SI Joint Dysfunction: Understanding Your Low Back Pain in Napa

Diagnosing Sacroiliac Joint Instability: A Medical Guide for Napa Valley Patients

By Dr. Jackie Weisbein, DO, Board Certified in Physical Medicine & Rehabilitation and Pain Medicine, Fellowship-trained in Interventional Pain Management

Quick Insights

SI joint dysfunction occurs when the sacroiliac joint connecting your spine and pelvis malfunctions, causing low back, hip, or buttock pain that often mimics other conditions. Research suggests accurate diagnosis requires specialized physical provocation tests and image-guided anesthetic blocks, not just standard imaging. This condition frequently goes undiagnosed for years, as MRI scans rarely reveal SI joint problems. Treatment options range from physical therapy and targeted injections to minimally invasive procedures for persistent cases.

Key Takeaways

• SI joint dysfunction can cause persistent low back, hip, or buttock pain when other treatments have failed.
• Diagnosis usually requires provocation tests and image-guided anesthetic blocks, not just standard imaging.
• Many in the North Bay, including Napa and Vallejo, live with undiagnosed SI joint instability for years.
• Early identification offers new hope for those frustrated by years of missed or unclear diagnoses.

Why It Matters

For patients who feel lost after countless failed treatments, recognizing SI joint dysfunction could finally reveal the true source of pain. Research indicates that proper diagnosis prevents unnecessary suffering and restores confidence that lasting relief—and normal life—are possible.

Introduction

As a double board-certified pain specialist in Physical Medicine & Rehabilitation and Pain Medicine, I see so many people desperate for answers about their low back pain—especially those who've tried everything without success and wonder if SI joint dysfunction could be the cause. SI joint dysfunction means your sacroiliac joint (the link between your spine and pelvis) isn’t working right, often causing nagging pain that mimics other back conditions.

This often-overlooked source of pain is tricky. It’s far more common than most folks (and many doctors) realize, and early, expert diagnosis can change everything for someone stuck in a cycle of failed treatments.

Research suggests a combination of specialized physical tests and image-guided diagnostic blocks are keys to getting it right—something I rely on every day in my Napa practice (see current clinical guidelines). I also watch closely for sacroiliac joint instability, another hidden culprit.

If you’re worn down by years of pain with no clear answers, you’re not alone—I created this guide for people just like you, searching for real hope.

Why SI Joint Dysfunction Is Commonly Misdiagnosed

I can’t tell you how many people walk into my office after years of being told their MRI is “normal” or that their pain is just part of aging. SI joint dysfunction is one of the most underdiagnosed causes of chronic low back pain, especially here in the North Bay. For patients like Lena—who’s seen half a dozen providers and still feels invisible—the frustration is real.

The tricky part? SI joint pain often mimics other back or hip problems. Standard imaging rarely shows the problem, so it’s easy for even experienced physicians to miss. In my practice, I’ve seen that careful physical exams and listening to the patient’s story are just as important as any scan. Research suggests that physical provocation tests and image-guided blocks are key to getting the diagnosis right.

As a pain management specialist with double board certification, I’ve learned that there’s no substitute for a thorough, hands-on evaluation. When someone tells me, “I’ve tried everything and nothing has worked,” it often comes down to this issue being overlooked because the SI joint just doesn’t show up on most imaging. I always reassure patients: you’re not crazy—this really is a common roadblock, even for diligent providers. For those living with ongoing symptoms, understanding more about managing chronic pain long term can be foundational as part of their journey.

If you’re tired of being told “it’s all in your head,” you’re not alone. Many of my patients have lived with undiagnosed SI joint instability for years before finally getting answers. For more on the diagnostic challenges, see this systematic review on SI joint pain.

Dr. Jackie Weisbein’s Diagnostic Approach

When someone comes to me for sacroiliac joint pain, I start by listening—really listening—to their story. Some patients with chronic pain have explored treatments such as chiropractic care and spinal cord stimulation; however, the effectiveness of these treatments varies among individuals. That’s when I dig deeper.

My approach combines:

• A detailed history and physical exam, including specific provocation tests that research indicates are clinically significant for SI joint dysfunction.
• Ruling out other causes, like lumbar disc or hip problems, which often overlap.
• If SI joint dysfunction is suspected, I use image-guided anesthetic blocks. Studies suggest these blocks are the gold standard for confirming the diagnosis, since they can pinpoint the true pain source.

As someone who teaches these techniques to other physicians, I want my patients to know that research-backed protocols are essential, but what truly matters is interpreting those results through the lens of real-world experience. For example, when a patient gets significant relief after a precisely-placed diagnostic injection, it’s more than a technical “win”—it gives us both confidence to move forward, targeting the actual source of pain rather than just guessing. In my Napa Valley clinic, I’ve seen this approach restore hope for people who’ve almost given up.

I’ve seen firsthand how this stepwise process can finally give patients the validation they’ve been seeking. For many in Napa, especially those who’ve bounced between providers, just having someone take their pain seriously is a huge relief. If you want to understand more about the diagnostic process, check out this current concepts review.

What Are the Latest Treatments for SI Joint Pain?

Once I’ve confirmed SI joint dysfunction, I tailor treatment to each person’s needs and goals. For someone like Mark, who’s skeptical after years of failed therapies, it’s important to know that this isn’t just another “band-aid.” My goal is to restore function, not just mask pain.

Here’s how I approach it:

• Physical therapy and targeted exercise: These are often the first steps, focusing on core and pelvic stability.
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can be helpful as part of a multimodal plan, but I always aim to minimize medication when possible.
• Image-guided SI joint injections: Studies suggest these can provide both diagnostic clarity and temporary relief, especially when used as part of a broader strategy.
• Minimally invasive procedures: For those with persistent pain or instability, options like SI joint fusion (using advanced devices) or restorative neurostimulation (like ReActiv8) may be considered. Research indicates these procedures can offer meaningful improvement for the right candidates, though results vary and not everyone is a match.

As a fellowship-trained interventional pain physician, I’ve worked with hundreds of North Bay patients seeking options that don’t involve major surgery. While research shows promise for minimally invasive procedures, what stands out in my practice is how a tailored, whole-person approach leads to real progress—especially for people frustrated by “one-size-fits-all” care elsewhere. Many patients seek care after trying years of physical therapy or repeated injections without lasting relief; often, matching each patient’s unique pain pattern to the right combination of therapies is more effective than following a generic protocol.

I’ve helped many patients from Napa, Sonoma, and Fairfield get back to activities they thought were lost—whether that’s gardening, coaching Little League, or just walking the dog. If you’d like to hear others’ perspectives on their recoveries, you can read verified patient testimonials from our practice community. If you’re curious about how these treatments stack up, you can read more in this systematic review of SI joint interventions.

Your Experience at Our Napa Valley Clinic

When you come to Napa Valley Orthopaedic Medical Group, you’re not just another chart. I personally oversee every advanced procedure, from diagnostic blocks to minimally invasive SI joint fusion. For people like George—who’s worried about safety and recovery time—knowing that I’m double board-certified and have performed thousands of these procedures can be reassuring.

As someone who’s practiced and taught advanced pain procedures both locally and nationally, I believe that the environment where you receive care is just as important as the procedure itself. In my clinic, I focus on combining cutting-edge treatments with a compassionate, boutique experience—especially for those who have felt dismissed elsewhere. Patients from surrounding communities seek specialized medical expertise at nearby healthcare facilities.

Our clinic is designed for comfort and privacy, with a boutique feel that’s rare in larger hospital systems. Many of my patients travel from places like St. Helena, Yountville, and even rural Sonoma County because they want expert care close to home. I also coordinate with local hospitals, such as Queen of the Valley Medical Center, when additional resources are needed (though most procedures are done right here in our office).

I’ve seen how a supportive, personalized environment can make all the difference—especially for those who’ve felt dismissed elsewhere. If you’re ready to explore your options, you can learn more about our approach and local resources at Queen of the Valley Medical Center.

Voices from Our Community

As someone who’s dedicated my career to restoring function and hope—especially for folks in Napa Valley and the North Bay—I know how much trust matters when you’re searching for answers about pain. My approach as a double board-certified, fellowship-trained pain specialist (and President of Women Innovators in Pain Management) is all about combining advanced options like spinal cord stimulation, Intracept, SI-BONE fusion, and ReActiv8 with a truly personal, boutique experience. It means the world to see our community recognize that difference. One Google review shared:

Google Review Spotlight

David: This was my second injection experience with Dr Weisbein, and it was another pleasant (almost!) experience. Answering my questions about this procedure versus my previous one, and her ongoing explanation as to what she was doing was helpful and all went just as she said it would! I am enjoying significant relief from my pain at this time! View Review

Read the full review on Google

Conclusion

In summary, SI joint dysfunction is a leading—but often overlooked—cause of persistent low back pain, especially for patients who feel like nothing has truly explained their symptoms.Accurate sacroiliac joint pain diagnosis requires a careful, stepwise approach that goes beyond standard imaging, using specialized tests and image-guided blocks to finally pinpoint the real source of pain.

If you’re tired of feeling dismissed or stuck after years of failed treatments, please know you’re not alone—and you don’t have to keep living this way. As a double board-certified physician in Physical Medicine & Rehabilitation and Pain Medicine, and President of Women Innovators in Pain Management, I’m here to help you reclaim your life. To take the next step, schedule your consultation today and move toward lasting relief and renewed confidence.

This article is for educational purposes only and should not be used as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment options. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.