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SI Joint Pain

Pain around the sacroiliac (SI) joint can make simple activities like walking, sitting, rolling over in bed, or getting out of a chair surprisingly uncomfortable. Because SI joint pain often feels similar to low back pain or sciatica, it can be difficult to determine exactly where the pain is coming from. Fortunately, most cases respond well to conservative treatment, exercise, and a gradual return to normal activity. 

This guide was created by Dr. Michael Hoiles as an educational resource to help you better understand SI joint pain, common causes, treatment options, recovery timelines, and how chiropractic care and exercise-based rehabilitation may help you get back to moving comfortably and confidently. 

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Quick Facts 

✔ The SI joints connect your spine to your pelvis and help transfer forces during movement. 

✔ SI joint pain typically causes pain on one side of the lower back or buttock. 

✔ Symptoms can sometimes mimic sciatica but usually do not involve significant nerve compression. 

✔ Most people improve with conservative treatment and a progressive rehabilitation program. 

✔ Surgery is rarely required for SI joint dysfunction. 

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​​The sacroiliac joints are located where the sacrum (the triangular bone at the bottom of the spine) meets the pelvic bones (ilium). There is one SI joint on each side of the pelvis. 

Although these joints only move a small amount, they play an important role in transferring forces between the upper body and the legs during walking, running, lifting, and everyday movement. When the joint or surrounding ligaments become irritated, pain can develop around the low back, buttock, or occasionally the upper leg. 

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What Is SI Joint Pain? 

SI joint pain refers to irritation or dysfunction involving one or both sacroiliac joints. 

Contrary to popular belief, the SI joint is rarely “out of place” or “dislocated.” More commonly, the pain develops because the joint, surrounding ligaments, or nearby muscles become irritated after excessive loading, repetitive stress, pregnancy, trauma, or prolonged periods of sitting or standing. 

SI joint pain is frequently mistaken for low back pain or sciatica because the symptoms often overlap. An assessment helps determine whether the SI joint is likely contributing to your symptoms or whether another structure may be responsible. 

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Common Causes & Risk Factors 

SI joint pain can develop from several different factors, including: 

  • Lifting injuries 

  • Twisting movements 

  • Falls onto the buttocks 

  • Pregnancy and postpartum changes 

  • Running or repetitive impact sports 

  • Uneven loading of the pelvis 

  • Previous low back injuries 

  • Reduced hip mobility 

  • Weakness of the core and gluteal muscles 

  • Prolonged sitting or standing 

  • Leg length differences (occasionally) 

  • Arthritis affecting the SI joints 

Often, there is no single cause. Instead, symptoms develop gradually due to repeated stress over time. 

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Common Symptoms 

People with SI joint pain commonly experience: 

  • Pain on one side of the lower back 

  • Buttock pain 

  • Pain near the “dimples” at the back of the pelvis 

  • Pain when standing after prolonged sitting 

  • Pain rolling over in bed 

  • Pain climbing stairs 

  • Pain during single-leg activities 

  • Stiffness after inactivity 

Some people experience pain extending into the back of the thigh or groin. Although SI joint pain can resemble sciatica, it typically does not extend below the knee with significant numbness or weakness. 

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How Is It Diagnosed? 

Diagnosing SI joint pain begins with a detailed history and physical examination. 

During your assessment, your healthcare provider may ask: 

  • Where is your pain located? 

  • What movements make it worse? 

  • Did symptoms begin suddenly or gradually? 

  • Have you experienced similar episodes before? 

Several physical examination tests that place gentle stress across the SI joint can help determine whether it is likely contributing to your symptoms. Because no single test is perfect, clinicians often use a combination of provocation tests together with your history. 

Imaging such as X-rays or MRI scans is not routinely required for uncomplicated SI joint pain but may be appropriate if symptoms persist, trauma has occurred, or another condition is suspected. 

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What Helps? 

Many people improve with conservative treatment. 

Helpful strategies often include: 

  • Remaining as active as symptoms allow 

  • Gradually increasing walking tolerance 

  • Improving hip and core strength 

  • Chiropractic assessment and treatment 

  • Manual therapy 

  • Targeted rehabilitation exercises 

  • Short-term use of pain-relieving medication when appropriate 

  • Image-guided injections for selected persistent cases 

  • Improving lifting mechanics and posture 

  • Avoiding prolonged positions 

Complete bed rest is generally discouraged because gentle movement often promotes recovery. 

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How Chiropractic Can Help 

Every case of SI joint pain is different. A thorough assessment helps determine whether the SI joint is actually contributing to your symptoms or whether another structure may be involved. 

Treatment may include: 

  • Joint mobilization or manipulation when appropriate 

  • Soft tissue therapy to surrounding muscles 

  • Improving hip and lumbar spine mobility 

  • Individualized exercise prescription 

  • Core and glute strengthening 

  • Education about activity modification 

  • Guidance for returning to work, sport, and daily activities 

The goal is not simply to reduce pain but to improve movement quality and reduce the likelihood of future flare-ups. 

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Recovery Timeline 

Recovery varies depending on the severity of symptoms and contributing factors. 

Acute Phase (0–2 Weeks) 

  • Reduce pain and irritation 

  • Gentle mobility 

  • Stay active within tolerance 

Improving Phase (2–6 Weeks) 

  • Restore normal movement 

  • Increase walking and daily activities 

  • Begin strengthening 

Strengthening Phase (6–12 Weeks) 

  • Progress core and hip exercises 

  • Improve balance and movement control 

  • Resume higher-level activities 

Return to Normal Activity 

Most people gradually return to normal work, exercise, and recreational activities as strength, mobility, and confidence improve. 

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Can I Still Exercise? 

In most cases, yes. 

Remaining active generally leads to better outcomes than complete rest. 

Activities that are often well tolerated include: 

  • Walking 

  • Swimming 

  • Gentle cycling 

  • Light mobility exercises 

  • Core strengthening within tolerance 

  • You may need to temporarily modify activities such as: 

  • Heavy lifting 

  • Sprinting 

  • Jumping 

  • Deep squats 

  • Running during painful flare-ups 

Your rehabilitation program should gradually progress back toward your normal activities.

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Exercises Commonly Recommended 

Phase 1 – Pain Reduction 

  • Pelvic tilts 

  • Gentle knee-to-chest stretches 

  • Hip flexor stretching 

  • Diaphragmatic breathing 

  • Walking 

Phase 2 – Stability 

  • Glute bridges 

  • Clamshells 

  • Bird Dog 

  • Side-lying hip abduction 

  • Dead Bug 

Phase 3 – Functional Strength 

  • Split squats 

  • Step-ups 

  • Single-leg Romanian deadlifts 

  • Farmer carries 

  • Hip hinge training 

Exercises should always be selected based on your individual presentation and tolerance. 

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Common Mistakes That Slow Recovery 

Avoid these common setbacks: 

  • Resting for too long 

  • Returning to heavy lifting too quickly 

  • Ignoring glute and core strengthening 

  • Continuing painful movements without modification 

  • Skipping your rehabilitation exercises 

  • Expecting passive treatment alone to solve the problem 

Long-term improvement usually comes from combining treatment with progressive exercise and movement changes. 

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Frequently Asked Questions 

Can SI joint pain cause sciatica? 

SI joint pain can mimic sciatica because pain may travel into the buttock or thigh. However, true sciatica usually results from irritation of the sciatic nerve or nerve roots. 

Is walking good for SI joint pain? 

For most people, yes. Walking is often one of the best activities during recovery as long as symptoms remain manageable. 

Should I stretch my SI joint? 

Gentle stretching of the hips and surrounding muscles may help, but strengthening the core and gluteal muscles is often equally important. 

Do I need an MRI? 

Not usually. Imaging is generally reserved for persistent symptoms, trauma, or situations where another condition is suspected. 

How long does SI joint pain take to recover? 

Many people notice significant improvement within several weeks, although complete recovery may take several months depending on the underlying cause and consistency with rehabilitation. 

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When Should I Seek an Assessment? 

Consider an assessment if: 

  • Pain lasts longer than two to four weeks 

  • Symptoms continue returning 

  • Pain limits work, exercise, or daily activities 

  • Walking becomes increasingly difficult 

  • Home management is not helping 

Seek immediate medical attention if you develop: 

  • Significant leg weakness 

  • Loss of bowel or bladder control 

  • Numbness around the groin or saddle region 

  • Severe pain following major trauma 

  • Fever, unexplained weight loss, or other concerning symptoms 

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Summary 

✔ SI joint pain commonly causes pain in the lower back, buttock, or pelvis. 

✔ It can mimic low back pain or sciatica but usually responds well to conservative treatment. 

✔ Staying active and progressively strengthening the hips and core are important parts of recovery. 

✔ Most people improve without surgery. 

✔ A proper assessment can help determine whether the SI joint is truly the source of your symptoms and guide the most appropriate treatment plan. ​

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Ready to Get Back to Moving Comfortably? 

If your SI joint pain isn’t improving, continues to return, or is limiting your ability to work, exercise, or enjoy your daily activities, an assessment can help identify the underlying cause and determine the most appropriate treatment plan. 

Dr. Michael Hoiles is a Calgary chiropractor who provides evidence-informed care combining hands-on treatment, exercise-based rehabilitation, and practical advice to help people recover from injury, move better, and stay active. 

Book an appointment today to start your recovery and get back to doing the activities you enjoy.

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Related Conditions 

You may also find these resources helpful: 

  • Herniated Disc 

  • Hip Pain

  • Facet Joint Syndrome 

  • Thoracic Pain 

  • Whiplash 

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