Sacroiliac (SI) joint pain: causes, symptoms, treatment, and exercises

If you’ve never heard of your sacroiliac (SI) joints, that’s okay: Many people haven’t. But these joints, which link the pelvis to the lower spine, play a crucial role in your movement, stability, and comfort. 

You have two SI joints — one on each side of the sacrum, which is the triangular bone that sits below your lumbar spine (low back), explains Samantha Charlotin, PT, DPT, a physical therapist at Hinge Health. The SI joints aren’t supposed to move very much — their main job is to transfer weight and forces from your upper body or trunk to your lower extremities while keeping you stable. 

When these joints get irritated, it can trigger a condition called SI joint pain (also called sacroiliitis), which often presents as one-sided low back and butt pain. In fact, research has shown that up to 30% of reported low back pain may actually be related to ‌SI joints. As a result, SI joint pain can make walking, climbing stairs, sleeping, running — pretty much everything — uncomfortable. The most common effect it has on people, though, is how uncomfortable it can be to sit with SI joint pain. But take heart: There’s a lot you can do to relieve SI joint pain. 

Here, learn more about SI joint pain and find out how to feel better with tips and exercises from our Hinge Health physical therapists.

Symptoms of sacroiliac joint pain  

SI joint pain can present in a variety of ways, says Dr. Charlotin. Some symptoms include:

• Pain in your buttock, or pain that starts in your low back and extends into your butt

• Discomfort that’s accompanied by pain in your low back

• Pain in your thigh (which may be referred pain that originates in the SI joint, says Dr. Charlotin)

If you have these symptoms, but are also experiencing numbness, tingling, or weakness in your legs, you may have a related condition called sciatica. One key difference is that SI joint pain symptoms usually stop before the knee, says Dr. Charlotin. With sciatica, the numbness or weakness typically extends below the knee.

Causes of SI joint pain

Many factors can contribute to SI joint pain or sacroiliitis. No matter what’s causing your discomfort, there’s a lot you can do to feel better. Some possible causes include:

• Arthritis. Any type of arthritis can cause SI joint pain, including osteoarthritis and axial spondyloarthritis 

• Pregnancy. Hormonal changes and other daily life changes that may come with pregnancy, like poor sleep and higher levels of stress, may be associated with the SI joint becoming inflamed, says Dr. Charlotin.

• A genetic disorder, such as Ehlers-Danos syndrome, that causes the joints to be overly flexible.

• Injury. If you fall or otherwise injure your hip, it could set off an inflammatory response in that region of your body, says Dr. Charlotin.

• Doing too much too soon. SI joint pain that develops gradually is often due to repeatedly doing too much of an activity, or doing something that requires a lot of repetitive motion, without doing the right strengthening exercises to prepare your body for those activities. Going past your movement sweet spot can irritate the SI joint.

• Ankylosing spondylitis. This autoimmune condition primarily causes inflammation in the spine. Over time, it may progress and cause the vertebrae to fuse so that the spine loses flexibility. This can impact the SI joints, leading to pain.

• Gout. Another form of inflammatory arthritis that results in pain, redness, and tenderness in joints, gout develops when excess uric acid in the body forms crystals in a joint or surrounding tissue, causing inflammation and pain. Gout can occur in any joint, including the SI joints.

Many types of everyday movement can help SI joint pain, but targeted exercises are especially helpful. The exercises above, recommended by Hinge Health physical therapists, stretch and strengthen the muscles around your pelvis. These are generally beneficial for treating SI joint pain, but a physical therapist can provide exercises more tailored to you if you need it. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatments for SI joint pain

There are many things you can do to ease SI joint pain. The following tips from our Hinge Health physical therapists can provide relief for SI joint pain. 

• Physical therapy. Physical therapy can aid in managing SI joint pain. A physical therapist (PT) can recommend various exercises, like the ones above, aimed at the affected joint and surrounding structures to alleviate pain in the SI joint. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

• Ice or heat. It’s your choice and a matter of what makes you most comfortable, says Dr. Charlotin. That said, she typically recommends ice for acute SI injuries (like those from a recent fall) and heat for a chronic problem, like arthritis.

• Maternity support belt. If you experience SI joint pain during pregnancy, a flexible band that sits under your belly can relieve some of the pressure and help to reduce the load on your low back and hips.

• Pillow placement. Whether you’re pregnant or not, an S-shaped pillow — or even a regular pillow strategically placed between your knees — may help you achieve a more comfortable sleeping position if your SI joint pain flares up at night. 

• Medication. If your SI joint pain is due to a type of inflammatory arthritis, such as axial spondyloarthritis, see a rheumatologist. Certain medications, known as disease-modifying anti-rheumatic drugs (DMARDs), are very effective in preventing your immune system from attacking your joints.

SI joint pain: a Hinge Health perspective

SI joint pain can be challenging and inconvenient, especially when it persists or interferes with your daily activities. No matter how bad your sacroiliitis is, or how long it’s been going on, you can always do something to help improve it. And that usually starts with moving more. 

Although moving through SI joint and back pain can seem scary and uncomfortable, small changes to your habits can yield huge benefits. Movement, low-impact exercise like swimming or biking, and maintaining a healthy weight (for less pressure on your joints) can all play a role in easing SI joint pain. 

PT tip: Modify movements as needed

If you have SI joint pain, remaining active is important, but some activities might be too painful for you at first. To stay active, you might have to find easier variations of some movements, take breaks, or cut the overall time you do an activity until your pain subsides.

Dr. Charlotin also highlights another option that she often tries with her patients to temporarily change how they move due to pain. “When you’re walking, going up and down stairs, or getting in and out of a car or bathtub, try to keep your pelvis square and your legs together rather than separating them a lot,” says Dr. Charlotin. “This is one of many modifications I might explore with my patients to see if it reduces their pain.” A physical therapist can explore this with you, as well as create a specific exercise routine to help you heal. 

How Hinge Health can help you

If you have pelvic pain or symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Sacroiliac joints. (n.d.). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/sacroiliitis/multimedia/sacroiliac-joints/img-20005962 

2. Kiapour, A., Joukar, A., Elgafy, H., Erbulut, D. U., Agarwal, A. K., & Goel, V. K. (2020). Biomechanics of the Sacroiliac Joint: Anatomy, Function, Biomechanics, Sexual Dimorphism, and Causes of Pain. International Journal of Spine Surgery, 14(Suppl 1), S3–S13. doi:10.14444/6077

3. Sacroiliac Joint Dysfunction. (n.d.). Cedars-Sinai. Retrieved from https://www.cedars-sinai.org/health-library/diseases-and-conditions/s/sacroiliac-joint-dysfunction.html

4. Jurik, A. G. (2023). Diagnostics of Sacroiliac Joint Differentials to Axial Spondyloarthritis Changes by Magnetic Resonance Imaging. Journal of Clinical Medicine, 12(3), 1039. https://doi.org/10.3390/jcm12031039

5. Added, M. A. N., de Freitas, D. G., Kasawara, K. T., Martin, R. L., & Fukuda, T. Y. (2018). Strengthening The Gluteus Maximus In Subjects With Sacroiliac Dysfunction. International Journal of Sports Physical Therapy, 13(1), 114–120. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5808006/