SI Joint Pain: Common Symptoms, Causes, and Treatment Options

Sacroiliac (SI) joint pain can cause discomfort in the lower back, buttocks, hips, or legs, making it difficult to determine exactly where the pain originates. Because SI joint symptoms can resemble other spinal or musculoskeletal conditions, identifying the source of pain is an important first step toward appropriate treatment.

What Is the Sacroiliac Joint?

The sacroiliac joint connects the sacrum at the base of the spine with the pelvis. There are two SI joints, one on each side of the body. These joints help transfer forces between the upper body and legs while providing stability during standing, walking, and other movements.

Although the SI joints normally have limited movement, irritation, inflammation, injury, or changes in the surrounding structures can cause pain.

What Are the Common Symptoms of SI Joint Pain?

Common symptoms of SI joint pain include lower back pain, buttock pain, hip discomfort, and pain that may extend into the thigh or leg. The pain is often felt on one side, although both SI joints can become symptomatic.

People with SI joint pain may experience discomfort when climbing stairs, standing for extended periods, walking, getting out of a chair, or turning over in bed. Some people also notice increased pain when standing on one leg or moving from sitting to standing.

Because these symptoms can overlap with conditions such as lumbar disc problems, spinal stenosis, or hip disorders, symptoms alone may not establish the SI joint as the source.

What Causes SI Joint Pain?

SI joint pain can have several possible causes. Injury, repetitive stress, arthritis, pregnancy-related changes, and altered movement patterns can all contribute to SI joint dysfunction.

A fall or other trauma can strain the ligaments supporting the joint. Repetitive activities that place stress on the pelvis may also contribute to irritation. Arthritis can affect the SI joint as well, particularly with aging.

During pregnancy, hormonal changes loosen pelvic ligaments while changes in posture and body mechanics increase stress on the SI joints. These factors can sometimes contribute to pain during or after pregnancy.

Previous surgery involving the lower back or pelvis may also change biomechanics and place additional stress on the SI joint.

How Is SI Joint Pain Diagnosed?

Diagnosing SI joint pain typically involves a medical history, physical examination, and assessment of movement. A healthcare professional may use specific physical examination maneuvers designed to place stress on the SI joint and determine whether they reproduce the patient’s familiar pain.

Imaging such as X-rays, CT scans, or MRI may be used when appropriate to evaluate the spine, pelvis, hips, or other potential sources of symptoms. Imaging can help identify arthritis, structural changes, or other conditions, although imaging findings do not always directly identify the source of pain.

In some cases, a diagnostic SI joint injection may be used to help determine whether the joint is contributing to a patient’s symptoms. When an injection temporarily reduces the familiar pain, it can provide additional information as part of the diagnostic process.

What Conservative Treatments Can Help SI Joint Pain?

Treatment for SI joint pain often begins with conservative approaches. Physical therapy, activity modification, targeted exercises, and medications when medically appropriate may help reduce symptoms and improve function.

Physical therapy may focus on strengthening the muscles supporting the pelvis and core, improving flexibility, and correcting movement patterns that place unnecessary stress on the SI joint.

Temporary modification of activities that aggravate symptoms may also allow irritated tissues to recover. Depending on the individual situation, a healthcare professional may recommend additional strategies for managing pain and maintaining appropriate activity.

Can SI Joint Injections Treat SI Joint Pain?

For some patients, an SI joint injection may provide both diagnostic information and therapeutic relief. During the procedure, medication is delivered directly into or around the SI joint under image guidance.

The specific medication and technique depend on the patient’s condition and the treating clinician’s approach. Relief from an injection may be temporary, but the response can help guide subsequent treatment decisions.

SI joint injections are not appropriate for every patient, so proper diagnosis is important before considering an injection.

What Other Treatment Options Are Available for Persistent SI Joint Pain?

When SI joint pain continues despite conservative treatment, additional interventional options may be considered. Radiofrequency ablation, for example, may be appropriate for certain patients with persistent SI joint-related pain.

Radiofrequency ablation uses controlled heat to interrupt specific nerves that transmit pain signals from the area. Patient selection is important, and diagnostic procedures may be used beforehand to determine whether this approach is appropriate.

In uncommon cases involving severe, persistent SI joint dysfunction that has not responded to nonsurgical treatment, surgical options may be considered. The appropriate treatment depends on the underlying cause, severity of symptoms, and response to previous therapies.

When Should Someone See a Pain Specialist for SI Joint Pain?

A pain specialist evaluation may be appropriate when lower back or buttock pain persists, interferes with daily activities, or does not improve with initial conservative care.

Because SI joint pain can resemble other conditions, a comprehensive evaluation can help distinguish SI joint-related symptoms from pain originating in the lumbar spine, hip, or other structures. An accurate diagnosis can help prevent unnecessary treatments and support a more targeted treatment plan.

What Is the Outlook for People With SI Joint Pain?

The outlook for SI joint pain varies depending on its underlying cause. Many people can manage SI joint pain with a combination of conservative care, targeted rehabilitation, and appropriately selected interventional treatments.

The most effective approach depends on identifying the actual source of pain rather than treating symptoms alone. When SI joint dysfunction is suspected, an evaluation by an appropriately qualified healthcare professional can help determine the cause and identify treatment options suited to the individual’s needs.