Sacroiliac Joint Pain

Pain around the sacroiliac joint can make sitting, walking, bending and everyday movement surprisingly difficult.

Sacroiliac joint pain is a common cause of pain around the lower back, buttock and posterior pelvis. It can develop after an injury, change in activity, prolonged sitting, repetitive loading or changes in how the pelvis and lower back are being used.

The challenge is that pain in the sacroiliac region does not always come directly from the sacroiliac joint itself. The lower back, hips, surrounding muscles, ligaments and nerves can produce similar symptoms.

At Vitality Chiropractic Australia, our approach is to look beyond the location of the pain and assess how the lumbar spine, pelvis, hips and surrounding tissues are contributing to your symptoms.

The goal isn’t simply to make the area feel better temporarily.

It’s to help you understand what’s contributing to your pain, restore comfortable movement and progressively rebuild your capacity to move, work and exercise with confidence.

What Is Sacroiliac Joint Pain?

The sacroiliac joints, commonly called the SI joints, connect the sacrum at the base of the spine with the left and right sides of the pelvis.

There is one SI joint on each side.

These joints play an important role in transferring forces between the upper body and the legs. They are designed to provide stability while allowing a small amount of movement as you walk, change position and load the lower limbs. Pain can arise from structures within the joint or from the surrounding ligaments and tissues that form part of the sacroiliac region.

Importantly, there is no single examination finding or imaging test that can reliably identify the SI joint as the sole source of pain in every person. This is why a thorough assessment is important.

Where Does Sacroiliac Joint Pain Usually Occur?

Sacroiliac joint-related pain is commonly felt:

Around one side of the lower back
Over or beside the dimples at the back of the pelvis
Deep within the buttock
Around the posterior hip
Along the upper buttock or pelvic region
Occasionally into the groin or thigh

Symptoms are often one-sided, although both sides can be involved.

Pain may also fluctuate depending on your position, activity level and the amount of load placed through the pelvis. Research suggests that SIJ pain can have a highly variable referral pattern, which is one reason it can sometimes be difficult to distinguish from other causes of lower-back or hip pain.

What Does Sacroiliac Joint Pain Feel Like?

People with pain around the SI joint may describe their symptoms as:

Aching or deep pain in the buttock
Sharp pain when changing position
Pain when standing from a chair
Pain when getting out of a car
Discomfort when climbing stairs
Pain with prolonged standing
Pain when turning in bed
Pain when walking for longer periods
A feeling of stiffness around the pelvis
Pain during single-leg activities
Discomfort after prolonged sitting

Some people experience a relatively constant ache, while others notice pain primarily during particular movements or activities.

Common Causes Of Sacroiliac Joint Pain

There isn’t one single cause of SI joint pain. It can develop when the tissues around the sacroiliac region are exposed to a change in mechanical demand that exceeds their current capacity.

Sudden increases in activity

Increasing running, walking, gym training, lifting or sport too quickly can increase the load placed through the pelvis and surrounding tissues.

Injury

A fall, sporting injury, motor vehicle accident or awkward lifting movement may irritate structures around the SI joint.

Repetitive loading

Repeated movements such as running, twisting, lifting or prolonged standing may contribute to symptoms in some people.

Pregnancy and postpartum changes

Pregnancy can alter load distribution around the pelvis and may contribute to pelvic girdle and SI-region pain.

Previous spinal surgery

Changes in spinal mechanics following certain spinal procedures can alter how forces are distributed through the lumbopelvic region. Previous spine surgery has been identified as an association with SI joint pain in the literature.

Hip and lumbar spine problems

Pain from the lumbar spine or hip can sometimes feel very similar to SI joint pain. This is why simply finding tenderness over the SI joint does not necessarily establish the diagnosis.

Is The SI Joint “out of alignment”?

This is one of the most common questions people ask. The SI joints do move, but the amount of normal movement is very small. SI joint pain should not automatically be interpreted as the pelvis being “out of place” or the joint needing to be repeatedly put back into position.

Modern assessment focuses more on:

Where your pain is located
How your symptoms behave
Your injury and activity history
Lumbar and hip function
Pelvic and lower-limb loading
Reproduction of symptoms with appropriate clinical tests
Your overall movement and functional capacity

The evidence also shows that no single physical examination test is sufficiently accurate to diagnose SI joint pain on its own. A combination of provocative tests is generally more useful than relying on one finding.

How Is Sacroiliac Joint Pain Diagnosed?

Diagnosing SI joint pain can be challenging because several different conditions can produce similar symptoms.

Your assessment may include:

1. Detailed history

We look at:

When your symptoms began
Whether there was an injury
Your current activity levels
Aggravating and relieving factors
Previous episodes of back or pelvic pain
Previous spinal or pelvic injuries
Your work and exercise demands

2. Lumbar spine assessment

The lower back can refer pain into the buttock and pelvic region. Assessing lumbar movement helps determine whether the lumbar spine may be contributing to your symptoms.

3. Hip assessment

Hip disorders can produce pain around the buttock, groin and posterior pelvis. Assessing hip mobility and function helps differentiate potential sources of symptoms.

4. Sacroiliac joint provocation testing

A clinician may use a combination of specific tests designed to reproduce the patient’s familiar pain. Evidence suggests that a cluster of positive provocation tests is more useful than any single test in identifying people who may have SI joint-related pain.

5. Functional assessment

We may also assess movements such as:

Walking
Squatting
Step-down movements
Single-leg loading
Sit-to-stand
Bending
Lifting
Other movements relevant to your daily activities or sport

The purpose is not simply to identify what hurts.

It’s to understand what your body currently tolerates and where your rehabilitation needs to begin.

Do I Need An MRI Or X-ray?

Not necessarily. Imaging does not automatically confirm that the SI joint is responsible for pain. Changes seen on imaging can also occur in people who have little or no pain, while significant symptoms may occur without a clear structural abnormality. Imaging may nevertheless be appropriate when your history or examination raises concern about another condition, significant trauma, inflammatory disease or another cause of symptoms. For persistent or diagnostically uncertain cases, medical specialists may sometimes use image-guided diagnostic injections as part of a more specialised assessment.

Sacroiliac Joint Pain vs Sciatica

SI joint pain and sciatica can sometimes be confused because both may involve the buttock and leg. However, they are not the same condition.

Sciatica generally involves irritation or compression of a lumbar spinal nerve root and may produce symptoms such as radiating leg pain, tingling, numbness or weakness.

SI joint-related pain is usually centred around the lower back, posterior pelvis or buttock, although symptoms can sometimes extend further into the leg.

If you have significant numbness, weakness, altered reflexes or neurological symptoms, the lumbar spine and nerve roots need to be appropriately assessed.

Sacroiliac Joint Pain vs Hip Pain

The hip can also produce pain that feels as though it is coming from the pelvis or buttock.

Hip-related symptoms may include:

Groin pain
Difficulty putting on shoes or socks
Pain getting in or out of a car
Reduced hip rotation
Pain with squatting
Pain with prolonged walking

Because the hip, lumbar spine and SI region can influence each other, a comprehensive assessment is often more useful than treating one structure in isolation.

What Treatment Helps Sacroiliac Joint Pain?

Treatment depends on the individual’s symptoms, contributing factors, physical capacity and goals. For many people, conservative management is the starting point. Current literature describes approaches including exercise-based rehabilitation, education, physical therapy/manual therapy and other conservative strategies, with interventional treatments considered for selected persistent cases.

Chiropractic care

Appropriately selected manual therapy may help reduce pain and improve movement in the short term for some people. Treatment is tailored to the individual’s presentation rather than assuming that the SI joint simply needs to be “realigned.”

Exercise rehabilitation

Exercise is an important part of developing longer-term capacity. Depending on the individual, rehabilitation may address:

Hip strength
Gluteal function
Trunk control
Pelvic stability
Single-leg capacity
Movement coordination
General strength and conditioning

Load management

Sometimes the problem isn’t one particular movement. It is the overall amount of load being placed on the tissues relative to what they currently tolerate. Rehabilitation therefore involves gradually rebuilding capacity rather than avoiding movement indefinitely.

Mobility work

Where appropriate, mobility exercises may be used to address restrictions in the lumbar spine, hips or surrounding tissues.

Recovery strategies

Sleep, activity modification and sensible progression of exercise can all influence recovery.

Can Chiropractic Treatment Help SI Joint Pain?

Chiropractic care may form one component of a broader management plan for people with mechanical low-back or SI-region pain. Manual therapy can sometimes provide short-term improvements in pain and movement, but it should not be viewed as the entire solution. The more durable goal is to help you develop the strength, movement tolerance and confidence required to return to your normal activities. That is why we combine hands-on care with active rehabilitation where appropriate.

Exercises For Sacroiliac Joint Pain

The right exercises depend on what is contributing to your symptoms. There is no universal “best SI joint exercise.” A rehabilitation program may progressively address:

Early stage

Comfortable movement
Gentle trunk and pelvic control
Appropriate hip mobility
Low-load muscle activation
Gradual exposure to daily activities

Building capacity

Glute strengthening
Trunk strengthening
Hip control
Squatting and step patterns
Single-leg exercises
Progressive resistance training

Return to activity

Higher-load strength
Running or impact progression where relevant
Sport-specific movements
Lifting capacity
Work-specific conditioning
Confidence with previously aggravating activities

The objective is to progressively increase your capacity rather than permanently protecting the painful area.

How Long Does Sacroiliac Joint Pain Take To Recover?

Recovery time varies considerably. A relatively mild episode following a change in activity may settle relatively quickly. More persistent symptoms may take longer, particularly when there are contributing factors involving the lumbar spine, hip, training load, strength, movement patterns or previous injuries.

A useful way to think about recovery is:

Symptoms → movement → capacity → confidence → normal activity

Rather than waiting for every symptom to disappear before becoming active, rehabilitation can progressively expose the body to appropriate levels of movement and load.

What Should You Avoid With SI Joint Pain?

There is no universal list of movements that everyone with SI joint pain needs to avoid. However, it can be useful to temporarily modify activities that consistently produce a significant increase in symptoms. Depending on your presentation, this might include temporarily reducing:

Heavy lifting
High-volume running
Repetitive twisting
Prolonged static positions
High-impact exercise
Activities that repeatedly provoke your familiar pain

The goal should be modification rather than fear-based avoidance. As your capacity improves, appropriately selected activities can usually be progressively reintroduced.

When Should You See A Health Professional?

Consider an assessment if:

Your pain persists or keeps returning
Symptoms are interfering with work or exercise
You are avoiding normal activities because of pain
You are unsure whether the pain is coming from your SI joint, hip or lower back
Symptoms followed a significant injury
You have persistent pain despite modifying your activity

A clinical assessment can help determine whether the presentation is consistent with SI-region pain or whether another condition needs to be investigated.

Red flags and when to seek medical care

Most lower-back and pelvic pain is not caused by a serious condition. However, some symptoms require prompt medical assessment. Seek urgent medical attention if you develop:

New loss of bladder or bowel control
Numbness around the groin, genitals or inner thighs
Significant or rapidly worsening weakness in the legs
Severe symptoms following major trauma
Fever or systemic illness associated with severe back pain
Unexplained significant weight loss
Severe night pain or pain that is not affected by movement
Other symptoms that suggest serious infection, inflammatory disease or another significant medical condition

Your chiropractor will consider these factors during your assessment and refer you appropriately when required.

Our Approach At Vitality Chiropractic Australia

We don’t believe in treating every person with SI joint pain using the same technique. Instead, we assess the bigger picture.

Assess

We look at your symptoms, history, lumbar spine, hips, pelvis, movement and functional capacity.

Reduce

Where appropriate, treatment is used to help reduce pain and improve your ability to move.

Rebuild

We progressively develop strength, control and load tolerance.

Return

The ultimate goal is to help you return to the activities that matter to you.

Treatment is the beginning. Building capacity is what helps create lasting change.

Your Sacroiliac Joint Pain Recovery Blueprint

For individuals who want a more structured approach to their recovery, Vitality’s Sacroiliac Joint Pain Recovery Blueprint provides a comprehensive education and rehabilitation resource designed to complement your individual care. The Blueprint brings together:

Understanding SI joint-related pain
Recovery education
Activity and load management
Progressive rehabilitation
Strength and movement development
Symptom monitoring
Return-to-activity guidance
Recommended recovery tools

It is designed to give you a structured framework to follow between appointments while still allowing your rehabilitation to be individualised to your presentation.

The Blueprint is not a substitute for individual clinical assessment.

Learn more about the Vitality Sacroiliac Joint Pain Recovery Blueprint →

Recommended Recovery Tools

The right equipment can make rehabilitation more convenient and consistent.

Essential Recovery Tools

Serola Sacroiliac Belt

A pelvic support belt may be useful for selected people who experience symptoms with standing, walking or other weight-bearing activities. It should be considered an adjunct rather than a replacement for rehabilitation.

Fortress Medium Round Foam Roller

Useful for selected mobility and recovery exercises as part of a broader rehabilitation program.

Fortress Rubber Trigger Point Ball

Extremely helpful for reducing lumbar and gluteal muscle trigger points that may also be contributing to general discomfort.

Recommended Training Tools

Fortress Premium Power Bands

Resistance bands provide a convenient way to progressively strengthen the hips, glutes and trunk at home.

Optional Comfort & Support Products

Ortholife Premium Maxi-D Lumbar Roll

May be useful for people who spend extended periods sitting and require additional lumbar support.

Why Choose Vitality Chiropractic Australia?

At Vitality, our approach is built around more than simply treating pain.

We want you to understand:

What is happening → What you can do about it → How to rebuild your capacity → How to stay active

Our care combines evidence-informed clinical assessment, appropriate hands-on treatment and progressive rehabilitation to help you move with greater confidence.

Take The Next Step

If pain around your sacroiliac joint is affecting your ability to work, exercise, walk or enjoy everyday activities, a comprehensive assessment can help determine what is contributing to your symptoms and what your next step should be.

Book an assessment with Vitality Chiropractic Australia in Melbourne.

Sacroiliac Joint Frequently Asked Questions

Is sacroiliac joint pain the same as lower-back pain?

Not necessarily.

SI joint-related pain is one possible contributor to lower-back or buttock pain. The lumbar spine, hip and surrounding soft tissues can produce similar symptoms, which is why assessment is important.

Can SI joint pain cause leg pain?

It can. SI-region pain may sometimes refer into the thigh or further down the leg. However, significant neurological symptoms such as numbness, weakness or persistent tingling may indicate involvement of the lumbar nerves and should be appropriately assessed.

Does an SI joint need to be put back into place?