Find the source of your lower back pain. Find the fastest path to lasting relief.
A sacroiliac (SI) joint injection is a precision, image-guided injection placed into the SI joint where the base of the spine connects to the pelvis. The procedure serves two purposes in one visit: it confirms whether the SI joint is the source of chronic lower back and buttock pain, and the corticosteroid component can provide weeks to months of therapeutic relief.
SI joint injections are for adults in Houston with chronic lower back, buttock, or one-sided hip pain that has not improved with rest, physical therapy, or oral medications, especially when the pain is worse with prolonged sitting, climbing stairs, rolling over in bed, or transitions like standing up from a chair. They are also the first diagnostic step before lateral branch blocks and radiofrequency ablation of the SI joint.
or call 346-217-1111 · Houston office
By the Pain Management Team at Performance Pain and Sports Medicine
Suzanne Manzi, MD · Matthias Wiederholz, MD · Jade Nemeth, PA-C
Updated May 2026
On This Page:
- What Is the Sacroiliac Joint?
- What Causes SI Joint Pain?
- Symptoms of SI Joint Dysfunction
- How SI Joint Injections Work
- What to Expect During the Procedure
- Recovery and Results
- Risks and Side Effects
- When SI Joint Injections Are Not Enough
- Cost and Insurance
- SI Joint Injections at Our Houston Office
- Frequently Asked Questions
Houston sits at the heart of the Texas Medical Center ecosystem, with a patient population that includes oilfield and offshore workers, longshoremen and Ship Channel logistics staff, NASA engineers from the Clear Lake corridor, TMC healthcare professionals, and active-adult residents from the Galleria, River Oaks, West University, Sugar Land, The Woodlands, and Katy. The unifying thread is years of high-load work or active living, often interrupted by chronic lower back and buttock pain that no longer responds to rest, physical therapy, or oral medications. Research estimates that the sacroiliac (SI) joint is responsible for 15 to 30 percent of all chronic low back pain cases (Szadek et al., Pain Practice, 2023), yet it is frequently underdiagnosed because its symptoms overlap with disc and hip conditions.
A sacroiliac joint injection is a minimally invasive, image-guided procedure that serves two purposes: it can confirm whether the SI joint is the source of your pain, and it can deliver targeted anti-inflammatory medication to reduce it. At Performance Pain and Sports Medicine in Houston, Dr. Suzanne Manzi, MD and Dr. Matthias Wiederholz, MD perform SI joint injections using fluoroscopic (real-time X-ray) guidance for precise needle placement. Conservative, non-surgical spine treatments are always explored first. Our Houston office is located in the T-Mobile Tower on the Southwest Freeway, near the intersection of I-59 and the 610 West Loop.
What Is the Sacroiliac Joint?
The sacroiliac joints are two large joints located where the base of the spine (the sacrum) connects to the pelvis (the iliac bones). You have one on each side of your lower back, just below the belt line.
These joints act as shock absorbers between the upper body and the legs. They transfer the weight of your torso to the pelvis and lower extremities during standing, walking, and sitting. Strong ligaments surround the SI joints to limit their range of motion and provide stability (Gartenberg et al., European Spine Journal, 2021).
When the SI joint becomes inflamed, hypermobile, or stiff from degeneration, it can produce pain that is often mistaken for a herniated disc or hip problem. Because the SI joint sits deep within the pelvis and lacks a distinctive pain pattern, it is frequently underdiagnosed as a source of chronic lower back pain.
What Causes SI Joint Pain?
Research estimates that the SI joint is responsible for 15 to 30 percent of all chronic lower back pain cases (Szadek et al., Pain Practice, 2023; Cohen et al., Expert Review of Neurotherapeutics, 2013). Despite how common it is, SI joint dysfunction often goes unrecognized for months or years because its symptoms overlap with other spinal conditions.
Common causes of SI joint pain include:
- Trauma or injury, such as a fall, car accident, or impact during sports
- Pregnancy and childbirth, which loosen the pelvic ligaments and increase joint stress
- Prior lumbar spine surgery, which can shift mechanical loads onto the SI joint (Horton et al., JBJS, 2024)
- Degenerative arthritis, particularly in adults over age 50
- Gait abnormalities or leg length differences that create uneven stress on the pelvis
- Repetitive stress from activities like running, heavy lifting, or prolonged sitting
For patients in Houston dealing with persistent back pain that has not responded to conservative treatments, a thorough evaluation of the SI joint should be part of the diagnostic workup. This pattern is common in patients with years of heavy lifting on Ship Channel terminals, offshore platforms, and in petrochemical plant turnarounds, as well as in long-tenured TMC nurses, runners across Memorial Park and the Buffalo Bayou trails, and adults with prior lumbar fusion.
Symptoms of SI Joint Dysfunction
SI joint pain typically presents as a deep, aching discomfort on one side of the lower back or buttock. The pain often extends into the hip or upper thigh, which is why it is frequently confused with sciatica or hip joint problems.
Common symptoms include:
- Pain in the lower back, buttock, or hip that is usually worse on one side
- Pain that worsens with prolonged sitting, standing, climbing stairs, or rolling over in bed
- Stiffness in the pelvis or lower back, especially in the morning
- Pain during transitions, such as standing up from a seated position or getting out of a car
- Difficulty with activities like walking, bending, or lifting
A clinical review in American Family Physician notes that when three or more physical provocation tests reproduce a patient’s typical pain pattern, this strongly suggests SI joint dysfunction as the source (Newman & Soto, American Family Physician, 2022). If your symptoms match this pattern, a diagnostic SI joint injection can confirm or rule out the joint as the pain generator.
How SI Joint Injections Work
SI joint injections serve two purposes: diagnosing the source of pain and treating it. This dual role makes them one of the most important tools in evaluating chronic lower back and pelvic pain.
Diagnostic SI Joint Block
When a physician suspects the SI joint is causing your pain, a diagnostic block is performed first. A small amount of local anesthetic is injected directly into the SI joint under fluoroscopic (real-time X-ray) guidance. If you experience significant temporary pain relief, this confirms the SI joint as the pain generator.
This step is critical because SI joint pain can mimic disc, facet, or hip problems. The diagnostic block removes guesswork and ensures that any further treatment targets the correct structure. Research supports the use of provocation testing followed by diagnostic blocks as the standard approach for confirming SI joint dysfunction (Buchanan et al., Journal of Pain Research, 2021).
Therapeutic SI Joint Injection
Once the SI joint is confirmed as the source, a therapeutic injection combines local anesthetic with a corticosteroid medication. The anesthetic provides immediate short-term relief, while the corticosteroid reduces inflammation within the joint over the following days.
A randomized controlled trial found that fluoroscopy-guided corticosteroid injections significantly reduced pain and disability scores compared to placebo at both two and four weeks after the procedure (Patel et al., Cureus, 2023). Joint guidelines from ASRA, AAPM, ASIPP, and SIS support the appropriate use of corticosteroid injections across musculoskeletal pain conditions (Benzon et al., Regional Anesthesia and Pain Medicine, 2025).
Recent clinical practice guidelines have questioned the strength of evidence for SI joint injections when pooled across broad patient populations (Busse et al., BMJ, 2025). However, clinical practice guidelines from ASIPP, SIS, and other interventional pain societies continue to support SI joint injections in appropriately selected patients, particularly when a positive diagnostic block confirms the joint as the pain source. This underscores the importance of working with a physician trained in proper patient selection and image-guided technique.
What to Expect During the Procedure
Understanding what happens before, during, and after an SI joint injection can help reduce anxiety and prepare you for a smooth experience.
- Before the procedure. Your physician reviews your medical history, imaging studies, and prior treatments during an initial consultation. You may be asked to stop certain blood-thinning medications several days beforehand. Plan to have someone drive you home after the procedure if sedation is used.
- During the procedure. You lie face down on a procedure table. Your physician cleans and numbs the skin over the SI joint with a local anesthetic. Using fluoroscopic guidance, a thin needle is advanced into the SI joint. Contrast dye confirms correct needle placement before the medication is delivered. The entire procedure typically takes 15 to 30 minutes.
- After the procedure. You rest briefly in the recovery area and are monitored before being discharged the same day. Most patients are able to walk out of the office shortly after the injection. Mild sedation is available for patients who experience anxiety about needle-based procedures.
Recovery and Results
Most patients return to light daily activities the same day or the day after their SI joint injection. There is no extended recovery period, though your physician may recommend avoiding heavy lifting and strenuous exercise for 24 to 48 hours.
What to expect in the days following the injection:
- Day of the procedure: You may experience immediate pain relief from the local anesthetic. This temporary relief often fades within a few hours as the anesthetic wears off.
- Days 1 to 3: A mild post-injection flare, including temporary soreness at the injection site, is common and normal. Ice and over-the-counter pain medication can help manage this discomfort.
- Days 3 to 7: The corticosteroid begins to take full effect, and many patients notice a meaningful reduction in their SI joint pain.
How long does relief last? A prospective study found that patients receiving SI joint corticosteroid injections experienced significant pain reduction from a baseline VAS score of 5.85 to 3.00 at six months, with improvement in both physical examination findings and functional outcomes (Ab Aziz et al., Cureus, 2022). A comprehensive review by the World Institute of Pain documented pain relief lasting three months or longer for many patients (Szadek et al., Pain Practice, 2023).
Individual results vary based on the underlying cause, severity of joint inflammation, and overall health. When pain relief begins to fade, repeat injections or alternative treatments such as radiofrequency ablation may be discussed with your physician.
Risks and Side Effects
SI joint injections are considered a low-risk procedure. A systematic review evaluating safety across more than 1,300 patients found only 29 adverse events and 3 serious adverse events, confirming a favorable safety profile for image-guided sacroiliac joint interventions (Lee et al., Interventional Pain Medicine, 2023).
Common side effects (typically resolve within 1 to 2 weeks):
- Mild soreness or discomfort at the injection site
- Temporary numbness near the treated area
- Minor bruising or swelling
Rare side effects:
- Infection at the needle insertion site
- Prolonged numbness or temporary nerve irritation
- Allergic reaction to the anesthetic or contrast dye
- Temporary increase in blood sugar (relevant for patients with diabetes)
Your physician will discuss your complete medical history, including any medications or allergies, before recommending an SI joint injection.
When SI Joint Injections Are Not Enough
For some patients, SI joint injections provide significant but temporary relief that fades over time. When that happens, the pain management team evaluates the next step in a structured treatment pathway that progresses from least invasive to most invasive.
Radiofrequency ablation (RFA) is the most common next step after SI joint injections. This procedure uses controlled heat to disrupt the lateral branch nerves that transmit pain signals from the SI joint. A diagnostic lateral branch block is performed first to confirm which nerves are involved. A systematic review and meta-analysis found radiofrequency ablation effective for managing sacroiliac joint pain, with pain relief sustained at 6 to 12 months in many patients (Janapala et al., Current Pain and Headache Reports, 2024). Learn more about radiofrequency ablation at the Houston practice.
Additional options for patients with persistent SI joint pain include:
- Platelet-rich plasma (PRP) therapy, an emerging biologic treatment that uses your own blood components to support joint healing
- Physical therapy focused on pelvic stabilization, core strengthening, and targeted stretching
- SI joint fusion surgery, considered only for severe, refractory cases that have not responded to multiple rounds of conservative and interventional treatment (Horton et al., JBJS, 2024)
The treatment approach at Performance Pain and Sports Medicine follows the principle of exhausting less invasive options before considering surgical alternatives. An expert review on treatment sequencing for SI joint pain supports this stepwise approach, progressing from conservative management through interventional procedures based on each patient’s response (Cocconi et al., Expert Review of Neurotherapeutics, 2024). For patients whose pain proves to be discogenic rather than SI-related, an epidural steroid injection may be the more appropriate next step.
Cost and Insurance
SI joint injections are typically covered by most major insurance plans when deemed medically necessary, including Medicare and Texas workers’ compensation. Coverage may require prior authorization, and many plans require documentation that conservative treatments (physical therapy, anti-inflammatory medication) have not provided adequate relief. The cost depends on insurance coverage, whether a diagnostic block alone or a therapeutic injection with corticosteroid is performed, and whether sedation is used.
Our Houston office accepts most major commercial insurance plans, Medicare, and Texas workers’ compensation, and routinely handles documentation for injuries sustained on Ship Channel terminals, in petrochemical plant turnarounds, on offshore platforms, and in Houston healthcare settings. The office team can verify your specific insurance coverage and discuss any out-of-pocket costs before your appointment. For coverage questions, call 346-217-1111.
SI Joint Injections at Our Houston Office
Performance Pain and Sports Medicine performs SI joint injections at the Houston office at 4126 Southwest Freeway, Suite 1700, Houston, TX 77027, in the T-Mobile Tower on the Southwest Freeway. The location sits inside the 610 Loop near the intersection of I-59 and 610 West, with covered garage parking and validation, making it convenient for patients from Uptown, the Galleria, River Oaks, West University, Bellaire, Memorial, the Energy Corridor, the Texas Medical Center, Greenway Plaza, Upper Kirby, Sugar Land, Missouri City, Pearland, Katy, and The Woodlands.
Dr. Suzanne Manzi, MD is quadruple board-certified in Physical Medicine and Rehabilitation, Pain Medicine, Electrodiagnostic Medicine, and Obesity Medicine. She completed her residency at Baylor College of Medicine and her fellowship in interventional spine and pain management at Michigan State University. She currently serves as off-site clinical faculty at UT Health Houston McGovern Medical School and brings specialized expertise in electrodiagnostic testing (EMG/NCS), which supports precise identification of pain generators before any injection is recommended.
Dr. Matthias Wiederholz, MD is quadruple board-certified in Physical Medicine and Rehabilitation, Pain Medicine, Sports Medicine, and Anti-Aging, Regenerative and Functional Medicine. He founded Performance Pain and Sports Medicine in 2009 and continues to perform interventional spine procedures alongside Dr. Manzi at the Houston office. Jade Nemeth, PA-C supports patients throughout evaluation, treatment, and follow-up care.
The Houston patient population reflects the city’s unique mix of high-load industrial work, world-class medical and research employment, and active suburban living. Oilfield and offshore workers, longshoremen and Ship Channel logistics staff, NASA engineers from the Clear Lake corridor, TMC healthcare professionals, Galleria-area knowledge workers, runners along Buffalo Bayou and Memorial Park, and active-adult residents from Memorial, Sugar Land, The Woodlands, and Katy all present with chronic lower back and buttock pain that has not responded to standard care. The office accepts most major commercial insurance, Medicare, and Texas workers’ compensation, and routinely handles referrals from Texas Medical Center providers, Houston Methodist, Memorial Hermann, HCA Houston, and primary care offices across Greater Houston.
What sets the Houston practice apart:
- Fellowship-trained interventional pain specialists performing every procedure
- Fluoroscopic guidance for all SI joint injections
- Comprehensive diagnostic evaluation before recommending any intervention
- A complete treatment pathway from injections through radiofrequency ablation and beyond, all under one roof
- Most major insurance plans accepted
To schedule an evaluation, call the Houston office at 346-217-1111 or contact us online. SI joint injections are also available at the League City, Baytown, and Lawrenceville Performance Pain locations.
Performance Pain and Sports Medicine
Address: 4126 Southwest Freeway, Suite 1700, Houston, TX 77027
Landmark: T-Mobile Tower, Suite 1700
Major Cross Streets: I-59 (Southwest Freeway) at 610 (West Loop)
Parking: Covered garage with validation provided
Phone: 346-217-1111
Frequently Asked Questions
Is the SI joint injection procedure available at the Houston office?
Yes. Sacroiliac joint injections are performed at the Houston office in the T-Mobile Tower on the Southwest Freeway, by Dr. Suzanne Manzi, MD and Dr. Matthias Wiederholz, MD. All procedures use live fluoroscopic guidance and are completed as outpatient visits, with most patients leaving the office within 30 to 45 minutes of the injection.
How painful are SI joint injections?
Most patients tolerate the procedure well. The physician applies a local anesthetic to numb the skin and tissue before inserting the needle, which significantly reduces discomfort. You may feel brief pressure or a dull ache as the needle reaches the joint. Mild sedation is available for patients who are anxious about the procedure.
Do you get put to sleep for an SI joint injection?
General anesthesia is not required. SI joint injections are performed under local anesthesia, meaning you remain awake throughout the procedure. Light sedation (such as IV sedation) is available if needed, but most patients do not require it. The procedure typically takes 15 to 30 minutes.
What should you not do after an SI joint injection?
Avoid heavy lifting, strenuous exercise, and soaking in a bath or pool for 24 to 48 hours after the injection. You should also avoid driving on the day of the procedure if sedation is used. Light walking and normal daily activities are generally safe to resume the same day.
What is the best injection for an SI joint?
The most commonly used and well-studied injection for SI joint pain is a corticosteroid combined with local anesthetic, delivered under fluoroscopic guidance. PRP (platelet-rich plasma) injections are an emerging biologic alternative for some patients. Your physician will recommend the most appropriate option based on your diagnosis, medical history, and treatment goals.
How long does an SI joint injection last?
Pain relief duration varies by patient. Many patients experience meaningful relief lasting several weeks to several months. A prospective study documented significant pain reduction maintained at six months for patients receiving corticosteroid SI joint injections. When relief fades, the injection can often be repeated or your physician may recommend radiofrequency ablation for longer-lasting results.
How much does an SI joint injection cost?
The cost of an SI joint injection depends on your insurance plan, whether a facility fee applies, and the specific medications used. Many insurance plans cover SI joint injections when a diagnostic block has confirmed the joint as the pain source and conservative treatments have been tried. Contact the Houston office at 346-217-1111 to discuss coverage and out-of-pocket costs before scheduling.
What happens if SI joint injections do not work?
If an SI joint injection provides only partial or temporary relief, several options are available. Radiofrequency ablation of the lateral branch nerves can provide longer-lasting pain reduction. Physical therapy focused on pelvic stabilization may complement interventional treatments. In severe cases, SI joint fusion surgery may be considered. The physicians at Performance Pain and Sports Medicine evaluate each patient individually to determine the best next step.
Can an SI joint injection help sciatica?
SI joint injections target the sacroiliac joint specifically, not the spinal nerve roots that cause sciatica. However, SI joint dysfunction can produce pain that radiates into the buttock and upper thigh, which is often confused with sciatica. A diagnostic SI joint injection can help distinguish between these two conditions. If the injection relieves your symptoms, the SI joint is likely the source. If it does not, your physician may evaluate other causes such as a herniated disc with an epidural steroid injection.
Do you accept workers' compensation for oilfield, offshore, Ship Channel, or TMC healthcare injuries?
Yes. The Houston office accepts Texas workers’ compensation and routinely treats injured workers from oil and gas companies, offshore operators, longshore and Ship Channel terminal employers, petrochemical contractors, and Texas Medical Center healthcare systems. The office handles documentation and authorization directly with carriers.
Schedule Your SI Joint Injection Consultation in Houston
If you are living with chronic lower back or buttock pain that has not improved with rest, physical therapy, or oral medications, the pain management team at Performance Pain and Sports Medicine can help determine whether an SI joint injection is appropriate for you. Contact the Houston office or call 346-217-1111 to schedule a consultation with Dr. Suzanne Manzi, MD or Dr. Matthias Wiederholz, MD.
MEDICAL DISCLAIMER
This article is for educational purposes only and does not replace professional medical advice, diagnosis, or treatment. The information presented reflects an interventional pain management perspective and is intended to support, not substitute, your relationship with a qualified healthcare provider. Individual results vary based on diagnosis, pain duration, overall health, and response to treatment. Some procedures may not be covered by insurance. Treatment outcomes depend on proper patient selection and accurate diagnosis. Always consult a board-certified physician before pursuing any pain management treatment.
Medically reviewed by Dr. Suzanne Manzi, MD · Performance Pain and Sports Medicine · Last reviewed: May 2026
Medically reviewed by Suzanne Manzi, MD
Board-Certified in Physical Medicine & Rehabilitation, Pain Medicine, Electrodiagnostic Medicine, and Obesity Medicine
Last reviewed: May 2026
