Sacroiliac joint pain: Symptoms, Causes, Treatment
Have you developed pain at the base of your spine? Is it on one side? Have you suddenly noticed it’s hard to put on pants or shoes? Perhaps you’ve discussed this with a friend, and in their best Aussie accent they’ve said “mate, that’s ya SIJ!”. At PhysioTec Physiotherapy, we see a lot of people who come to our clinic with these symptoms and question whether they have sacroiliac joint (SIJ) pain and in some cases – they do!
Symptoms of SIJ pain can overlap with several other musculoskeletal conditions which can make it a little trickier to diagnose. So, if you have pain at the base of your spine, or perhaps feel it’s in your buttock or hip, a thorough assessment is needed to get to the bottom (pardon the pun) of what’s causing your pain.
In this blog, we will discuss what SIJ pain is, its symptoms and causes, and finally how to treat it.
This blog will cover the following topics on Sacroiliac Joint Pain:
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The sacroiliac joints and SIJ pain
Sacroiliac joint pain is commonly referred to as “SI joint” pain or “SIJ” pain and is also the main culprit in pelvic girdle pain, posterior pelvic pain, or pregnancy related pelvic pain. It is a common but often misdiagnosed condition.
The sacroiliac joints are located at the back of the pelvis where the sacrum (the bone shaped like an upside-down triangle at the base of your spine) meets the iliac bones of the pelvis. There are two sacroiliac joints, one on each side of the body that are reinforced by strong ligaments and muscles.1 These ligaments and muscles play a crucial role in transferring weight and forces between the upper body and the lower limbs.2 Although these joints do not have very little movement compared to other joints (such as hips, knees, and ankles), they are essential for stability, balance, and efficient movement.
When the sacroiliac joints become irritated, they can produce pain that can be difficult to pinpoint. As a result, SIJ pain is often mistaken for other conditions such as sciatica, hip pain, or low back pain. The symptoms of SIJ pain overlap with several musculoskeletal presentations and can affect people of all ages and activity levels. Thus, accurate diagnosis at the very beginning is crucial for effective management.
SIJ pain can often be mistaken for lower back, hip, or buttock pain and can be aggravated by activities such as standing on one leg, stairs, rolling in bed, or getting dressed. Because symptoms can overlap with other conditions, an accurate assessment is important.
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Symptoms of SIJ Pain
The symptoms of sacroiliac joint pain can vary widely from person to person, which is why the condition can be challenging to diagnose. Pain will typically present in a few key areas; at the base of your spine where it meets with the sacrum, in the buttock, at the back of your hip and occasionally in the groin and upper thighs.
SIJ pain may feel deep, aching, or sharp depending on the underlying cause and may be on one or both sides of the body. Stiffness is also a common complaint, particularly first thing in the morning or after long periods of rest – either lying or sitting.
Aggravating Factors:
Often single leg activities will aggravate SIJ pain such as – standing on one leg, dressing in standing, ascending/descending stairs, lunges/split squats, hip stretches. Other weight transfer movements such as rolling over in bed, standing from sitting or alternatively prolonged sitting or standing might also aggravate SIJ symptoms. Symptoms can range from mild discomfort to severe pain and if left untreated may become chronic or persistent.
Causes of SIJ Pain
Sacroiliac joint pain can arise for several reasons, although pain is often due to the SI joints not coping with the amount of load they’ve been put under. Listed below are a few reasons why SIJ pain may arise:
Trauma
Direct trauma to the pelvis may result in SIJ pain.3 Examples of this include a fall onto the bottom, or a motor vehicle accident. These events result in a big sudden and unexpected force through the SIJ which can be painful.
Pregnancy
Hormonal changes during pregnancy allow the joints to loosen and expand to adjust for a growing baby and prepare for delivery. Subsequently, this can place higher stress and demand on the SIJ. Additionally, your centre of gravity shifts forward as the baby grows which again places additional stress on the lumbar spine and SIJ to keep you upright. This may result in pain for some people, particularly if the muscles around the pelvis are not adapting to these changes well enough.
Hypermobility
People with Ehlers Danlos Syndrome (EDS) or Hypermobility Spectrum Disorders (HSD) also have more stretchy ligaments around their SIJs. This may reduce their ability to transfer loads between the limbs and back, resulting in the development of pain for some people with hypermobility.
Repetitive Stress
There are many different contexts for repetitive stress causing SIJ pain. Some of these include:
- Sport- Due to the SIJ’s role in weight/force transfer, SIJ pain is common in people who engage in sports with lots of jumping, running, heavy landing (especially on one foot) or with loaded rotational forces such as golf and tennis.
- New activity/change in lifestyle – Changes in lifestyle or new activity such as a big holiday with lots of walking OR more challenging exercise routes (such as walking in a mountainous/hilly region) can sometimes trigger the onset of SIJ pain. Or conversely, changes at work might lead to SIJ pain, for example a significant increase in standing time at your desk.
Spinal Surgery
SIJ pain may arise following spinal surgeries due to changes in the way the spine moves, or the limitations of movement that have been put in place post-surgery. This is most common after spinal fusion of the lower lumbar spine, as the movement and loads need to be absorbed at neighbouring joints, like the SIJ.
Biomechanical Factors
Some anatomical or biomechanical factors such as scoliosis, substantial leg-length differences (>2cm), abnormal walking patterns or muscle imbalances can place uneven stress on the sacroiliac joints.4 These factors can contribute to the development of SIJ pain in some people.
Age
Age related changes to joints and muscles are common in later stages of life. SIJ pain might arise as a symptom of age-related changes within these joints.3
Systemic Diseases
Sacroiliac joint pain and inflammation (sacroiliitis) may also in some cases be a sign of systemic inflammatory diseases, such as ankylosing spondylitis, Psoriatic Arthritis, Reactive Arthritis, and arthritis related to Inflammatory Bowel Disease (IBD) like Crohn's or Ulcerative Colitis. If you’ve developed SIJ pain without pregnancy, a clear injury or history of physical overload, ensure you tell your medical practitioner about any other health conditions that you have noticed – even if they don’t seem related – scaley skin, red irritable eyes, changes in your nails, and any gut issues.
Experiencing pain at the base of your spine, in your buttock, or the back of your hip?
Finding single-leg tasks, stairs, rolling in bed, or getting dressed uncomfortable?
Book today and let one of our experienced PhysioTec physiotherapists assess your pelvis and hips, identify the source of your pain, and create a personalised plan to restore comfort, strength, and confidence in movement.
Helping you move better and get back to the activities you love.
Treatments For SIJ
Treatment for sacroiliac joint pain typically begins with conservative management with the aim to reduce pain and restore normal function. Physiotherapist led rehabilitation is an effective first port of call for managing sacroiliac joint pain. A physio with good knowledge in this area will provide education and activity modification advice, a gradually progressing exercise program, pain management techniques and offer advice on temporary use of supportive devices.
Education and Activity Modification for SIJ Pain:
This includes clear advice about how you can modify what and how you are doing in some daily, recreational or sporting tasks, to better control your SIJ pain. Minimising exposure to movements that aggravate pain and modifying movement patterns such as rolling in bed, lifting, getting on and off the floor, in and out of the car, dressing and bending over can be very effective for managing pain. Short periods of rest can help calm inflammation, but prolonged inactivity is generally discouraged, as it can lead to weakness and stiffness.
Exercise Program for SIJ Pain
A home exercise program will usually be prescribed to help improve control, stability and strength around the sacroiliac joints and improve movement patterns that could be placing extra stress on the joints. An exercise program will be particularly important with pregnancy related pelvic pain, and SIJ pain in those with hypermobility. Optimising function of deep muscles around the pelvic ring can assist will improving load transfer and stability, and in reducing pain. The program progresses in a graduated way to improve strength and function around the whole pelvis, starting with low challenge exercises for the SIJ, and gradually progressing to more challenging activities, as pain allows.
Pain relief for SIJ Pain
- The best way to relieve SIJ pain is to figure out what is aggravating the joints and address these issues as quickly as possible. In the meantime, temporary pain relief may be provided with some manual therapy (hands on treatments) of the SIJ (when appropriate) and surrounding muscles.
- Pain relief methods such as heat or cold therapy may also provide temporary comfort. Cold packs can help reduce inflammation during acute flare-ups, while heat may relax tight muscles and improve blood flow.
- Over-the-counter pain relievers are sometimes used, but they should be taken responsibly and as directed by your GP or pharmacist.
Supportive devices for SIJ Pain
Supportive devices such as sacroiliac belts, or compression pants can offer additional help by gently compressing the pelvis. These belts are particularly helpful for individuals with joint instability, including those who are pregnant or postpartum.3 While not a permanent solution, they can reduce pain during daily activities. You can find these at your local physiotherapy clinic.
For most cases, physiotherapy management is effective, though in some more persistent or severe cases, further medical management such as medications or injections may be required. If the SIJ pain is related to a systemic inflammatory condition, a Rheumatologist will be able to assist with diagnosis and medical management, usually with specific medications targeting the medical condition. Surgery is a last resort and is generally only considered if all non-surgical treatments have failed and quality of life is substantially impaired.
If you think you might have sacroiliac joint pain, book in a consultation with one of our friendly physiotherapists at PhysioTec. We see a high volume of patients with hip and pelvic pain, as this is one of our clinic’s key areas of expertise. We will be able to conduct a thorough investigation and tell you whether or not your pain is SIJ related and put together a plan to get your pain under control.
Ready to take control of your SIJ pain?
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Author
This blog was written by Dr. Molly Connolly, one of our Sports Physiotherapists and Pilates Instructors. Molly's undergraduate degree was in Exercise and Sports science and she completed a PhD of the title: A multidisciplinary approach to understanding low back pain in elite adolescent tennis athletes. She also has a love of triathlon! Molly completed a post-graduate Masters in Physiotherapy at the University of South Australia.
You can read more about Molly here.
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References:
- Raj, M. A., Ampat, G., & Varacallo, M. A. (2023). Sacroiliac joint pain. In StatPearls [Internet]. StatPearls Publishing.
- Kiapour, A., Joukar, A., Elgafy, H., Erbulut, D. U., Agarwal, A. K., & Goel, V. K. (2020). Biomechanics of the sacroiliac joint: anatomy, function, biomechanics, sexual dimorphism, and causes of pain. International journal of spine surgery, 14(s1), S3-S13.
- Vleeming, A., Schuenke, M. D., Masi, A. T., Carreiro, J. E., Danneels, L., & Willard, F. H. (2012). The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. Journal of anatomy, 221(6), 537-567.
- Barros, G., McGrath, L., & Gelfenbeyn, M. (2019). Sacroiliac joint dysfunction in patients with low back pain. Federal practitioner, 36(8), 370.