Question: I have had severe low back pain lately, and I suspect sacroiliac joint problems……would this show up on an MRI?

I have had severe lower right back pain lately and I suspect sacroiliac joint problems (SJD) because it is worst when there is pressure below the waist on my lower right back side, like if I press on it. Will SJD or any other sacroiliac joint problems show up in an MRI? What would be the best way to diagnose this? If an MRI would come out inconclusive anyway, I’d rather not pay for one. Also, what is the best type of doctor to go to for a diagnosis of the cause of my lower right back pain?

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Doctor’s Response: You need a diagnosis as to whether or not the pain being generated is coming from the sacroiliac joint – an MRI can be inconclusive.

Basically, what needs to be done is you need a diagnosis as to whether or not the pain being generated is coming from the sacroiliac joint. An MRI can be extremely inconclusive when it comes to sacroiliac joint pain. Because you have severe right lower back pain, your pain could be coming from the lumbar spine. In essence, both the lumbar spine and the sacroiliac joint would have to be scanned, and all pathology would have to be ruled out first in the lumbar spine before you move to the sacroiliac joint.

In order to diagnose that the sacroiliac joint is indeed generating pain, you would need an injection into the sacroiliac joint by a professional, under image, using both a Novocain-type substance and a steroid-type substance. The Novocain-type substance numbs up the joint, and if you get relief for the length of the time the Novocain is working, then that tells you that the pain is being generated from the sacroiliac joint. That test is more conclusive than an MRI in making the diagnosis.

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In Spine-health’s Doctor Advice section, physicians respond to frequently asked questions about back pain issues. These responses represent the opinion of one physician, and do not necessarily reflect the views of the broader medical community. The advice presented has not been peer reviewed by Spine-health’s medical advisory board.