29 Sep Is It Sciatica or SI Joint Pain? A North Dallas Guide to Accurate Diagnosis
Is It Sciatica or SI Joint Pain? A North Dallas Guide to Accurate Diagnosis
If you suffer from chronic pain that travels from your lower back down your leg, you may assume it’s sciatica. While sciatica — a sharp, shooting pain caused by nerve irritation in the spine — is common, many patients are surprised to learn that their symptoms may actually come from the sacroiliac (SI) joint, a small but powerful joint in the pelvis that can also cause radiating leg pain.
The key difference lies in where the pain travels and how it behaves when you sit, stand, or move. Because treatment for a pinched nerve differs from treatment for an inflamed joint, getting the correct diagnosis from a pain management specialist is essential to finding relief that lasts.
Why Back Pain Is So Hard to Identify
Chronic lower back pain affects millions of Americans, but identifying its source can be challenging. The body’s nerve pathways are complex, and similar symptoms can arise from very different problems.
For instance, two people might both feel tingling or numbness down one leg:
- One person’s pain may stem from a pinched nerve in the spine (true sciatica).
- The other’s pain could be caused by SI joint dysfunction in the pelvis.
If you treat the nerve when the joint is the real culprit, the pain won’t improve. That’s why so many people spend years trying treatments that don’t work — the issue isn’t the treatment itself, but an inaccurate diagnosis.
What Is True Sciatica?
Sciatica isn’t a condition by itself — it’s a symptom of irritation or compression of the sciatic nerve, the largest nerve in the body.
Common Sciatica Symptoms:
- Shooting or burning pain: Feels sharp, electric, or stinging, typically starting in the lower back or buttock and traveling down the back of the leg — often below the knee and into the foot.
- One-sided pain: Usually affects only one leg.
- Numbness or tingling: The leg or foot may feel weak, heavy, or experience “pins and needles.”
- Movement triggers: Pain may worsen when sitting, standing for long periods, or coughing.
If your pain feels sharp and radiates far down the leg, sciatica from nerve compression could be the cause.
Understanding the SI Joint
If your pain doesn’t fully match the symptoms above, it may be related to your sacroiliac (SI) joint — a strong joint that connects the base of the spine to the pelvis.
What the SI Joint Does:
- Connects the spine to the hips and legs
- Helps absorb impact when walking or bending
- Moves very little but carries a large load
When Problems Arise:
- Too Much Movement (Hypermobility): Pain may radiate into the lower back, hip, or groin.
- Too Little Movement (Fixation): Pain may feel localized to one side of the lower back or buttock.
SI joint issues are more common than most people realize — research suggests they account for 15% to 30% of chronic lower back pain cases.
Sciatica vs. SI Joint Pain: How to Tell the Difference
| Symptom | Sciatica (Nerve Pain) | SI Joint Pain (Joint Pain) |
| Pain Location | Starts in the lower back or buttocks and shoots down the leg | Localized to the lower back, pelvis, hip, or buttock |
| Pain Travel | Sharp, burning pain that may travel past the knee into the foot | Usually stays above the knee and feels dull or achy |
| Daily Triggers | Worsens with coughing, sneezing, or sitting too long | Worsens when changing positions or standing from sitting |
| Other Sensations | Numbness, tingling, or leg weakness | Possible leg instability or “giving way” feeling |
Quick Tip:
If your pain is mostly located in your lower back or buttocks and rarely extends below the knee, the SI joint is a likely suspect.
Why Getting the Correct Diagnosis Matters
Accurate diagnosis is the cornerstone of effective pain management. Treating the wrong area means the problem — and the pain — will persist.
- If it’s sciatica: Treatment often focuses on reducing nerve inflammation and pressure, such as with Epidural Steroid Injections (ESI).
- If it’s SI joint pain: Relief comes from targeting the joint itself with SI joint injections or, for longer-term relief, Radiofrequency Ablation (RFA) — a minimally invasive procedure that uses heat to quiet the small nerves transmitting pain from the joint.
Because the treatment approach differs, your doctor’s goal is to precisely identify which structure — the nerve or the joint — is responsible before proceeding.
The Diagnostic Process
If you’re experiencing chronic low back pain in Carrollton, Denton, or the surrounding North Dallas or North DFW areas, we recommend scheduling a consultation with Dr. Paul Kurian, a pain management specialist who can perform targeted diagnostic testing.
What to Expect:
- Physical exam: Your doctor will perform movement-based tests to locate the pain’s origin.
- Diagnostic Nerve Block: A small amount of numbing medication is injected into the suspected area — either the SI joint or near the nerve.
- If your pain temporarily disappears, it confirms the source.
- If the pain remains, the doctor will continue to investigate other possible causes.
Once the true source is identified, your specialist can recommend a customized plan that includes interventional procedures, physical therapy, or other evidence-based treatments to improve mobility and function over time.
Take the Next Step Toward Relief
If chronic back or leg pain is affecting your daily life, don’t keep guessing the cause. By working with Dr. Paul Kurian, an experienced Pain Management Physician with locations in Carrollton and Denton, you can take a meaningful step toward relief through accurate diagnosis and individualized care.
Dr. Paul Kurian offers comprehensive evaluations and advanced diagnostic procedures to help pinpoint the root cause of pain and develop tailored, personalized treatment plans.