlier studies had measured larger effects of surgery than theirs⁵. In their account, industry bias and, chiefly, missing blinding can help to produce such differences⁵. The authors of both open-label trials named the absence of blinding among their study’s main limitations^8,24. The second trial’s authors also wrote that their large effect sizes argue strongly against a marked contribution from placebo effects²⁴.

A 2022 systematic review covered 40 studies, two of them randomised trials²⁶. Its conclusion concerned patients who have not responded to conservative care²⁶. For them, minimally invasive fusion probably does more than conservative management to reduce pain and improve physical function²⁶. The same review found that adverse events (unwanted effects) appear to be higher after minimally invasive fusion than with conservative management through six months²⁶. It judged revision surgery (a repeat operation) likely no more frequent than 3.8% at two years²⁶.

What two guidance documents say

Two guidance documents judged the fusion evidence available when each was written, and this page endorses neither^2,27. UK guidance from NICE, published in 2017, covers minimally invasive fusion for chronic sacroiliac pain²⁷. It calls the evidence on safety and efficacy adequate to support the operation’s use²⁷. It adds a proviso: standard arrangements for clinical governance, consent and audit²⁷. It also says patients having it should have confirmed sacroiliac joint dysfunction due to degenerative sacroiliitis (joint inflammation) or sacroiliac joint disruption²⁷.

The 2025 multispecialty guideline found the evidence weak or very weak that minimally invasive fusion can give benefit lasting a year or more². That finding was for carefully selected patients whose pain arises inside the joint². They had not improved with conservative approaches².

The same guideline notes that the two open-label trials’ publications were sponsored by industry². For fusion from the side (the lateral approach), it judged the evidence conflicting: two positive randomised trials against one negative sham-controlled one².

A neighbouring group: pelvic girdle pain in pregnancy

The trials in this section enrolled a related but separate group: women with pelvic girdle pain during or after pregnancy^6,28. The two reviews are described by what each covered^29,30. A European guideline group concluded that pelvic girdle pain is one specific form of low back pain³¹.

What studies of exercise, belts and acupuncture found

Two trials reported less pain with stabilising exercises^28,32:

• In a randomised single-blind trial of 386 pregnant women with pelvic girdle pain, one group added six weeks of stabilising exercises to the standard programme³². That group had less pain than the group on the standard programme alone³². The acupuncture (fine needles put into set points on the skin) group had less evening pain than the stabilising exercise group³².
• In a randomised controlled trial of 81 women with pelvic girdle pain after pregnancy, one group’s 20-week programme focused on specific stabilising exercises²⁸. After the programme and one year after delivery, that group had lower pain and disability than a group whose individualised programme left them out²⁸.

Pooling six of its seven studies, a 2025 meta-analysis of pelvic belts in pregnancy found that pain scores fell by a mean of 20.17²⁹. The 95% confidence interval ran from −40.73 to 0.4, and the evidence was rated low and very low²⁹.

A 2015 review covered pregnancy-related lumbopelvic pain (pain in the lower back, the pelvis or both)³⁰. It rated the evidence as strong for positive effects of acupuncture and of pelvic belts during pregnancy³⁰. It rated the evidence as low for specific stabilising exercises and for exercise in general³⁰.

Connections

The sacroiliac joint page covers the joint itself, which is the transition from the spine to the pelvis⁷. Several studies on this page counted sacroiliac joint pain among people with low back pain^13,15.

Sources

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17. Shen J, Boudier-Reveret M, Majdalani C, Truong VT, Shedid D, Boubez G, Yuh SJ, Wang Z (2023). Incidence of sacroiliac joint pain after lumbosacral spine fusion: A systematic review.. Neuro-Chirurgie. doi:10.1016/j.neuchi.2023.101419 PMID 36754146
18. Mirdamadi N, Khadembashiri MM, Moghadam N, Kordi R (2025). Prevalence and Risk Factors of Sacroiliac Joint Pain in Athletes: A Systematic Review and Proportional Meta-Analysis.. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine. doi:10.1097/JSM.0000000000001341 PMID 40135982
19. Trager RJ, Baumann AN, Rogers H, Tidd J, Orellana K, Preston G, Baldwin K (2024). Efficacy of manual therapy for sacroiliac joint pain syndrome: a systematic review and meta-analysis of randomized controlled trials.. The Journal of manual & manipulative therapy. doi:10.1080/10669817.2024.2316420 PMID 38353102
20. Jangra P, Kaur J, Malik M, Rani M (2025). A systematic review and meta-analysis of randomized controlled trials on the effect of various therapeutic interventions on sacroiliac joint dysfunction.. Journal of bodywork and movement therapies. doi:10.1016/j.jbmt.2025.09.019 PMID 41316629
21. Janapala RN, Knezevic E, Knezevic NN, Pasupuleti R, Sanapati MR, Kaye AD, Pampati V, Manchikanti L (2023). Systematic Review and Meta-Analysis of Effectiveness of Therapeutic Sacroiliac Joint Injections.. Pain physician. PMID 37774179
22. Maas ET, Ostelo RW, Niemisto L, Jousimaa J, Hurri H, Malmivaara A, van Tulder MW (2015). Radiofrequency denervation for chronic low back pain.. The Cochrane database of systematic reviews. doi:10.1002/14651858.CD008572.pub2 PMID 26495910
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25. Kibsgård TJ, Gerdhem P, Diarbakerli E, Randers EM (2026). Minimally Invasive Sacroiliac Joint Fusion Compared with Sham Operation (SIFSO Trial). The Journal of bone and joint surgery. American volume. doi:10.2106/JBJS.25.00918 PMID 42154897
26. Chang E, Rains C, Ali R, Wines RC, Kahwati LC (2022). Minimally invasive sacroiliac joint fusion for chronic sacroiliac joint pain: a systematic review.. The spine journal : official journal of the North American Spine Society. doi:10.1016/j.spinee.2022.01.005 PMID 35017057
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29. Lauridsen J, Dalbøge A, Jahn A (2025). The effect of pelvic belts to manage low back and pelvic pain during pregnancy a systematic review and meta-analysis.. Midwifery. doi:10.1016/j.midw.2025.104529 PMID 40716213
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Every source the library cites

Changes

• October 9, 2026 First published.