After an SI Joint Injection: Recovery, Pain Diary, Leg Numbness, and Worse Pain

Your pain diary

Stays on this device. What you enter here is saved only in this browser, so you can close the page and come back. Nothing is sent to Modal Pain or to anyone else. Print it or bring your phone to the follow-up visit.

Before the block

Date of the block Time of the block Your usual pain (0–10), doing the activity below Choose 012345678910 The activity that usually brings the pain on (optional)

Pain scores after the block

Check	Pain (0–10)	Relief	Did the activity that usually hurtsDid the activity	Took pain medicinePain pill
15 minutes	– 012345678910	–
30 minutes	– 012345678910	–
1 hour	– 012345678910	–
1½ hours	– 012345678910	–
2 hours	– 012345678910	–
3 hours	– 012345678910	–
4 hours	– 012345678910	–
5 hours	– 012345678910	–
6 hours	– 012345678910	–
8 hours	– 012345678910	–
Next morning	– 012345678910	–

Enter your usual pain score before the block to see your relief.

Print or save my diary Start a new diary

You get home, and the test is getting out of the car. For a year that movement has sent a jolt through the buttock below your belt line. Today it might not. Do it anyway, then stand up from a chair, climb the stairs, and write down the number. The hours after an SI joint injection are when its result is read.

These are the instructions Dr. Alex Movshis gives after a sacroiliac (SI) joint injection at Modal Pain Management. If yours was done elsewhere, the diary still works, but follow your own physician’s discharge instructions where they differ.

How to fill in the diary so it means something

The injection places numbing medicine (local anesthetic) inside the SI joint, where the pelvis meets the base of the spine. If the joint is the source of your pain, the familiar pain should fall while the anesthetic works and come back as it wears off. Your job is to give that test a fair chance.

Provoke the pain at every check. Before you score it, do what normally brings it on: getting out of a car, standing up from a low chair, climbing stairs, rolling over in bed, standing on the painful leg. Pain scored while lying still is not the test.

Score the familiar pain, not new soreness. The injection site may ache. That is a different pain. Rate the one you came in with.

Keep scoring into the next day. The Medicare policy that applies in New York asks for pain scores before the injection, after it on the same day, and on the days that follow (CMS L39455). The diary checks at 15 and 30 minutes, hourly to eight hours, and the next morning. After that, jot down your familiar pain once a day for the following few days and bring those notes too.

Don’t add pain medicine unless you need it. A pill and an injection both lower the score, and the diary cannot tell them apart. If you take something, tick the box.

Why diagnostic injections are done without sedation. Sedation can make an injection look positive when it is not, and the 2025 multisociety guideline recommends against routine sedation for diagnostic SI joint injections (McCormick 2025).

Why one injection is not always enough

A single numbing injection can be falsely positive. A systematic review put the false-positive rate of single, uncontrolled SI joint blocks at about 20% (Simopoulos 2012). In a study of 54 patients, 19 responded to a first injection, but only 10 confirmed with a second (Maigne 1996).

How much relief counts, and whether a second injection is needed, is set by your insurance plan’s policy, and we follow it. The 2025 multisociety guideline treats at least 50% relief as positive (McCormick 2025). The Medicare policy for New York requires at least 75% relief of your familiar pain (CMS L39455). Commercial plans set their own rules, and our office checks yours before the injection.

Leg numbness or weakness

This surprises people, so it is worth knowing in advance. The SI joint capsule is often not watertight. In an imaging study of 76 joints, contrast leaked out of 61% of them, and three of the five leak patterns reached nerves: the sacral nerve openings behind the joint, the sheath of the L5 nerve root, and the nerves of the lumbosacral plexus in front of it (Fortin 1999). The 2025 guideline puts defects in the front of the capsule at about 40% of people with suspected SI joint pain, and notes that numbness or weakness in the same leg after the injection suggests the anesthetic reached those nerves (McCormick 2025).

It wears off as the anesthetic does, within a few hours, or longer if a long-acting anesthetic was used. Until then, walk with someone, be careful on stairs, and do not drive. Numbness or heaviness lasting more than 24 hours needs a call. Weakness that is getting worse instead of better is an emergency.

When pain comes back, or feels worse

The return of the pain as the anesthetic wears off is expected, and it is part of the result: relief that tracks the anesthetic is the pattern the test looks for. Returning pain often feels worse than it is because the contrast with the last few hours is sharp. Score it against your usual number.

Pain that is genuinely worse the next day is usually soreness at the injection site. In a study of 191 fluoroscopically guided SI joint injections, 132 had follow-up about two days later. Of those, 12.9% had soreness at the injection site and 5.3% a temporary increase in pain, and side effects in the days afterward were more common in younger patients and after injections on both sides (Plastaras 2012). Ice helps. If the pain is still climbing after two days, call us.

Activity, work and blood thinners

No study has tested rest or activity limits after an SI joint injection, and there is no reason to rest. Go back to normal activity and work the next day, or the same day if your leg feels normal. Keep up your physical therapy or home exercise program. Insurers often expect it: the Medicare policy for New York, for example, requires active participation in a rehabilitation or home exercise program around SI joint injections (CMS L39455).

Blood thinners. The multisociety guideline places SI joint injections in the low bleeding-risk group and treats people with a higher bleeding risk more cautiously (Narouze 2018). The 2025 SI joint guideline likewise does not recommend stopping them for these low-risk injections (McCormick 2025). Follow the plan we made with you before the injection. If you are not sure when to take the next dose, call before you take it.

When to go to the emergency room

Serious problems are rare. Infection after an SI joint injection is known from case reports, including deep infections that began about two and three days after the injection in elderly patients in whom stool contamination of the skin was the documented or suspected source (McHugh 2008, Kurnutala 2015). Fever or chills with buttock, hip or back pain that is getting worse in the days after the injection, leg weakness that is getting worse instead of wearing off, new numbness in the groin, or loss of bladder or bowel control are emergencies. Call 911 or go to the nearest emergency room, and tell the team you had an SI joint injection and on what date.

After the result

Dr. Movshis reviews the diary with you at the follow-up visit. Relief that tracked the anesthetic points to the SI joint. The next step depends on how long relief lasted and on your plan: a repeat injection, or blocks of the small lateral branch nerves before SI joint radiofrequency ablation. The placebo-controlled trial of that ablation selected patients with a diary recorded every 30 minutes for six hours after a diagnostic SI joint injection (Cohen 2008), and the radiofrequency ablation aftercare page covers what follows it. No change points toward a different source of the pain, and the routes below are where we usually look next. The SI joint injection page explains who the injection is for and how it is done.

If the SI joint injection did not help: what that usually means

A properly placed SI joint injection that leaves the familiar pain unchanged is useful information. It means the inside of the joint is probably not the main source. These are the patterns we look at next, including for patients whose injection was done elsewhere. Bring the procedure note and your imaging.

Relief that tracked the numbing medicine, then the familiar pain came back

Usually: Sacroiliac joint pain, likely (a second block may be needed)

At Modal Pain: Lateral branch blocks, then SI joint radiofrequency ablation if your plan covers it

Low back pain centered over the spine, worse leaning back or twisting, unchanged by the SI injection

Usually: Facet joint pain

At Modal Pain: Medial branch block, then radiofrequency ablation if the block works

Groin or front-of-thigh pain, worse walking or putting on socks

Usually: Hip joint pain that mimics back pain

At Modal Pain: Image-guided hip joint injection

Pain that runs down the leg below the knee, with numbness or tingling in the same strip

Usually: Radicular pain from a pinched nerve root

At Modal Pain: Epidural injection

Deep buttock pain, worse sitting, with tenderness in the middle of the buttock

Usually: Piriformis syndrome

At Modal Pain: Ultrasound-guided injection at the piriformis muscle, with a stretching program

Modal Pain Management accepts most commercial PPO plans, including Aetna, Anthem Blue Cross Blue Shield, Cigna, Empire Blue Cross Blue Shield, the Empire Plan, Oscar, Oxford, UMR and UnitedHealthcare, and does not accept Medicare, Medicaid, HMO plans, or workers' compensation. Our office handles prior authorization, and self-pay prices are published. Insurance details · Self-pay pricing

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References

Every figure on this page comes from the sources below. Where no study exists, the page says so and explains the reasoning instead.

1. McCormick ZL, Hurley RW, Anitescu M, et al. Consensus practice guidelines on sacroiliac joint complex pain from a multispecialty, international working group. Pain Med. 2025. doi:10.1093/pm/pnaf129 · PubMed
2. Plastaras CT, Joshi AB, Garvan C, et al. Adverse events associated with fluoroscopically guided sacroiliac joint injections. PM R. 2012. doi:10.1016/j.pmrj.2012.02.001 · PubMed
3. Fortin JD, Washington WJ, Falco FJ. Three pathways between the sacroiliac joint and neural structures. AJNR Am J Neuroradiol. 1999. · PubMed
4. Simopoulos TT, Manchikanti L, Singh V, et al. A systematic evaluation of prevalence and diagnostic accuracy of sacroiliac joint interventions. Pain Physician. 2012. · PubMed
5. Maigne JY, Aivaliklis A, Pfefer F. Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain. Spine. 1996. doi:10.1097/00007632-199608150-00012 · PubMed
6. McHugh RC, Tiede JM, Weingarten TN. Clostridial sacroiliitis in a patient with fecal incontinence: a case report and review of the literature. Pain Physician. 2008. · PubMed
7. Kurnutala LN, Ghatol D, Upadhyay A. Clostridium sacroiliitis (gas gangrene) following sacroiliac joint injection: case report and review of the literature. Pain Physician. 2015. · PubMed
8. Cohen SP, Hurley RW, Buckenmaier CC, et al. Randomized placebo-controlled study evaluating lateral branch radiofrequency denervation for sacroiliac joint pain. Anesthesiology. 2008. doi:10.1097/ALN.0b013e31817f4c7c · PubMed
9. Narouze S, Benzon HT, Provenzano D, et al. Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications (second edition). Reg Anesth Pain Med. 2018. doi:10.1097/AAP.0000000000000700 · PubMed
10. Wellpoint Federal (Medicare Administrative Contractor). Local Coverage Determination L39455: Sacroiliac Joint Injections and Procedures. CMS Medicare Coverage Database. 2026. Source

These are general instructions after a sacroiliac (si) joint injection. If the instructions you were given at discharge differ, follow the ones you were given, because they account for your medications and your procedure. For anything you are unsure about, call (646) 290-6660. See the sacroiliac (si) joint injection page for how the procedure works and who it helps, or the aftercare instructions for other procedures.