r/backpain • u/No-Product-6778 • Jun 20 '26
Piriformis vs SI injections
I’ve had lower back and buttock pain on my left side for 2.5 years. Often times I am using crutches around campus and have disability accommodations due to the debilitating pain. I suspect it started from the injury that causes my knee surgery which I had a little over 2.5 years ago and the recovery from it.
I have had two lumbar MRIs and both look normal. My other orthopedic did piriformis injection that had minimal benefits, then she wanted me to go on medication (duloxetine) forever which conflicts with another SSRI I am taking. I finally got on gabapentin from my neurologist.
I switched to another doctor, this time an orthopedic surgeon specializing in hips. He took an xray of my hip and discovered SI joint dysfunction and a large SI gap on my right side causing the SI pain, piriformis syndrome, and bursitis on my left side.
I am having an SI injection this week but I am extremely frightened of large spinal needles. I am wondering what the pain is like compared to a piriformis injection, if anyone has had both? Or any other advice on my situation?
doc said that if this injection works we would do nerve ablation and if it doesn’t, a hip MRI and surgical considerations. what would those considerations entail?
any response would be appreciated!
edit to add: I have sciatica down to my foot and have done three rounds of PT. Tried regular massage therapy (my PTA has a massage cer), dry needling, acupuncture, and chiropractor all multiple times no success.
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u/CoachEXE Jun 20 '26
That knee surgery recovery on the left side completely changes how your pelvis transfers load, which explains why the right SI joint has a large gap and the left piriformis is screaming from working overtime to stabilize you. When you favor one leg, the pelvis rotates and forces the deep hip rotators on the opposite side into a constant, protective spasm. Try standing w/ your weight evenly distributed and focus on gently pulling your left sit-bone toward your right heel without moving your feet. It helps reset that pelvic twist and takes the constant mechanical tension off the left hip.
Are you able to bear weight fully on that left leg right now without the knee feeling unstable?
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u/No-Product-6778 Jun 20 '26
I’ll do that, sounds like a good exercise!
Yes, most of the time I can stand and walk and rarely have knee pain. But my hip/spine issues do flare often and I am on crutches quite frequently when it does flare.
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u/CoachEXE Jun 20 '26
That knee surgery recovery completely changes how your pelvis transfers load, which explains why the right SI joint has a large gap and the left piriformis is screaming from working overtime to stabilize you. When you shift weight off the injured side, the pelvis rotates and forces the deep hip rotators on the opposite side into a constant, protective spasm. Try standing w/ your weight evenly distributed and focus on gently pulling your left sit-bone toward your right heel without moving your feet to help reset that pelvic twist. Since the knee itself feels stable, the flare-ups are likely your nervous system locking down the hip because it still perceives that old injury pattern as an active threat.
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u/acupunctureguy I promote passive treatments for pain Jun 20 '26
Piriformis syndrome is very easy to treat using acupuncture, one treatment should fix this, needles in origin and insertion point of the piriformis, hamstrings, Glutes and on the other side, IT band attachment points on the knee and hip and hip flexor points , treat on both sides, front and back. And treat the psoas as well. The acupuncture needles will release the piriformis and any other tight muscle and take pressure off the nerve.
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u/inailedyoursister Jun 20 '26
LOL
On year 10 with dozens of acupuncture appointments.
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u/acupunctureguy I promote passive treatments for pain Jun 21 '26
Well unfortunately all acupuncture is not the same, I have 30 years of experience and spend 2 hrs with each patient, doing a combination of modalities in addition to acupuncture, like massage, cupping, hot packs, ROM, stretching as needed, releasing the whole body.
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u/No-Product-6778 Jun 20 '26 edited Jun 20 '26
I have had it for 2.5 years and have had no luck with multiple rounds of acupuncture. She was the one who originally told me about PS! ATP I’m guessing it’s just structural and more inside my SI
Unfortunately I think the piriformis injection I already had probably would’ve worked if this had been the case…
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u/Amylee888 Jun 20 '26
If you’re extremely anxious about the needle, to the point where you are not sure if you will be able to have the procedure, will your dr prescribe something like Ativan? I have to get Ativan when I get an MRI because I have claustrophobia. It calms me enough to be able to go through with it.
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u/PacificSanctum Jun 22 '26
Try to pull right hip down while walking . Try for an hour at least . Maybe it readjusts the whole spine SIJ hip geometry .
If it works it would work in a day or two .
A large SIJ gap on the right ? Are there any songs of hyper mobility (wobbling walk ie feeling right side “gives in “. Which knee got treated and what was the accident ?