Sacroiliac Joint Dysfunction

What is sacroiliac joint dysfunction?

  • This refers to pain originating from the sacroiliac joint (a joint at the base of your back whereby the spine joins to the pelvis) commonly caused by abnormal motion (mainly stiffness) in the area.

How common is sacroiliac joint dysfunction?

  • Sacroiliac joint dysfunction is a common source of lower back pain.
  • It has been estimated that the sacroiliac joint can be responsible for 15% to 30% of low back pain cases (1).
  • It is particularly common in pregnant women and those who have recently given birth (2).

Should I worry?

  • No.
  • Sacroiliac joint dysfunction responds very well to physiotherapy treatment and exercise.
  • It is not linked to any other serious conditions.

Who is most likely to suffer form sacroiliac joint dysfunction?

  • People involved in asymmetrical sports such as hockey and tennis.
  • Pregnant women experience joint laxity due to hormonal changes; this is when the sacroiliac joint is the most vulnerable (4).

What are the common symptoms?

  • Low back pain.
  • Buttock region pain.
  • Stiffness.
  • Pain can sometimes radiate to the hip, groin and/or upper thigh.
  • Can be one or both sides (6).

What can I do?

  • Education on posture.
  • Advice on lifting techniques.
  • Rehabilitation exercises.
  • Stretching exercises.
  • Over-the-counter medications such as pain relief or NSAIDs.

How long will it take to recover?

  • The timeframe varies depending on treatment approaches. It can range from 1-2 rest days after injury, to 6-8 weeks conservative treatment (8).

1. Introduction

The sacroiliac joint (SIJ) is a joint at the base of your back whereby the spine joins to the pelvis. There is a sacroiliac joint on each side of the sacrum where it joins onto the ilium (pelvis bone). It is thought to be a significant contributor to low back pain, particularly in the younger population.

The sacroiliac joint is heavily reliant on strong ligament structures to help support it. As with all soft tissue injuries, these can be overloaded and often produce a painful response. The common causes are during pregnancy when the extra load in front can overload these ligaments or cause trauma to this area (4).

There is very little movement in the sacroiliac joint; as we get older, the movement reduces to a point where the bones begin to fuse together and therefore no further movement comes from the joint. (6).


2. Signs & Symptoms

The main symptoms are usually:

3. Causes

There are a number of reasons why this condition can occur, such as a fall typically onto the hip area or a collision in sport, but it can occur without clear reason, possibly due to a muscle imbalance. There is a close link between pregnancy and patients who are overweight. Smokers are also at risk of sacroiliac joint pain. The relationship between the sacroiliac joint and low back pain has been a topic of debate, with some believing that the sacroiliac joint does not contribute towards low back pain (3).


4. Risk Factors

This is not an exhaustive list. These factors could increase the likelihood of someone developing sacroiliac joint dysfunction. It does not mean everyone with these risk factors will develop symptoms.


5. Prevalence

In the general population, sacroiliac joint dysfunction affects between 1% to 3% of people. In people who have already been diagnosed with back pain, it is believed to be a part of the problem 25% – 33% of the time.

6. Assessment & Diagnosis

If you experience the symptoms of sacroiliac joint pain then you should see your physiotherapist take a complete background history and offer an examination. During the examination, you will be asked to perform a few special tests to determine if the sacroiliac joint is involved or not. Different movements and positions can determine what elements are giving you your symptoms. Your physiotherapist may also check for any tenderness over the sacroiliac area.

Other tests such as X-ray, computer tomography (CT) or magnetic resonance imagery (MRI) scans are rarely used in the initial stages of the condition as we often find that these can be misleading and provide information that may not be linked to your symptoms. These investigations can be used if needed to differentiate between hip or serious lumbar spine problems, but only in severe cases or when treatment has been unsuccessful (2, 5).

7. Self-Management

As part of the sessions with your physiotherapist, they will help you to understand your condition and what you need to do to help you recover from your sacroiliac joint dysfunction. This may include reducing the amount or type of activity, as well as other advice aimed at reducing your pain. It is important that you try and complete the exercises you are provided as regularly as possible to help with your recovery. Rehabilitation exercises are not always a quick fix, but if done consistently over weeks and months then they will, in most cases, make a significant difference.

Self-help techniques include:

  • Regular pain relief, such as over the counter paracetamol.
  •  Heat vs cold therapy.
  • Adopting a good posture and use correct lifting techniques.
  • Maintain a healthy lifestyle and regular fitness activities like stretches and strengthening techniques.
  • Undertake in stress management if this is a factor. Use relaxation techniques or mindfulness.
  • If your work is heavy, manual tasks, try to use suitable equipment and ask people to help to try and adapt to the workplace setting.

8. Rehabilitation

Below are three rehabilitation programmes created by our specialist physiotherapists targeted at addressing sacroiliac joint dysfunction. In some instances, a one-to-one assessment is appropriate to individually tailor targeted rehabilitation. However, these programmes provide an excellent starting point, as well as clearly highlighting exercise progression.

9. Sacroiliac Joint Dysfunction Rehabilitation Plans

Early Plan

Exercises at this stage aim to reduce the stress on the joint, increase muscle flexibility and movement around the area. This should not exceed any more than 4/10 on your perceived pain scale.

Early Plan  - Rating

Intermediate Plan

At this stage the emphasis changes to include more focus on increasing the stability and strength around the hips and pelvis. This should not exceed any more than 4/10 on your perceived pain scale.

Intermediate Plan - Rating

Advanced Plan

The advanced stage aims to further increase stability and core strength to ensure a full return to normal daily activities and reduce the risk of recurrence of the problem. This should not exceed any more than 4/10 on your perceived pain scale.

Advanced Plan  - Rating

10. Return to Sport/Normal life

For patients wanting to achieve a high level of function or return to sport we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage. Before returning to sport a rehabilitation program should incorporate plyometric based exercises this might include things like bounding, cutting, and sprinting exercises (5,7).

As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain reliving treatments to support symptom relief and recovery. Whilst recovering you might benefit from further assessment to ensure you are making progress and establish appropriate progression of treatment.  Ongoing support and advice will allow you to self-manage and prevent future re-occurrence.

11. Other Treatment Options

  • Joint injections where a corticosteroid is used can settle inflammation and swelling of the nerves; they are often used with an analgesic numbing agent. Although it may be a temporary measure, people can have up to 3 injections a year (5).
  • Use of gels or pain relief patches to help. Your GP is the best person to see to discuss this further.

Book an Appointment

Please book an appointment with one of our physiotherapists if you think you are suffering from this condition and would like to find out more.

We have Pure Physiotherapy clinics across the country including Norwich, Dereham, Bolton, Manchester, Rochdale, Sheffield and Barnsley. Please view our clinics to find the closest physiotherapy clinic for you.


  1. Cohen SP, Chen Y, Neufeld NJ. (2013). Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis, and treatment. Expert Rev Neurotherapy. 13, 99-116.
  2. Evidence-Based Diagnosis and Treatment of the Painful Sacroiliac Joint. Mark Laslett. (2008). FNZCP, PhD, Dip MT, Dip MDT. J Man Manipulation Therapy. 10.1179/jmt.2008.16.3.142. 16, 142–152.
  3. Anterior dysfunction of the sacroiliac joint as a major factor in the etiology of idiopathic low back pain syndrome. DonTigny RLPhys Ther. (1990). 70, 250-65; 262-5.
  4.  Sacroiliac Joint Injury. Alexander M. Dydyk; Stephen D. Forro; Andrew Hanna. (2020).
  5.  Chronic low back pain in older adults: prevalence, reliability, and validity of physical examination findings. Weiner DK, Sakamoto S, Perera S, Breuer P. J Am Geriatr Soc. (2006). 54, 11-20.
  6.  Sacroiliac joint pain. Marc Orlando, (2019). MD, William Tobler, MD.
  7. Evaluation of Efficacy of Bone Scan With SPECT/CT in the Management of Low Back Pain. A Study Supported by Differential Diagnostic Local Anesthetic. Jain, Anuj MD; Jain, Suruchi MD; Agarwal, Anil MD; Gambhir, Sanjay MD; Shamshery, Chetna MD; Agarwal, Amita MDS. (2015). The Clinical Journal of Pain: 31, 1054-1059.
  8. Postoperative complications in patients undergoing minimally invasive sacroiliac fusion. Spine. Schoell K, Buser Z, Jakoi A, Pham M, Patel NN, Hsieh PC, Liu JC, Wang JC. (2016). 16, 1324-1332.
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