Sacroiliac Joint Dysfunction: Symptoms and Solutions

Sacroiliac joint dysfunction is one of the most commonly missed causes of chronic lower back pain. Many patients have been treated for years for “back pain” when the actual source is the sacroiliac joint — and once correctly identified, SI joint dysfunction often responds well to targeted treatment. This guide is for patients who either have a new SI joint diagnosis or suspect the SI joint may be involved in their pain.

What the SI Joint Is and What It Does

You have two sacroiliac joints, one on each side, where the sacrum (the triangular bone at the base of the spine) meets the iliac bones of the pelvis. The joints are reinforced by strong ligaments and have limited movement. Their main role is transferring forces between the spine and the legs during standing, walking, and other weight-bearing activities.

Because the SI joint does not have dramatic motion, it is easy to overlook as a source of pain — people expect “joint pain” to come from a joint with obvious movement. But the SI joint can become inflamed, develop arthritis, lose its normal alignment, or become irritated in ways that produce significant chronic pain.

Classic Symptoms of SI Joint Pain

SI joint pain often follows a recognizable pattern:

• Pain typically on one side, at the lower back, at or just above the buttock on the side of the sacrum
• Pain that may radiate into the buttock, groin, or upper thigh — but rarely past the knee
• Worsens with specific movements and positions: rising from a seated position, standing on one leg, stepping up a curb
• Often uncomfortable with prolonged sitting, particularly with one leg crossed over the other
• Discomfort with rolling over in bed
• Sometimes a deep ache; sometimes sharper with specific motions

Not every patient fits every element of this pattern. And pain from other sources (disc problems, facet arthritis, hip problems) can sometimes mimic SI joint pain. Distinguishing them matters, which is why a thoughtful evaluation precedes targeted treatment.

What Causes SI Joint Dysfunction

Several situations commonly produce SI joint pain:

Pregnancy and postpartum. Ligament changes during pregnancy can leave the SI joints more mobile or misaligned, and some patients develop persistent SI joint pain after delivery.

Trauma. A fall onto one side of the lower body, a motor vehicle accident, or other events that asymmetrically load the pelvis can strain the SI joint.

Post-lumbar-fusion. Patients who have had lumbar spine fusion sometimes develop SI joint pain because the altered biomechanics put more load on the SI joints.

Leg length discrepancy. Significant differences in leg length can chronically overload one SI joint.

Inflammatory conditions. Ankylosing spondylitis and related conditions can affect the SI joints.

Arthritic changes. Age-related arthritis in the SI joint.

Unclear onset. Many patients develop SI joint pain without a clearly identifiable triggering event.

Why Diagnosis Is Tricky

SI joint pain is notorious for being missed, for several reasons:

Imaging is often unrevealing. MRI and CT may show normal SI joints even when the joint is clearly the source of pain. This is because the problem is often functional rather than structural.

Other sources can mimic SI pain. Lumbar disc problems, facet arthritis, and hip pathology can all produce pain patterns that overlap with SI joint pain.

Physical examination requires specific maneuvers. Generic back exams do not reliably identify the SI joint. Specific provocative maneuvers designed to stress the SI joint are more informative.

A diagnostic injection is often the gold standard. Placing local anesthetic precisely into the SI joint and assessing whether it relieves the typical pain is often the most reliable confirmation of SI joint as the source.

How Diagnosis Works in Practice

A typical workup for suspected SI joint pain includes:

• Detailed history of the pain pattern
• Physical examination including specific SI joint provocative tests
• Review of any prior imaging, focused on ruling out other sources
• Consideration of the broader clinical context (pregnancy history, prior surgery, trauma, etc.)
• In many cases, a diagnostic SI joint injection to confirm

This process is important because treatments are most effective when targeted at the correct source.

Treatment Options

Once the SI joint is confirmed as the source, several treatments are available:

Physical therapy. A physical therapy program targeting pelvic stability is often central to SI joint care. Strengthening the glutes, core, and hip stabilizers reduces load on the SI joint and addresses the mechanical contributors.

Activity modification. Specific activities that clearly aggravate the SI joint (asymmetric loading, prolonged crossed-leg sitting, certain exercises) are worth modifying.

SI joint support. A pelvic support belt can help some patients during particularly painful periods or during specific activities.

Medication. Non-opioid analgesics, anti-inflammatory medications, and occasionally other medications as appropriate.

Therapeutic SI joint injection. An SI joint injection combining an anesthetic with a corticosteroid can reduce inflammation and provide meaningful relief for patients with confirmed SI joint pain. Relief typically lasts weeks to months.

Radiofrequency procedures. For patients whose pain responds well to diagnostic blocks but for whom injections provide shorter relief than desired, a radiofrequency procedure targeting the nerves that carry pain from the SI joint can provide longer-lasting relief.

SI joint fusion. For a small subset of patients with clearly confirmed SI joint pain who have failed comprehensive non-surgical management, minimally invasive SI joint fusion is sometimes considered. This is a surgical procedure not appropriate for most patients.

The Importance of the Broader Plan

SI joint injections can be very effective, but they are rarely the entire solution. Durable results typically require combining injections with physical therapy, activity modification, and ongoing attention to pelvic mechanics. Pain that returns quickly after injections usually indicates that the other components need more attention.

SI Joint Care at Southwest Pain Management

Our clinics regularly evaluate and treat SI joint dysfunction. Given how frequently this condition is missed, we consider it in any lower back pain workup. Treatment is tailored to the specific clinical picture and typically combines interventional and physical therapy components.

Frequently Asked Questions

How do I know if my pain is from the SI joint or my spine? Pattern of pain, physical examination, and often a diagnostic injection help distinguish the two. They can coexist, and both may need to be addressed.

Is SI joint pain a real medical condition? Yes. It is a well-described and common cause of chronic lower back pain, though it is often missed because imaging does not always reveal it.

How long does an SI joint injection last? Varies from weeks to months.

Will I need SI joint fusion surgery? Most SI joint patients are managed successfully without surgery.

Can I exercise with SI joint pain? Usually yes, with appropriate guidance. Specific activities may need to be avoided; physical therapy can guide you through appropriate progression.

Does pregnancy always cause SI joint problems? Many pregnancies lead to temporary SI joint discomfort that resolves postpartum. Some patients develop persistent SI joint dysfunction that requires treatment.

What if my pain has been diagnosed as “just low back pain” for years? It is worth considering SI joint evaluation. This diagnosis is frequently missed in initial workups.

Request a Consultation

Contact Southwest Pain Management to schedule an SI joint evaluation.