in confirming diagnosis), as well as manipulative or manual therapy. for the most severe and chronic forms of sacroiliac dysfunction, treatment should proceed with the support of a sacroiliac belt, injection therapy, and finally, surgery. the anti-inflammatory effect of injection therapy is not permanent, and the injections do not offer an opportunity to stabilize an incompetent joint. surgery is often considered a last resort, but for some patients, it is the only method of effectively stabilizing the loose joint. a fixation of the joint (screws or similar hardware only, without the use of bone grafting) is more common than a spinal fusion, as it is much less invasive, surgically straightforward, and results in a quicker recovery time for the patient. some experts in the field believe that it is important to make sure the sacroiliac joint is in an anatomically correct position prior to fixation or fusion, but published research contradicts this belief. platelet-rich plasma (prp) injections have shown positive results as a treatment for sacroiliac joint dysfunction, with randomized trials and case reports showing them to be more effective over periods of 3 months than steroid injections. studies have also shown prp injections into the sacroiliac joint are able to provide complete relief of symptoms, lasting as long as four years. dextrose prolotherapy injections performed either intraarticularly or into the dorsal sacroiliac ligaments is sometimes performed as an alternative treatment option. this is a controversial therapy but it does have research evidence to support its use. kim et al. in 2010 published a randomized controlled trial evaluating the effect of intraarticular prolotherapy injections versus intraarticular steroid injections in proven sacroiliac joint pain. the two interventions were equal in the short term at 3 months, but the prolotherapy group had superior pain relief at the 15 month mark at the end of follow up. this type of trial is considered high level evidence in medical circles. hoffman et al. in 2018 published a prospective cohort study with positive results in the treatment of those with sacroiliac joint dysfunction.