Nonsurgical Sacroiliac / SI JOINT Treatments in Raleigh & Cary NC 

SI Joint Pain Treatment in Raleigh & Cary, NC

 

 SI Joint Pain Is Rarely a Surgical Problem

Pain around the sacroiliac joints — where the base of the spine meets the pelvis — is one of the most misdiagnosed sources of "low back pain." It aches in the low back and buttock, sometimes into the groin or down the back of the thigh, and it gets blamed on discs that were never the problem.

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Here's what most people aren't told: SI joint pain is usually a ligament problem, not a joint-destruction problem. The SI joints are held together by some of the strongest ligaments in the body. When those ligaments are injured, stretched, or lax — from trauma, childbirth, repetitive loading, or just years of wear — the joint moves more than it should, and everything around it hurts.

Ligaments don't show up well on MRI. They can't be fixed with surgery in any meaningful way — SI joint fusions exist, but they're a last resort for a small minority. What injured ligaments need is a reason to repair. That's what we do.

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Who This Page Is For

• Your pain sits low and off to one side — over the "dimple" above the buttock — rather than in the center of the back

• It gets worse with standing, walking, climbing stairs, or rolling over in bed

• You've been told it's your discs, but disc treatments didn't help

• You've had SI joint steroid injections that wore off — or you don't want more steroids

• You're wondering if you need an SI joint fusion (you almost certainly don't)

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Why Prolotherapy and PRP for the SI Joints

Both treatments target the same thing: the injured ligaments stabilizing the SI joint.

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Prolotherapy. A dextrose-based solution injected at the attachment points of the dorsal sacroiliac ligaments and surrounding stabilizers. The goal is to provoke a controlled, local repair response in ligament tissue that has stopped healing on its own. Prolotherapy was developed specifically for ligament injuries — this is its home turf.

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PRP (platelet-rich plasma). Your own concentrated platelets, injected under ultrasound guidance into the injured SI ligaments and surrounding soft tissue. Where prolotherapy uses dextrose to stimulate repair, PRP delivers your body's own concentrated growth signals directly to the site.

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We use one or both depending on the severity and chronicity of the ligament injury. Both are done in the office, under ultrasound guidance, with no sedation and no downtime beyond brief post-injection soreness.

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What We Treat 

• SI ligament sprain, laxity, or chronic ligament injury

• Post-traumatic SI pain (falls, car accidents, sports injuries)

• Postpartum SI instability that never resolved

• Muscular pain around the SI joints — gluteal trigger points, piriformis dysfunction — that accompanies the ligament problem

What We Don't Treat

• Inflammatory sacroiliitis — ankylosing spondylitis and related autoimmune conditions are rheumatologic diseases, not ligament injuries. If we suspect this, we refer you to rheumatology.

• Pain from inside the SI joint requiring diagnostic blocks — confirming intra-articular SI joint pain requires image-guided diagnostic injections, which is interventional spine care. If your evaluation points there, we refer rather than guess.

• Surgical SI conditions — fractures, tumors, infections involving the SI joint need surgical or specialist care.

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And as with everything we do: we don't prescribe opioids or manage pain medications.

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What to Expect

1. Evaluation. We confirm the SI ligaments are the pain generator — history, physical exam patterns, and ruling out disc, hip, and inflammatory causes. Getting this diagnosis right is the whole game.

2. Treatment series. Ligament treatments are typically done as a short series spaced several weeks apart — ligaments heal slowly, and one visit rarely finishes the job.

3. Rehab. As the ligaments tighten up, the surrounding muscles need retraining. We'll give you a straightforward plan.

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A Straight Answer on Results

The honest version: prolotherapy and PRP for SI ligament pain have supportive but not overwhelming evidence — small trials and large case series, not the kind of massive trials drugs get. What we can say is that ligament-targeted treatment matches the actual anatomy of the problem far better than steroid injections into the joint or, worse, fusion surgery for a ligament issue. We'll give you our real assessment of your case before you spend anything, including telling you when we don't think you're a candidate.

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