Sacroiliac Joint Dysfunction: Understanding the Condition and the Importance of Physiotherapy

September 6, 2026

Introduction

Low back pain is super common.
Most people think it’s from a disc problem or muscle strain.
But there’s one cause that’s often missed: the SI joint.

Your SI joints connect your spine to your pelvis.
They help transfer weight from your upper body to your legs.

When these joints get irritated, too loose, or too stiff, they can cause pain in your lower back, butt, hips, groin, and sometimes even your leg.

The good news?

Most people get much better with physiotherapy, exercise, and learning the right movements.

Understanding the Sacroiliac Joint

To understand SI joint dysfunction, it is important to understand the anatomy of the sacroiliac joint.

The human body has two sacroiliac joints, one on each side of the pelvis.

These joints are formed by:

• The sacrum (the triangular bone at the base of the spine)
• The ilium (the large pelvic bone)

These joints are held together by very strong ligaments.
They’re not made for big movement. Their job is stability.

Functions of the Sacroiliac Joint

✓ Carry your body weight to your legs
✓ Absorb shock when you walk or run
✓ Keep you stable when standing
✓ Help you balance
✓ Connect your trunk to your legs

Even small problems in this joint can cause big pain.

What Is Sacroiliac Joint Dysfunction?

It just means the SI joint isn’t moving or behaving normally.

This can happen if:

• The joint moves too much (hypermobility)
• The joint moves too little (hypomobility)
• Ligaments are strained
• There’s inflammation inside
• You had an injury that changed how it moves

The pain can feel a lot like sciatica or a disc problem.
That’s why getting the right diagnosis matters.

Causes of Sacroiliac Joint Dysfunction

1. Trauma

Falls, car accidents, sports injuries, or lifting something heavy the wrong way.

Trauma is a common cause of acute SI joint pain.

2. Pregnancy and Childbirth

Pregnancy hormones make pelvic ligaments loose. Plus extra weight = more stress on the SI joints. Some women continue to experience SI joint pain even after childbirth.

3. Repetitive Stress

Running, climbing stairs, standing all day, or heavy labor can irritate the joint over time. Over time, these stresses may contribute to dysfunction.

4. Leg Length Discrepancy

A difference in leg length may alter pelvic alignment and place uneven stress on the SI joints. Even small discrepancies can contribute to chronic symptoms in some individuals.

5. Muscle Imbalance

Weakness or tightness of muscles surrounding the pelvis can affect joint stability. Weak glutes, tight hip flexors, weak core = less support for the SI joint.

Poor muscular support can increase stress on the SI joints.

6. Degenerative Changes

Age-related wear and tear may affect the SI joints, causing:

• Joint stiffness
• Cartilage degeneration
• Reduced shock absorption

Degenerative changes become more common with advancing age.

7. Inflammatory Conditions

Conditions like Ankylosing Spondylitis, Psoriatic Arthritis can also affect the SI joint.

Inflammation can cause pain, stiffness, and joint damage.

Risk Factors

Who’s at Risk?

• Pregnancy
• Previous pelvic injury
• Repetitive heavy lifting
• Poor posture
• Sedentary lifestyle
• Obesity
• Leg length differences
• Weak core muscles
• Inflammatory arthritis
• Previous lumbar spine surgery

Common Symptoms

Symptoms vary from person to person but often include:

Pain in the Lower Back

Pain is commonly felt on one side of the lower back, although both sides may be affected.

Buttock Pain

Pain deep within the buttock is one of the most characteristic symptoms.

Hip Pain

Some individuals mistakenly believe they have a hip problem when the SI joint is actually responsible.

Groin Pain

Pain may extend toward the groin region.

Leg Pain

Pain may radiate into the thigh and occasionally below the knee, sometimes mimicking sciatica.

Pain During Specific Activities

Symptoms often worsen during:

• Standing for long periods
• Walking
• Running
• Climbing stairs
• Rolling in bed
• Rising from a chair

Stiffness

Many patients report morning stiffness or stiffness after prolonged inactivity.

How SI Joint Dysfunction Differs from Sciatica

Although symptoms may appear similar, there are differences.

Sciatica

Usually results from nerve compression in the spine.

Common symptoms:

• Numbness
• Tingling
• Burning pain
• Muscle weakness

SI Joint Dysfunction

Usually produces:

• Localized buttock pain
• Mechanical pain
• Pain with weight-bearing activities
• Minimal neurological symptoms

Accurate assessment is necessary because treatment approaches differ.

Diagnosis

There’s no single test.

We check:

For more information about sacroiliac joint pain and related conditions, you can also read the NHS guide on back pain.

History

Where is the pain? What makes it worse? Any injury?

Physical Examination

May include:

• Postural evaluation
• Gait analysis
• Pelvic alignment assessment
• Range of motion testing
• Palpation

Special tests may be used, including:

• FABER Test
• Gaenslen Test
• Compression Test
• Distraction Test
• Thigh Thrust Test

Imaging

X-ray, MRI, or CT to rule out other causes.

Injection

Sometimes a diagnostic SI joint injection is used to confirm it.

Medical Management

Treatment depend on the condition of a patient.

• Anti-inflammatory medications
• Pain-relieving medications
• Activity modification
• SI joint injections
• Radiofrequency ablation in selected cases

Most patients improve without surgery.

The Role of Physiotherapy in Sacroiliac Joint Dysfunction

Physio is the #1 treatment for SI joint dysfunction.

A physiotherapy program aims to restore normal movement, improve stability, reduce pain, and prevent recurrence.

Goals of Physiotherapy

The primary goals include:

• Reduce pain
• Improve pelvic stability
• Restore normal movement
• Correct postural abnormalities
• Improve muscle strength
• Enhance flexibility
• Improve walking mechanics
• Prevent future episodes

Physiotherapy Assessment

Being a physiotherapist I start evaluating the posture in the first than pelvic alignment and core stability, muscle strength and joint mobility. Always have an eye on walking pattern and functional limitations.

Treatment is then made according to the patient’s needs.

Physiotherapy Treatment Protocol

Phase 1: Pain Relief and Symptom Control

Objectives

• Reduce pain
• Decrease inflammation
• Improve comfort

Interventions

• Patient education
• Activity modification
• Heat therapy
• Ice therapy
• TENS
• Gentle mobility exercises

Phase 2: Restoration of Mobility

Objectives

• Improve joint mechanics
• Reduce stiffness

Interventions

• Pelvic mobility exercises
• Hip mobility exercises
• Gentle stretching
• Manual therapy
• Soft tissue techniques

Phase 3: Stabilization and Strengthening

Objectives

• Improve pelvic stability
• Enhance muscular support

Core Strengthening

Examples:

• Abdominal bracing
• Pelvic tilts
• Dead bug exercises

Gluteal Strengthening

Examples:

• Bridges
• Clamshells
• Hip abduction exercises

Hip Stabilization

Examples:

• Side-stepping exercises
• Single-leg balance exercises

Strong muscles help reduce stress on the SI joint.

Phase 4: Functional Rehabilitation

Objectives

• Return to normal activities
• Improve movement efficiency

Interventions

• Walking training
• Balance exercises
• Functional strengthening
• Stair training
• Work-specific rehabilitation

Home Exercise Recommendations

I always prescribed gentle movements for home exercises depending on the condition.

• Maintain good posture
• Stay physically active
• Avoid prolonged sitting
• Perform prescribed exercises regularly
• Strengthen core muscles
• Stretch tight muscles
• Maintain a healthy body weight

Prognosis

Most people with SI joint problems get much better without surgery.*

What helps you recover faster?

✓ Getting diagnosed early
✓ Sticking to your physiotherapy
✓ Doing your exercises regularly
✓ Maintaining good posture

Some people may get flare-ups again.

But with the right rehab, the chances of long-term disability are very low. You can get back to normal life.

Conclusion

SI Joint Dysfunction is a common but often missed reason for low back, butt, and pelvic pain.

It can happen because of:

An injury, pregnancy, too much repetitive strain, weak or tight muscles, age-related wear and tear, or inflammatory conditions.

The tricky part? The pain can feel a lot like sciatica or other back problems.

That’s why getting the right diagnosis is so important.

The good news: Physiotherapy works really well for this.

Physio helps by:

✓ Reducing pain
✓ Getting your movement back
✓ Making your pelvis stable again
✓ Strengthening the muscles that support the joint
✓ Helping you get back to daily life

With education, the right exercises, hands-on therapy, and small lifestyle changes, most people improve a lot and keep their SI joint healthy long-term.

This article is for educational purposes and should not replace professional medical advice.

Written by Dr Areej Nadeem PT
College of Physiotherapy
JPMC Karachi