Chronic pelvic pain is complex and often linked to multiple causes, including dysfunction in the sacroiliac (SI) joint. When discomfort becomes persistent and interferes with daily life, understanding your treatment options is essential.
At The Physicians Spine & Rehabilitation Specialists, we specialize in non-surgical pain management for chronic conditions affecting the spine, joints, and pelvis. Our expert team serves the greater Atlanta area with evidence-based care designed to relieve pain, improve mobility, and enhance quality of life. If you're living with ongoing pelvic or lower back pain, we invite you to schedule an appointment to explore the best approach for your needs.
In this blog, we’ll walk through the differences between SI joint fusion and conservative treatments for chronic pelvic pain, so you can feel more confident in your next step.
Understanding SI Joint Dysfunction and Chronic Pelvic Pain
The sacroiliac joint connects the base of the spine to the pelvis, stabilizing the pelvic region and supporting movement. When dysfunction occurs in this joint, it can cause sacroiliac joint pain, hip pain, groin pain, and lower back discomfort. This condition, known as sacroiliac joint dysfunction, is a common but often overlooked cause of chronic pelvic pain.
A combination of patient history, physical examination, and diagnostic tools such as sacroiliac pain provocation tests or sacroiliac joint double block using local anesthetic helps confirm the diagnosis. Recognizing specific characteristics, such as pain worsening with standing, sitting, or climbing stairs, is important when identifying the SI joint as the pain generator.
Chronic pelvic pain can also be complicated by associated conditions like pelvic floor muscle dysfunction, bladder pain syndrome, endometriosis-associated pain, irritable bowel syndrome, vulvar pain, and lower urinary tract symptoms. Understanding the interplay between these issues is crucial for successful treatment.
Conservative Treatments for Chronic Pelvic Pain
Most patients start with conservative management for chronic pelvic pain, focusing on relieving symptoms without surgery. Options include:
- Multimodal physical therapy: Exercises to strengthen the core and pelvic floor muscle function, reduce strain on the SI joint, and improve movement patterns.
- Manual therapy: Hands-on approaches to improve joint mobility and tissue flexibility.
- Injection therapy: Targeted SI joint injections to reduce inflammation and provide pain relief.
- Pharmacological treatment: Medications to control pain symptoms, inflammation, and nerve sensitivity.
- Psychological support: Chronic pain often impacts emotional well-being. Addressing psychological and physical function together improves outcomes.
Research, including randomized controlled trials and findings from systematic review and meta-analysis, shows that multimodal physical therapy resulted in lower pain intensity compared to inert or nonconservative treatments. The Physiotherapy Evidence Database scale also supports the effectiveness of these approaches in managing persistent pelvic pain.
In some cases, patients also explore complementary methods such as traditional Chinese medicine or behavioral therapy, especially when managing symptom severity related to complex chronic pain conditions.
When SI Joint Fusion Becomes a Necessary Option
While conservative therapies are effective for many, some patients continue to experience sacroiliac joint dysfunction symptoms despite treatment.
When pain intensity remains high and physical function does not improve, SI joint fusion may be considered.
SI joint fusion is a minimally invasive surgery that stabilizes the sacroiliac joint by inserting titanium implants. This helps eliminate excessive motion at the joint and reduces sacroiliac joint pain. According to data from controlled trials and systematic search studies, patients undergoing fusion often report significant improvements in pain symptoms, mobility, and health-related quality of life compared to those receiving continued conservative care.
Patients typically become candidates for SI joint fusion when:
- Conservative treatments have failed after a reasonable period.
- Diagnostic tests, such as a positive response to local anesthetic SI joint blocks, confirm the joint as the pain generator.
- Other causes of chronic pelvic and low back pain have been ruled out.
Although the risk of serious adverse events is low, as with any spine surgery, patients should fully discuss the benefits and risks with their care team before proceeding.
Recovery Expectations for Both Treatment Paths
Conservative Treatments:
- Recovery with conservative therapies is gradual and focuses on long-term management.
- Multimodal physical therapy and manual therapy can gradually improve pelvic floor muscle control, reduce pelvic pain, and enhance daily function.
- Consistency is key, and patients often see steady improvement over several months.
SI Joint Fusion:
- Recovery after joint fusion typically involves restricted activity for a short period, followed by a structured rehabilitation program.
- Most patients experience significant improvements in pain relief within a few months, although full healing and return to full activity can take up to six months.
- Post-surgical rehabilitation supports strengthening and restoring physical function in the pelvic region and spine.
Choosing the right path depends on the severity of symptoms, response to prior treatments, and overall health.
How The Physicians Spine & Rehabilitation Specialists Can Help
At The Physicians Spine & Rehabilitation Specialists, we specialize in managing chronic pelvic pain with a focus on conservative treatments such as multimodal physical therapy, SI joint injections, and manual therapy. When needed, we coordinate minimally invasive SI joint fusion using bone allografts to restore joint stability and relieve pain.
Our experienced team is committed to delivering expert, personalized care to help you achieve long-term pain relief and improved quality of life. Trust Atlanta’s leading pain management specialists to guide your recovery with proven solutions.
Find Relief from Chronic Pelvic Pain with Expert Care
Choosing between conservative treatment and SI joint fusion can be difficult, but you don't have to decide alone. The Physicians Spine & Rehabilitation Specialists are here to guide you through every step, helping you make the best choice for your health and goals.
Ready to find the right plan for your pelvic pain relief? Schedule an appointment with our team today or call us at (770) 679-7000 to get started.
