Sacroiliac lesions are commonly suspected in sport- and racehorses. Injection of the sacroiliac (SI) area can be performed for diagnostic purposes and/or for treatment of SI pain. Because of the deep location of the SI joint, blind injections may be unsafe. The purpose of this paper is to present how to perform ultrasonographic guided injection of the SI area using cranial and caudal approaches. With this technique drugs can be injected close to the SI joint and technical errors (needle implantation in the sciatic nerve, injection in the vertebral canal or in the rectum) can be avoided.