A global team of experts has developed the first unified, evidence-based approach to diagnosing and treating sacroiliac joint (SIJ) complex pain — a common, often overlooked cause of low back pain.
The effort was led by Zachary McCormick, MD, FAAPMR, Professor and Vice Chair of Physical Medicine & Rehabilitation (PM&R) at the University of Utah, and brought together 27 professional societies from North America, Europe, Latin America, Asia, and the South Pacific.
For more than three years, the group reviewed current research placed within the context of clinical experience to build consensus on best practices for diagnosing SIJ complex pain and guiding treatment — both where evidence is strong and where it’s still limited.
“We wanted to create a framework that clinicians worldwide can use to provide clearer, more consistent, and evidence-based care,” said Dr. McCormick. “Bringing together so many voices across specialties and regions isn’t easy, but it was well worth it to improve outcomes for patients.”
Why This Matters
SIJ complex pain affects 15% to 30% of people with chronic low back pain, yet care has often been inconsistent. This new framework helps clinicians:
- Standardize diagnosis, including guidance on the physical exam, imaging, and diagnostic injections.
- Provide evidence-based recommendations for treatments, from injections to interventional procedures and surgery.
- Offer practical guidance when high-quality research is lacking.
- Serve as a model for collaboration across multiple societies and specialties.
Key Research Insights
The committee’s review and consensus process highlighted several important findings:
- The physical exam can help identify pain from within the SIJ complex, though negative results are often more informative than positive ones.
- Both intra‑ and extra-articular corticosteroid injections provide short-term relief, with slightly stronger evidence for extra-articular injections.
- Sacral lateral branch radiofrequency ablation (RFA) offers substantial pain relief for at least six months in patients with extra-articular pain.
- Minimally invasive SIJ fusion may aid patients with confirmed intra-articular pain who haven’t improved with conservative treatment, though the current evidence is mixed.
- Many recommendations are limited by the quality of existing evidence, highlighting the need for further research.
About Dr. Zachary McCormick
Dr. McCormick serves as Vice Chair and Ambulatory Chief Value Officer in the Department of PM&R at the University of Utah and is the Chief of the Spine and Musculoskeletal Medicine Division. He is widely recognized for his leadership in advancing spine and musculoskeletal care.
He was recently named President-Elect of the International Pain and Spine Intervention Society (IPSIS), a global organization advancing research, education, and advocacy to ensure patients have access to high-quality interventional care.
About INSPIRE
The Interventional Spine & Musculoskeletal Medicine Research (INSPIRE) Program is dedicated to advancing evidence-based care for spine and musculoskeletal pain through high-quality outcomes research. As part of Physical Medicine and Rehabilitation, INSPIRE conducts investigator-initiated studies and sponsored clinical trials that evaluate and refine innovative, state-of-the-art treatments. Their work is driven by a commitment to improving patient outcomes and quality of life through rigorous research and clinical excellence.