Sacroiliac Joint Syndrome: Symptoms, Diagnosis & Treatment
Can the Sacroiliac Joint Cause Lower Back, Buttock or Sciatica-Like Pain?
Sacroiliac joint syndrome can cause pain around one side of the lower back or buttock and may sometimes spread into the groin, thigh or leg.
Because lower back, hip, disc and nerve problems can produce similar symptoms, the location of pain alone cannot confirm that the SI joint is the cause. Diagnosis is usually based on your history, examination and a combination of physical tests.
Lower Back or Buttock Pain That Keeps Returning?
Our chiropractors can assess whether your symptoms appear to be coming from the SI joint, lower back, hip or a nerve-related problem and explain the appropriate treatment options.
Pain around the sacroiliac joint is one possible cause of lower back and buttock pain. It can sometimes feel very similar to sciatica, despite the sciatic nerve itself not necessarily being compressed.
This guide explains what the SI joint is, what can cause pain around it, how we assess whether it is likely to be contributing to your symptoms, and the treatment options that may help.
What Is the Sacroiliac Joint Syndrome?
The sacroiliac joints are located at the base of the spine, where the sacrum joins the pelvis. There is one SI joint on each side.
These joints allow only a relatively small amount of movement. Their main role is to help transfer forces between the spine, pelvis and legs during activities such as walking, bending, lifting and changing position.
Pain may arise from the SI joint or surrounding tissues following injury, repetitive loading, pregnancy-related changes, inflammatory conditions or other mechanical stresses.
Part of Our Low Back Pain Guide
Sacroiliac joint pain is one of several possible causes of lower back and buttock pain.
Related information:
What Causes Sacroiliac Joint Pain?
SI joint pain can develop for several reasons. Sometimes symptoms begin after a specific incident, while in other people discomfort develops gradually following repeated loading.
Possible contributing factors include:
- Sudden lifting or twisting
- Falls or sporting injuries
- Motor vehicle accidents or other trauma
- Repeated bending, lifting or asymmetrical loading
- Pregnancy and post-partum changes
- Changes in walking or lower-limb mechanics
- Degenerative changes around the joint
- Inflammatory conditions affecting the sacroiliac joints
Sometimes pain develops without a single obvious cause. This is one reason the examination is important rather than assuming that one particular movement or structure is responsible.
SI Joint Dysfunction Is Not the Same as Sacroiliitis
The terms SI joint dysfunction and sacroiliitis are sometimes used interchangeably, but they do not mean exactly the same thing.
Mechanical SI joint pain generally refers to pain thought to arise from the joint or surrounding structures during movement or loading.
Sacroiliitis specifically means inflammation of one or both sacroiliac joints. It can occur with inflammatory arthritis and other medical conditions and may require medical investigation.
You can read more about sacroiliitis and SI joint inflammation on Healthdirect.
Who Is More Likely to Develop Sacroiliac Joint Syndrome?
SI joint pain can occur in many different people, but it may be more likely in:
- People with a previous lower back or pelvic injury
- People repeatedly exposed to asymmetrical lifting or loading
- Pregnant and post-partum women
- People whose symptoms followed a fall or accident
- People with significant changes in gait or lower-limb loading
- People with inflammatory conditions affecting the sacroiliac joints
What Does Sacroiliac Joint Pain Feel Like?
SI joint pain is commonly felt around one side of the lower back or buttock, often close to the small dimples at the back of the pelvis.
Symptoms can include:
- Localised pain on one side of the lower back
- Buttock pain
- Pain that may spread toward the groin or upper thigh
- Pain travelling into the leg that can resemble sciatica
- Discomfort when climbing stairs
- Pain when standing mainly on one leg
- Pain when rolling or turning in bed
- Symptoms with prolonged sitting or standing
- Pain during bending, lifting or getting out of a chair
These symptoms are not unique to the SI joint. Similar pain can arise from the lumbar spine, discs, hip joints, muscles and nerves.
Can SI Joint Pain Feel Like Sciatica?
Yes. SI joint pain can sometimes spread through the buttock and into the leg, making it feel similar to sciatica.
However, sciatica-type pain has several possible causes, including irritation or compression of spinal nerves.
Numbness, tingling or weakness are less typical of isolated SI joint pain. These symptoms may suggest nerve involvement or another cause and should prompt an appropriate neurological examination.
Why Can SI Joint Pain Keep Coming Back?
Recurring SI-area pain does not necessarily mean that the joint is permanently damaged or unstable.
Flare-ups may occur when the tissues have not yet regained enough tolerance for the loads being placed upon them.
Possible contributing factors include:
- Returning to lifting, work or sport too quickly
- Repeated bending or twisting loads
- Reduced hip or trunk strength
- Pregnancy or post-partum changes
- Ongoing lower-limb or gait problems
- Sudden increases in physical activity
- An underlying inflammatory condition
For this reason, treatment may include not only reducing pain but also gradually rebuilding strength, movement and tolerance to normal activity.
How Is Sacroiliac Joint Syndrome Diagnosed?
There is no single symptom, physical test, X-ray or MRI finding that proves that the SI joint is the source of pain.
Assessment therefore involves putting several pieces of information together.
Your History
We first consider:
- Where your pain started
- Whether there was an injury or change in activity
- Which movements or positions aggravate the pain
- Whether symptoms spread into the leg
- Whether numbness, tingling or weakness is present
- Previous lower back, pelvic or hip problems
- Any features suggesting inflammatory or other medical conditions
Physical and Neurological Examination
Depending on your symptoms, your examination may include:
- Lower back movement assessment
- Hip examination
- Neurological testing
- Walking and movement assessment
- Single-leg loading tests
- Palpation and functional examination
- Specific SI joint pain-provocation tests
No single SI joint test is considered definitive. Clinicians generally interpret a combination of examination findings rather than relying on one test in isolation.
You can read more about the clinical assessment of sacroiliac joint dysfunction.
Do You Need an X-ray or MRI for SI Joint Pain?
Usually not for uncomplicated mechanical SI joint pain.
Imaging may be appropriate when the history or examination suggests another problem such as:
- Fracture or significant trauma
- Inflammatory sacroiliitis
- Significant arthritis
- Another spinal or hip condition
- Symptoms that are unusual or not improving as expected
X-rays and MRI can be useful for investigating other conditions, but imaging alone generally cannot confirm that an SI joint is the source of mechanical pain.
Learn more about when chiropractors use X-rays and when an MRI may be needed.
What Treatment Can Help Sacroiliac Joint Syndrome?
Treatment depends on what appears to be causing the symptoms, how long the problem has been present and the findings from your examination.
For mechanical SI joint pain, conservative management may include:
- Temporary modification of aggravating activities
- Progressive movement and exercise
- Hip, gluteal and trunk strengthening
- Hands-on treatment where appropriate
- Advice about lifting and movement
- Gradual return to normal work, sport and exercise
If your symptoms suggest inflammatory sacroiliitis, significant neurological involvement, fracture or another medical condition, investigation or referral may be more appropriate than routine conservative care.
How Chiropractic Care May Help
At Ansell Chiropractic Centre in Mundingburra, treatment does not begin by assuming that pain around the SI joint must be coming from the SI joint.
We first assess the lower back, pelvis, hips and nervous system to determine the most likely source of your symptoms and whether chiropractic care is appropriate.
Where indicated, care may include:
- Gentle spinal or pelvic manual therapy
- Modified chiropractic techniques when appropriate
- Soft-tissue treatment
- Mobility exercises
- Hip, gluteal and trunk strengthening
- Movement and lifting advice
- A graded return to normal activity
Manual therapy may be used to help reduce pain and improve comfortable movement when examination findings indicate that it is appropriate. It is commonly combined with exercise rather than used as a stand-alone long-term treatment.
How Ansell Chiropractic Centre Approaches SI Joint Pain
We don’t assume that lower back or buttock pain is caused by the sacroiliac joint simply because that is where it hurts.
Our approach includes:
- A thorough history and examination to identify the most likely source of your symptoms
- Neurological and musculoskeletal assessment where clinically appropriate
- Clear explanations of what we find and the available treatment options
- Imaging only when clinically indicated
- Gentle or modified techniques when these are more appropriate
- Exercise and rehabilitation where this may improve recovery and reduce future flare-ups
- Referral when needed if your symptoms require medical investigation or another healthcare provider
- No long-term prepaid treatment plans
Not Sure Whether Your Pain Is Coming From the SI Joint?
A clinical assessment can help distinguish SI joint pain from lower back, hip, disc and nerve-related problems.
Reducing the Risk of Future SI Joint Flare-Ups
Not every episode can be prevented, but improving the ability of your back, pelvis and hips to tolerate normal loads may reduce recurrent flare-ups.
This can include:
- Gradually rebuilding activity after a painful episode
- Improving hip and trunk strength where appropriate
- Avoiding sudden large increases in lifting or exercise
- Taking regular movement breaks from prolonged sitting
- Using appropriate lifting strategies
- Gradually returning to sport or heavier work
- Addressing contributing hip or lower-limb problems when present
When SI-Area Pain Needs Medical Assessment
Most mechanical lower back and SI-area pain is not caused by a serious condition. However, some symptoms require further investigation.
Seek appropriate medical assessment if your pain is associated with:
- A significant fall, accident or other trauma
- Fever or feeling generally unwell
- Unexplained weight loss
- A history of cancer
- Severe or progressively worsening night pain
- Progressive weakness in one or both legs
- New loss of bladder or bowel control
- Numbness around the groin or saddle area
- Significant prolonged morning stiffness or other features suggesting inflammatory disease
Read more about red flags in back pain and chiropractic care.
Key Takeaway
Pain around the sacroiliac joint can closely resemble pain arising from the lower back, hip or sciatic nerve.
The location of pain alone is therefore not enough to diagnose SI joint dysfunction.
A careful history and examination, including neurological and musculoskeletal assessment and several SI joint provocation tests where appropriate, can help determine whether the SI joint is likely to be contributing.
When the problem appears mechanical, conservative treatment commonly involves movement advice, progressive exercise and, where appropriate, hands-on care.
Lower Back, Buttock or Sciatica-Like Pain?
We can assess the likely source of your symptoms and explain whether chiropractic care, rehabilitation, imaging or referral is appropriate.
Sacroiliac Joint Pain FAQs
What does SI joint pain feel like?
SI joint pain is commonly felt on one side of the lower back or buttock, often close to the dimple at the back of the pelvis. It may sometimes spread toward the groin, thigh or leg and can be aggravated by stairs, prolonged sitting, standing on one leg or turning in bed.
Can SI joint pain feel like sciatica?
Yes. Pain from around the SI joint can spread through the buttock and sometimes into the leg, which can resemble sciatica. Numbness, tingling or weakness are less typical of isolated SI joint pain and may suggest nerve involvement or another cause that requires further assessment.
How do you know if pain is coming from the SI joint?
There is no single symptom or physical test that confirms SI joint pain. Diagnosis is based on your history, examination of the lower back and hips, neurological testing where appropriate, and a combination of SI joint pain-provocation tests.
Can a chiropractor help SI joint pain?
Chiropractic care may be one part of conservative management when examination findings suggest a mechanical SI joint problem. Treatment may include manual therapy, movement advice and targeted rehabilitation. If another cause is suspected, imaging, medical assessment or referral may be more appropriate.
Do I need an X-ray or MRI for SI joint pain?
Most uncomplicated mechanical SI joint pain does not require imaging. X-rays or MRI may be considered when there has been significant trauma or when symptoms suggest inflammatory disease, fracture, arthritis or another condition that requires investigation.
How long does SI joint pain take to improve?
Recovery varies depending on the cause, how long symptoms have been present, the loads placed on the area and any contributing lower back or hip problems. Many mechanical episodes improve progressively with appropriate activity, treatment and rehabilitation, while persistent or unusual symptoms may require further investigation.
Can pregnancy cause SI joint pain?
Pregnancy can contribute to pain around the SI joints because of changes in load, posture and pelvic tissues. However, pelvic pain during pregnancy can have several causes, so symptoms should be assessed rather than automatically attributed to the SI joint.
When should I worry about SI joint pain?
Seek medical assessment if pain follows significant trauma or is accompanied by fever, unexplained weight loss, progressive weakness, new bladder or bowel changes, saddle numbness, severe worsening night pain or other symptoms suggesting a condition requiring further investigation.
Related Low Back Pain Guides
- Low Back Pain
- Sciatica
- What Causes Sciatica-Type Pain?
- Disc Injuries
- Bulging Disc
- Facet Joint Syndrome
- Has My Back Gone Out?
- When Do You Need an X-ray?
- When Do You Need an MRI?
Trusted External Resources
Dr Daryl Ansell is an experienced chiropractor and clinic director at Ansell Chiropractic Centre in Townsville, Queensland. With more than four decades of clinical experience, he has helped patients with low back pain, neck pain, headaches, sciatica, posture-related strain and other musculoskeletal problems.
His approach is evidence-informed and patient-centred, with a focus on careful assessment, clear explanations, improving joint movement, reducing muscle tension and supporting better functional movement. Care is tailored to the individual and may include spinal adjustments, low-force techniques, soft-tissue therapy, rehabilitation exercises and posture advice.
Dr Ansell has served on the Chiropractors Board of Queensland for more than 10 years and as ACA NQ Regional Coordinator and Media Liaison Officer — roles that reflect his longstanding commitment to chiropractic standards and community health in North Queensland.
Daryl places a strong emphasis on safety screening, communication and appropriate referral when needed. He works collaboratively with local healthcare providers, including GPs and imaging services such as Queensland X-Ray and I-MED Radiology.
Ansell Chiropractic Centre has been part of the Townsville community for more than 40 years, serving patients from Mundingburra, Aitkenvale, Annandale, Douglas, Idalia, Kirwan South Townsville, Townsville CBD and surrounding suburbs.