Sacroiliac joint pain is a complex and frequently overlooked cause of lower back and pelvic symptoms. Clear, evidence-informed guidance supports accurate diagnosis and consistent management across clinical settings. In partnership with stakeholder professional societies, the American Academy of Pain Medicine (AAPM) and American Society of Regional Anesthesia & Pain Medicine (ASRA-PM) recently developed consensus practice guidelines on sacroiliac joint pain in order to improve the standardization of diagnosis and treatment.
The sacroiliac joints connect the spine to the pelvis, transferring weight and movement between the upper body and legs. Pain in this region can arise from trauma, degenerative changes, pregnancy, or altered biomechanics and often mimics other causes of low back pain. Since symptoms can overlap with spinal or hip conditions, clear guidance on diagnosis and management remains critical 1–3.
Historically, approaches to sacroiliac joint pain have varied widely—differences in diagnostic criteria, imaging use, and treatment selection have resulted in inconsistent approaches and outcomes. The consensus guidelines aim to reduce this variability by synthesizing available evidence and expert agreement into practical recommendations for clinicians working with patients with sacroiliac joint pain. These guidelines help clinicians make informed decisions while providing patients with more predictable and standardized care 4–6.
The guidelines emphasize that diagnosis should first begin with a thorough clinical assessment. A detailed patient history and physical examination, including specific provocative maneuvers, are considered central to identifying sacroiliac joint involvement. Imaging is generally used to rule out other conditions rather than confirm the diagnosis on its own. Guided diagnostic injections can help determine whether the sacroiliac joint is the primary pain source.
Many organizations advise starting with conservative measures. Physical therapy focused on pelvic stabilization, mobility, and strength is commonly used. Activity modification, patient education, and non-invasive pain management strategies are also considered foundational. These approaches aim to restore function and reduce pain without exposing patients to unnecessary procedural risks. However, the literature review conducted for the AAPM and ASRA-PM consensus guidelines noted that evidence supporting conservative treatment for sacroiliac joint pain remains low quality 4.
Image-guided injections may be used for both diagnostic clarification and short-term pain relief. For carefully selected patients, more advanced procedures may be considered, but only after conservative options have been exhausted. Emphasis is placed on appropriate patient selection and realistic expectations 7–10. At the most invasive level, the consensus guidelines find that there is moderate quality evidence supporting surgical sacroiliac joint fusion to treat pain in carefully selected patients 4.
In general, it is important to understand the value of a multidisciplinary approach in treating this condition. Collaboration among pain specialists, physical therapists, primary care clinicians, and surgeons, as needed, helps in addressing the multiple mechanical, neurological, and functional aspects of sacroiliac joint pain. This team-based model improves continuity of care and reduces the likelihood of overtreatment 11–13.
By aligning clinical practice around shared principles, the consensus guidelines help improve outcomes for patients with sacroiliac joint pain. They encourage evidence-based decision-making while allowing flexibility for individual patient needs. As research evolves, these guidelines are expected to be refined, supporting more consistent, effective, and patient-centered management of this challenging condition.
References
1. Sacroiliitis – Symptoms and causes – Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/sacroiliitis/symptoms-causes/syc-20350747.
2. What Is Sacroiliitis? Cleveland Clinic https://my.clevelandclinic.org/health/diseases/17736-sacroiliitis.
3. Sacroiliac Joint Pain – StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK470299/.
4. Consensus practice guidelines on sacroiliac joint complex pain from a multispecialty, international working group | Pain Medicine | Oxford Academic. https://academic.oup.com/painmedicine/article/26/12/817/8346385.
5. NYSORA. New global guidelines on sacroiliac joint pain. NYSORA https://www.nysora.com/education-news/new-global-guidelines-on-sacroiliac-joint-pain/ (2026).
6. Sayed, D. et al. American Society of Pain and Neuroscience Best Practice (ASPN) Guideline for the Treatment of Sacroiliac Disorders. JPR 17, 1601–1638 (2024). DOI: 10.2147/JPR.S464393
7. Lee, A., Gupta, M., Boyinepally, K., Stokey, P. J. & Ebraheim, N. A. Sacroiliitis: A Review on Anatomy, Diagnosis, and Treatment. Adv Orthop 2022, 3283296 (2022). DOI: 10.1155/2022/3283296
8. Newman, D. P. & Soto, A. T. Sacroiliac Joint Dysfunction: Diagnosis and Treatment. American Family Physician 105, 239–245 (2022).
9. Buchanan, B. K. & Varacallo, M. A. Sacroiliitis. in StatPearls (StatPearls Publishing, Treasure Island (FL), 2025).
10. Australia, H. Sacroiliitis – sacroiliac joints, dysfunction, pain and treatment. https://www.healthdirect.gov.au/sacroiliitis (2025).
11. Bates, S. M., Lin, J., Allen, L. N., Wright, M. & Kidd, M. Can multidisciplinary teams improve the quality of primary care? A scoping review. eClinicalMedicine 88, 103497 (2025). DOI:10.1016/j.eclinm.2025.103497
12. Taberna, M. et al. The Multidisciplinary Team (MDT) Approach and Quality of Care. Front Oncol 10, 85 (2020). DOI:10.3389/fonc.2020.00085
13. Korylchuk, N., Pelykh, V., Nemyrovych, Y., Didyk, N. & Martsyniak, S. Challenges and Benefits of a Multidisciplinary Approach to Treatment in Clinical Medicine. Journal of Pioneering Medical Sciences 13, 1–9 (2024). DOI :10.61091/jpms202413301