SI Joint Pain

SI joint pain is discomfort that starts in one or both sacroiliac joints. These joints sit where the sacrum at the base of the spine meets the iliac bones of the pelvis. They help transfer weight between the upper body and legs while allowing only a small amount of movement.

When the SI joint moves too much, too little or becomes inflamed, it can cause pain that feels similar to other spine conditions. Some people mistake SI joint pain for sciatica, herniated disc or spinal stenosis, which is why a careful evaluation is important.

SI joint pain often causes aching, sharp or stabbing pain in the lower back, buttock or hip. Symptoms may appear on one side or both sides and can change with certain positions or activities.

Common symptoms include:

• Pain in the lower back, buttock, hip or groin
• Pain that worsens when standing, walking, climbing stairs or getting up from a chair
• Discomfort after sitting for a long time
• Pain that travels into the thigh, sometimes mimicking sciatica
• Stiffness or a feeling of instability in the pelvis or lower back
• Trouble sleeping on the painful side

Because symptoms can overlap with other spine and hip problems, your care team may evaluate your spine, pelvis, nerves and surrounding muscles before confirming the SI joint as the pain source.

SI joint pain can develop when the joint is strained, inflamed or affected by changes in movement. It may happen after an injury, during pregnancy, with arthritis or because of uneven stress across the pelvis and lower spine.

Risk factors may include:

• A fall, car accident or sports injury
• Pregnancy or recent childbirth, which can loosen ligaments around the pelvis
• Arthritis or inflammatory joint disease
• Prior lumbar spine surgery or spinal fusion
• Uneven leg length or changes in walking pattern
• Repetitive lifting, twisting or high-impact activity
• Weakness or imbalance in the core, hip or pelvic muscles

SI joint pain may also occur alongside other spine conditions, including spinal stenosis, herniated disc and degenerative changes in the lower back.

Diagnosing SI joint pain starts with a detailed medical history and physical exam. Your clinician may ask where the pain starts, what makes it worse and whether it spreads into the hip, groin or leg.

Your exam may include movement and pressure tests that place stress on the sacroiliac joint. Imaging, such as X-ray, CT or MRI, may help rule out other causes of pain, including spinal stenosis or herniated disc.

In some cases, an image-guided diagnostic injection may be recommended. If numbing medicine placed into the SI joint temporarily relieves pain, it can help confirm the joint as the source. Baptist Health Brain & Spine Care offers access to coordinated spine care, diagnostic evaluation and appointments with specialists who treat complex back and pelvic pain.

Treatment for SI joint pain usually begins with nonsurgical care. Your plan may include physical therapy, activity changes, anti-inflammatory medicines, posture and movement training, or targeted exercises to improve core, hip and pelvic stability.

If pain continues, your clinician may recommend interventional pain treatments, such as image-guided SI joint injections. In some patients, related treatments used for spine pain — including epidural injection for nerve-related pain — may be considered when symptoms come from more than one source.

Treatment may include:

• Physical therapy focused on flexibility, strength and movement mechanics
• Short-term use of anti-inflammatory medicines or other pain-relief options when appropriate
• Bracing or support during painful activity
• Image-guided SI joint injection to reduce inflammation and confirm the pain source
• Radiofrequency ablation when pain relief from diagnostic blocks suggests the nerves around the joint are involved
• Surgery, such as SI joint fusion, only when severe symptoms do not improve with conservative and interventional care

Untreated SI joint pain can interfere with walking, sleep, work and daily activities. People may also change how they move to avoid pain, which can place extra stress on the hips, lower back and legs.

Possible complications include reduced mobility, worsening stiffness, muscle weakness, balance changes and chronic pain patterns. Persistent pain may also overlap with nerve-related conditions such as sciatica, making diagnosis and treatment more complex.

Not all SI joint pain can be prevented, especially when it is related to injury, pregnancy or arthritis. However, healthy movement habits can reduce strain on the sacroiliac joints and lower back.

Prevention strategies may include:

• Building core, hip and glute strength
• Stretching tight hip flexors, hamstrings and lower-back muscles
• Using proper lifting technique
• Avoiding sudden increases in running, jumping or heavy lifting
• Maintaining a healthy weight
• Addressing walking changes, leg-length differences or muscle imbalances
• Seeking care early when lower-back, buttock or hip pain does not improve

If pain keeps returning, a specialist can help determine whether the SI joint, lumbar spine or another area is driving symptoms.

If lower-back, buttock or hip pain is affecting your daily life, the next step is a thorough evaluation. A Baptist Health Brain & Spine Care specialist can help identify whether SI joint pain, sciatica, herniated disc, spinal stenosis or another condition is causing your symptoms.

To schedule a visit with a Baptist Health Brain & Spine Care provider, fill out an appointment request form or call 833-596-3876.