The sacroiliac (SI) joint connects your spine to your pelvis. When it becomes dysfunctional, it refers pain into your lower back, buttock, hip, groin, and even your knee. This is the condition that gets misdiagnosed more than almost any other in orthopedics. Patients are told they have a disc problem, a hip issue, a nerve impingement, or degenerative spine disease. Some are told they need knee surgery, hip surgery, or spinal fusion. But the actual pain generator was never identified.
This is not a rare scenario. It is one of the most common presentations I see at Dynamic Athlete. Patients who have seen three, four, five other doctors. Patients who have had cortisone injections into their spine with no relief. Patients told nothing is wrong when something clearly is. The SI joint is the missing piece in their diagnostic workup, and when it is properly identified and treated, the results are often dramatic. If you have been told you need surgery for back, hip, or knee pain and something does not feel right about that diagnosis, the SI joint deserves evaluation.
The biggest problem with SI joint dysfunction is not the treatment. It is the diagnosis. Most physicians do not routinely assess the SI joint in their standard evaluation of lower back or hip pain. Imaging studies like MRI focus on the spine and may show incidental disc changes that get blamed for symptoms the SI joint is actually causing. Patients receive spinal injections, spinal surgery, or hip treatments targeting the wrong structure.
When SI joint dysfunction is eventually identified, conventional treatment includes cortisone injections into the joint, physical therapy focusing on pelvic stability, and in severe cases, SI joint fusion surgery. Cortisone provides temporary relief but does not address the underlying ligament laxity or joint instability. PT helps with surrounding muscle support but cannot regenerate damaged joint structures. Surgery fuses the joint permanently, eliminating its natural movement. For active adults, losing SI joint mobility affects walking gait and skiing mechanics.
At Dynamic Athlete, SI joint dysfunction treatment starts with something most clinics skip entirely: a thorough diagnostic evaluation that specifically assesses the SI joint as a potential pain generator.
For cases that do not settle with conservative care, physician-performed PRP therapy is one of the treatment options we offer.
Dynamic Shockwave+ combines focused shockwave therapy with EMTT (Extracorporeal Magnetotransduction Therapy) using Storz Medical devices. For SI joint dysfunction, shockwave stimulates blood flow to the joint and surrounding ligaments, reduces chronic pain signaling, and breaks down adhesions and scar tissue that contribute to joint dysfunction. EMTT penetrates deeper to accelerate cellular metabolism and address the neurological pain component. I founded the American Shockwave Training Institute (ASTI) and train clinicians nationally on these protocols.
Dynamic PRP+ delivers concentrated growth factors directly into the SI joint and its supporting ligaments under image guidance. For patients with ligament laxity contributing to SI joint instability, PRP promotes structural stabilization by strengthening the connective tissue that holds the joint in proper alignment.
Dynamic Stem Cell+ uses your body’s own regenerative cells from bone marrow aspirate (BMA) or adipose tissue through MFAT for patients with more significant joint degeneration or chronic instability. These cells can differentiate into connective tissue, providing deeper structural repair.
Dynamic Core+ (EMSELLA/HIFEM) is critical for SI joint patients because pelvic floor and deep core stability directly affects SI joint mechanics. Weak pelvic floor muscles allow excessive movement at the SI joint, perpetuating the dysfunction. EMSELLA strengthens these muscles to support the gains from regenerative treatment.
For neurological recovery, Dynamic Mind+ (EXOMIND/ExoTMS) enhances pain modulation and healing response. Dynamic Athlete is the only practice in the country offering all five modalities under one roof, making this the most comprehensive SI joint treatment program available anywhere. We do not apply the same protocol to every SI joint patient. Your treatment plan is built around your specific joint mechanics, the degree of instability present, and which structures are generating your pain. This precision is what separates an accurate, targeted protocol from the generic cortisone injection that failed you elsewhere.
The hardest part of SI joint dysfunction is not the treatment. It is the diagnosis. A standard lumbar MRI images the spine, not the SI joint, and it frequently shows incidental disc changes that get blamed for the pain. Because most evaluations do not specifically test the SI joint, patients cycle through spine-focused injections and therapy while the real source goes untreated. That is why the first job at Dynamic Athlete is to confirm, or rule out, the SI joint as the pain generator before any treatment begins.
An accurate diagnosis starts with a detailed history and a hands-on exam. Aneesh Garg, DO, CAQ uses a cluster of provocation tests that stress the SI joint in specific ways, checks the mechanics of the whole kinetic chain rather than the spine alone, and correlates the findings with your pain pattern and imaging. When the picture is still unclear, a diagnostic injection into the joint can help confirm it is the source. The goal is simple: treat the structure that is actually driving your pain, not the one that happened to show up on a scan.
Most SI joint dysfunction improves without surgery. Care generally moves in steps, and the right starting point depends on your exam.
The SI joint is the diagnosis everyone else missed. Aneesh Garg, DO, CAQ finds it because he was trained to look for it. His Yale residency and Andrews Sports Medicine fellowship taught him to evaluate the full kinetic chain rather than defaulting to spinal imaging and spinal injections. He is double board-certified in Sports Medicine and Internal Medicine and serves as Team Physician for USA Hockey and U.S. Soccer. His diagnostic precision is the single biggest reason patients find answers at Dynamic Athlete after years of being told nothing is wrong.
For SI joint dysfunction, his diagnostic expertise is the primary differentiator. He evaluates the full kinetic chain rather than defaulting to spinal imaging and spinal injections. His training at Andrews, combined with his sports medicine approach to pelvic mechanics, means he routinely identifies SI joint dysfunction that other physicians miss.
Our patients with SI joint dysfunction report dramatic improvement once the actual source of their pain is identified and treated.
One patient had attributed her lower back pain to structural issues for years. It was not until Dr. Garg looked further into her pain and considered other sources that they pinpointed the issue as her SI joint. Since receiving shockwave and EMTT to her SI joint, she can sit comfortably in a car again and no longer deals with the daily pain she was experiencing.
Another patient was told she needed a full knee replacement. Dr. Garg identified the actual source of her problem at her SI joint, treated it with stem cell and PRP, and she is now pain-free, climbing, and ready for ski season. Surgery on her knee would not have solved her problem.
The common thread: the SI joint was never evaluated by their previous physicians.
Yes. The SI joint is one of the most commonly missed sources of lower back, buttock, hip, and even knee pain. When the SI joint is dysfunctional, it refers pain into areas that mimic disc problems, hip arthritis, or nerve impingement. Many patients I see have been treated for spinal conditions for years without improvement because the SI joint was never evaluated. At Dynamic Athlete, SI joint assessment is part of every back, hip, and knee pain evaluation. Over 90% of our patients self-report a 75% or greater improvement, all without surgery. One patient had blamed structural back issues for years until Dr. Garg identified her SI joint as the actual source.
Proper SI joint diagnosis requires specific clinical tests that assess joint mobility, provocation signs, and referred pain patterns. Standard lumbar MRI does not evaluate the SI joint adequately, which is why it gets missed. At Dynamic Athlete, Dr. Garg performs a comprehensive physical examination including targeted SI joint provocation testing, palpation, and assessment of pelvic mechanics. Diagnostic imaging and, when indicated, diagnostic injections can confirm the SI joint as the pain generator. This thorough evaluation is what separates accurate diagnosis from the standard workup that focuses only on the spine. One patient was told she needed knee replacement when the real problem was her SI joint.
Focused shockwave therapy stimulates blood flow to the SI joint and its surrounding ligaments, reduces chronic pain signaling, and breaks down adhesions and scar tissue contributing to dysfunction. EMTT, paired with shockwave in our Dynamic Shockwave+ protocol, penetrates deeper to accelerate cellular metabolism and address neurological pain pathways. Dr. Garg founded ASTI and trains clinicians nationally on shockwave protocols using Storz Medical devices. This is not the same as radial pressure waves. Radial waves are not true shockwave. One patient can now sit comfortably in a car again after receiving shockwave and EMTT to her SI joint.
Yes. PRP delivers concentrated growth factors directly into the SI joint and its supporting ligaments under image guidance. For patients with ligament laxity contributing to joint instability, PRP promotes structural stabilization by strengthening the connective tissue holding the joint in alignment. Our Dynamic PRP+ protocol is often combined with Dynamic Shockwave+ to address both the pain and the structural instability. For more significant degeneration, Dynamic Stem Cell+ provides deeper regenerative support. Dr. Garg determines the right combination based on your exam findings and the degree of joint instability. One patient treated with stem cell and PRP is now pain-free and climbing.
Most physicians do not routinely assess the SI joint in their standard evaluation of back or hip pain. Standard imaging protocols focus on the lumbar spine and often reveal incidental disc changes that get blamed for symptoms the SI joint is actually causing. The SI joint requires specific clinical tests to evaluate, and these are not part of many physicians’ standard exam protocol. This is not necessarily a failure of the physician. It is a gap in how back pain is traditionally evaluated. At Dynamic Athlete, Dr. Garg evaluates the SI joint in every back, hip, and knee pain patient because he sees how often it is the actual source.
Core stability is central to SI joint health. The pelvic floor and deep core muscles are the primary stabilizers of the pelvis, and when they are weak, the SI joint absorbs excessive force with every step, sit, and movement. Our Dynamic Core+ (EMSELLA/HIFEM) protocol strengthens these muscles through high-intensity electromagnetic stimulation, providing the foundation that maintains the gains from regenerative SI joint treatment. Most clinics skip this step entirely. At Dynamic Athlete, we incorporate Dynamic Core+ into SI joint protocols because treating the joint without addressing the stability deficit leads to recurrence. Dr. Garg evaluates core function as part of every SI joint assessment.
Most clinics that identify SI joint dysfunction offer cortisone injections and physical therapy. We layer Dynamic Shockwave+ with EMTT, Dynamic PRP+, Dynamic Stem Cell+ when needed, Dynamic Core+ for pelvic stability, and Dynamic Mind+ for neurological optimization into a comprehensive protocol. But the biggest difference is diagnostic: Dr. Garg identifies SI joint dysfunction that other physicians miss because he evaluates the full kinetic chain rather than defaulting to spinal imaging. His training at Yale and Andrews Sports Medicine, combined with his role as Team Physician for USA Hockey and U.S. Soccer, means you get diagnostic precision backed by elite-level expertise. No other practice in Boulder offers all five modalities for SI joint treatment.
Yes. The SI joint is one of the most commonly missed sources of lower back, buttock, hip, and even knee pain. When it is dysfunctional it refers pain into areas that mimic a disc problem, hip arthritis, or a pinched nerve, which is why it is so often overlooked. A standard lumbar MRI images the spine, not the SI joint, so the joint gets missed unless a clinician specifically tests for it. At Dynamic Athlete, Aneesh Garg, DO, CAQ evaluates the SI joint directly with provocation testing and a full kinetic-chain exam, so the structure actually causing your pain is the one that gets treated.
For most patients, yes. Care usually begins with targeted physical therapy for pelvic and deep-core stability, activity changes, and manual therapy, which resolve many cases. When pain is driven by ligament laxity or joint irritation that has not settled with conservative care, physician-performed regenerative options such as PRP or cellular therapy may help by supporting the joint and its stabilizing ligaments, and are placed under live ultrasound guidance. SI joint fusion surgery is reserved for the small number of cases that fail every non-surgical option. The right starting point depends on your exam, which is why an accurate diagnosis comes first.
It can, for the right patient, when the diagnosis is accurate and the treatment is matched to the problem. PRP and cellular therapy aim to support the ligaments and joint tissue that stabilize the pelvis, addressing instability rather than only masking inflammation the way a steroid does. Results depend on an accurate diagnosis, correct target selection, and precise placement, which is why every procedure at Dynamic Athlete is performed by a physician under live ultrasound guidance. Regenerative treatment is not right for every case, and an honest evaluation will tell you whether it is a fit for your situation.
Dynamic Athlete in Boulder provides non-surgical, physician-performed care for SI joint dysfunction. Aneesh Garg, DO, CAQ personally performs the diagnostic evaluation and, when appropriate, the treatment, using PRP or cellular therapy placed under live ultrasound guidance, with focused shockwave added where tendon or ligament healing is involved. The clinic serves Boulder, Louisville, Lafayette, Erie, Broomfield, and Longmont, and accepts most insurance for consultations. A visit begins with finding the true source of your pain, then matching the least-invasive effective option to it. Call 303-997-1733 or book an evaluation online.
Across PRP, Stem Cell, Shockwave, EXOMIND, and EMSELLA. Tracked across active adults, postpartum patients, athletes, and surgery-avoiders.
Talk with our team about whether you're a candidate. Care is directed by Aneesh Garg, DO, CAQ, here in Boulder.
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