Sacroiliac Joint Pain

The sacroiliac (SI) joint connects the bottom of your spine (the sacrum) to your pelvis. You have two SI joints – one on the left and one on the right. Their primary job is to act as shock absorbers, transferring forces smoothly between your upper body and your legs.

When the mechanics of these joints are disrupted – or when natural wear and tear occurs – it can lead to sacroiliac joint dysfunction. This is a very common, yet frequently overlooked, cause of lower back and buttock pain.

SI joint dysfunction can make simple, everyday movements feel uncomfortable or painful. Typical symptoms include:

• Pain in the lower back and buttocks: Usually felt on one side, just below the beltline or around the dimples of your lower back.
• Referred pain: Pain that spreads outwards into your groin, hip, or down the back of your thigh.
• Aggravated by daily activities: Sitting or standing for long periods, walking, climbing stairs, turning in bed, or getting out of a car often trigger symptoms.

Did you know? Because SI joint pain feels similar to hip conditions or slipped (herniated) discs, it is frequently misdiagnosed as “general lower back pain”. In reality, research shows it accounts for roughly 15% to 30% of chronic lower back pain cases.

SI joint pain usually develops when the joint moves too much (hypermobility), too little (stiffness/ malalignment), or fails to absorb load evenly. Common causes include:

• Injury or trauma: Falls onto the buttocks, car accidents, or sudden heavy lifting.
• Wear and tear (Osteoarthritis): Natural age-related changes to joint cartilage and movement over time.
• Pregnancy and childbirth: Hormones naturally loosen pelvic ligaments, while shifts in posture and body weight put extra strain on the pelvic ring.
• Previous lower back surgery: Spinal fusions can alter back mechanics, shifting extra pressure downwards onto the SI joint.
• Uneven loading: A leg length difference, changes in your walking style (gait), or scoliosis (spinal curvature) can cause uneven pressure across the pelvis.

Targeted, non-surgical treatment is recommended as the first-line approach for SI joint dysfunction. With consistent guidance, most people begin to feel a noticeable difference within 4 to 6 weeks, with significant improvements in strength and mobility by 6 to 12 weeks.

1. Hands-On (Manual) Therapy

At ESIC, we use evidence-based treatments to help you find early relief. Hands-on techniques – including gentle joint mobilisations and Muscle Energy Techniques (METs) – help ease initial pain and stiffness, improve pelvic movement, and allow you to start your rehabilitation exercises comfortably.

2. Targeted Exercise & Real-Time Ultrasound Imaging

To properly support the SI joint, we focus on motor control – teaching the deep stabilising muscles of your stomach, back, and pelvic floor to coordinate effectively.

At ESIC, we often use Real-Time Ultrasound imaging. This allows you to visually see your deep core muscles working on a monitor in real time, ensuring you are activating them correctly.

Your tailored exercise programme may include:

• Deep stabiliser activation: Learning to gently engage your deep tummy muscle (transverus abdominis), lower back muscles (multifidus) and pelvic floor.
• Pelvic control exercises: Controlled movements such as the Bird-Dog, Dead Bug, Glute Bridges and Planks that train your pelvis to remain stable while your arms and legs move.
• Gluteal strengthening: Exercises like clamshells and side leg raises to strengthen the hip muscles that support the pelvic ring.
• Balance and functional stability: Standing balance drills that retrain your joints to handle real-world activities safely and confidently.

Recovery is a journey. Factors such as poor sleep, stress, or overall health can sometimes influence how quickly pain settles. However, a structured, progressive exercise programme guided by an experienced physiotherapist is the most effective way to restore pelvic stability, relieve pain, and help you get back to living life without restriction.