SI joint pain comes from the sacroiliac joints, the two spots where the base of your spine meets your pelvis. It usually feels like an ache or a sharp, stabbing pain low in your back and buttock, and it can spread into your hip or thigh. Often it flares when you sit or stand in one position too long, or when you turn your hips. The good news is that most back pain eases with time and simple care. Still, a few causes of SI joint pain need a medical doctor, so it helps to know the signs.
Where your SI joints are and what they do
You have two sacroiliac (SI) joints, one on each side of your lower back. Each one joins the sacrum, the triangle-shaped bone at the bottom of your spine, to the ilium, the top part of your pelvis. These are some of the biggest joints in your body. You use them every time you walk, climb stairs or shift your hips.
Cleveland Clinic describes sacroiliitis as painful inflammation in one or both SI joints. Some studies estimate that about one in four people with low back pain have it. However, you can also have pain in or near an SI joint without sacroiliitis. Low back pain is very common, and it has many possible causes. So the label matters less than finding what is behind your pain.
SI joint pain symptoms to watch for
Pain in the lower back is the most common sign. Beyond that, the pain may:
- Get worse after you sit or stand in one position for a long time
- Flare when you turn or rotate your hips
- Feel sharp and stabbing at times, or like a constant dull ache
- Spread from your low back into your buttock, hip or thigh
- Show up on one side, or on both sides at once
Morning stiffness is another clue. Most people feel a little stiff after a night of sleep. With sacroiliitis, though, the stiffness often lasts more than an hour each morning. That pattern can point to inflammatory arthritis, so tell a medical doctor about it.
Do you sit at a desk along Eisenhower Parkway all day? If your SI joint pain builds by evening, our guide to back pain from sitting all day has simple desk changes to try.
What causes SI joint pain?
Sacroiliitis happens when something irritates or damages one or both SI joints. That irritation leads to inflammation, and the inflammation causes pain. Arthritis is the main cause. Other conditions that cause inflammation in the body can affect these joints, too. Common causes include:
- Ankylosing spondylitis, a type of arthritis in the spine. Sacroiliitis is often one of its early signs.
- Psoriatic arthritis, which affects both the joints and the skin
- Bowel conditions such as Crohn’s disease or ulcerative colitis
- Reactive arthritis and other inflammatory conditions
- Pregnancy, since hormones can make the SI joints widen and rotate. This pain usually lasts only while you are pregnant.
- In rare cases, a bacterial infection in the joint
Is it SI joint pain or a disc problem?
Pain low in the back and buttock does not always come from the SI joint. A disc in your lower spine can cause it, too. When a disc bulges or herniates, it may press on a nerve root nearby. As a result, you may feel pain, numbness or tingling down your leg. Our post on bulging versus herniated disc explains what those words on an MRI report mean.
Discs also change with age. If a scan report mentions disc wear, our guide to degenerative disc disease explains what that means.
So how do you tell them apart? With SI joint pain, the ache often spreads into the buttock, hip or thigh. Nerve pain from a disc, on the other hand, can travel further down the leg, sometimes to the calf or foot. Still, the two overlap a lot, and no single symptom settles it.
Your hip can be a suspect too, since pain from the SI joint can spread into the hip. A full exam checks your hips and your back. You can read more on our hip and knee pain page.
How a provider finds the cause
A good exam starts with questions. When did the pain start, and what makes it worse? Do you have other health conditions, such as psoriasis or bowel problems?
Next comes a hands-on exam of your back, hips and legs. The provider may ask you to move in certain ways to check your range of motion. They may also press on or around the SI joints. Tell them if any position or pressure makes the pain worse.
Imaging can help in some cases. Options include X-rays of the pelvis, a CT scan or an MRI. A medical doctor may also order blood tests to rule out infection or other causes of inflammation.
What may help SI joint pain
For many people, simple care is the place to start. MedlinePlus notes that most back pain goes away on its own, though it may take a while. In the meantime, these steps may help:
- Keep moving with short, easy walks, because more than a day or two in bed can make back pain worse
- Change positions often, and get up from your chair every so often
- Try hot or cold packs, whichever feels better
- Use over-the-counter pain relievers if they are safe for you, and talk to your provider before taking NSAIDs such as ibuprofen for more than 10 days in a row
- Add gentle stretches that keep your hips and low back moving
Over time, exercise matters most. Cleveland Clinic says that the most common treatment for sacroiliitis is a guided program of stretches and exercises. Stronger muscles around the joint take pressure off it and help keep it stable. In addition, the right moves can help you move further without pain.
Where do adjustments fit in? Research on spinal manipulation looks at low back pain in general, not the SI joint alone. NCCIH reports a modest benefit for recent low back pain, and about the same benefit as other recommended care for chronic low back pain. So we see adjustments as one part of a plan, alongside exercise. Mild soreness or stiffness afterward is common and usually fades within a day or so.
If simple care does not help, a medical doctor may suggest prescription medicine, such as a muscle relaxer, or a steroid injection into the joint. When arthritis is the cause, you may also work with a rheumatologist, a doctor who treats inflammatory joint disease. Surgery for sacroiliitis is rare.
When to see a doctor or go to the ER
Most SI joint pain is not an emergency. Still, some signs need a medical doctor first, not a chiropractor. Go to the ER right away if you have:
- Loss of bladder or bowel control
- Numbness in the groin, buttocks or inner thighs
These can be signs of cauda equina syndrome, a nerve emergency. Also see a medical doctor soon if you have:
- Leg weakness
- Fever along with back pain
- A history of cancer, or weight loss you cannot explain
- Pain that started after a fall
- Night pain that wakes you up
- Morning stiffness that lasts more than an hour, which can mean inflammatory arthritis
- Severe pain, or pain that does not improve after three days
This post is educational and is not a diagnosis.
How we approach SI joint pain at HealthSource of Roseland
At our Roseland office, Dr. Jenna Patel, D.C. evaluates you before any care starts. Your first visit begins with a short tour, a health history questionnaire and a consultation. Next comes a physical exam of your posture, mobility and pain. We take X-rays only if clinically needed. Then Dr. Patel explains a report of findings and a personalized care plan, so you can ask questions and decide before we begin.
Her aim is to find the source of the problem, not only the symptoms. That matters here, because a joint, a disc or a hip problem can feel so alike. She has extra training in movement analysis and instrument-assisted soft tissue work. Depending on your exam, your plan may include hands-on adjustments, soft tissue work and Progressive Rehab® and functional exercise. If your exam points to arthritis or another problem that needs a medical doctor, we will tell you. You can learn more on our back pain relief page.
If SI joint pain keeps getting in the way of your workday, sleep or walks, a careful exam is a sensible next step. Book a visit online, or call (973) 200-2424 if you would like to ask a few questions first. Ask about our new-patient visit: consultation, exam and X-rays if clinically needed. The offer is for new patients only. It does not apply to Medicare, Medicaid, other federal healthcare program patients or ACN members.
