Referred pain location depends on the affected section of the sacroiliac joint

Eur Spine J. 2015 Mar;24(3):521-7. doi: 10.1007/s00586-014-3604-4. Epub 2014 Oct 5.


Purpose: Pain referred from the sacroiliac joint (SIJ) may originate in the joint's posterior ligamentous region. The site of referred pain may depend on which SIJ section is affected. This study aimed to determine the exact origin of pain referred from four SIJ sections.

Methods: The study included 50 patients with SIJ dysfunction, confirmed by more than 70 % pain relief after periarticular injection of local anesthetic into the SIJ. The posterior SIJ was divided into four sections-upper, middle, lower, and other (cranial portion of the ilium outside the SIJ)-designated sections 1, 2, 3, and 0, respectively. We then inserted a needle into the periarticular SIJ under fluoroscopy. After the patient identified the area(s) in which the needle insertion produced referred pain, we injected a mixture of 2 % lidocaine and contrast medium into the corresponding SIJ section.

Results: Referred pain from SIJ section 0 was mainly located in the upper buttock along the iliac crest; pain from section 1, around the posterosuperior iliac spine; pain from section 2, in the middle buttock area; pain from section 3, in the lower buttock. In all, 22 (44.0 %) patients complained of groin pain, which was slightly relieved by lidocaine injection into SIJ sections 1 and 0.

Conclusions: Dysfunctional upper sections of the SIJ are associated with pain in the upper buttock and lower sections with pain in the lower buttock. Groin pain might be referred from the upper SIJ sections.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anesthetics, Local / therapeutic use
  • Arthralgia / diagnosis*
  • Arthralgia / drug therapy
  • Arthralgia / physiopathology
  • Buttocks
  • Female
  • Groin
  • Humans
  • Injections, Intra-Articular
  • Leg
  • Lidocaine / therapeutic use
  • Ligaments, Articular / physiopathology
  • Low Back Pain / diagnosis
  • Low Back Pain / drug therapy
  • Low Back Pain / etiology
  • Low Back Pain / physiopathology
  • Male
  • Middle Aged
  • Pain Measurement
  • Pain, Referred / diagnosis*
  • Pain, Referred / drug therapy
  • Pain, Referred / etiology
  • Pain, Referred / physiopathology
  • Sacroiliac Joint* / physiopathology
  • Treatment Outcome


  • Anesthetics, Local
  • Lidocaine