Lower backŞişli, Istanbul
Sacroiliac joint dysfunction treatment
The sacroiliac joint connects the sacrum at the base of the spine to the pelvis. It moves very little but transfers the entire load of the upper body into the legs, and when that load distribution is disturbed it produces sharp, one-sided pain just above the buttock.
Also known as: SI joint pain, sacroiliac syndrome, pelvic girdle pain
What is it?
The sacroiliac joint is tightly wrapped in strong ligaments and normally moves only a few millimetres. That small amount of movement cushions the force passing from the trunk into the leg with every step. Its job is not to move but to transfer load safely.
The problem usually arises not from the joint itself but from the surrounding muscles distributing load unevenly. When the gluteal muscles are weak or work asymmetrically, the pelvis is loaded with a small imbalance at every step. Over time the joint capsule becomes irritated and the typical one-sided pain appears. In pregnancy, hormonal laxity accentuates that imbalance, which is why it is common in the postnatal period.
Pain is felt as a point just above the buttock, beside the tailbone. It can spread into the groin and back of the thigh but usually does not travel below the knee. Patients can point to the painful spot with one finger, and this 'pointing sign' is quite useful in diagnosis.
Symptoms
- Sharp, one-sided pain just above the buttock that can be pointed to with a finger
- Symptoms that increase with standing on one leg and climbing stairs
- Difficulty getting out of bed and out of a car
- Pain increasing with prolonged sitting, especially sitting weighted onto one buttock
- Pain spreading into the groin and back of the thigh but not below the knee
- A difference in step length between the two sides when walking
- A constant need to shift weight from one leg to the other when standing
Causes and risk factors
- Weakness in the gluteal muscles or a marked strength difference between sides
- Hormonal ligament laxity in pregnancy and the postnatal period
- Sudden one-sided loading — a misstep, a fall, jumping from height
- Leg length difference and gait asymmetry
- Habitual asymmetric sitting (a wallet in the back pocket, crossing the legs)
- Restricted hip joint range, shifting load onto the neighbouring joint
The assessment
No single test identifies the sacroiliac joint conclusively, so a battery is used. When at least three of five provocation tests that compress the joint from different directions reproduce the pain, the diagnosis is strongly supported. This approach avoids the wrong conclusions that a single test invites.
Attention then turns to why load is being distributed unevenly: gluteal strength is measured separately on each side, single-leg standing control is assessed and hip range is compared. Pain arising from the lumbar spine and the hip joint is ruled out, since all three can refer to a similar area.
Course of treatment
Weeks 0–2
Settling the joint
Daily habits creating asymmetric load are corrected: sitting position, how to roll in bed and how to get out of a car are taught. Manual techniques and soft tissue work reduce the protective tension around the joint.
Weeks 2–6
Building gluteal strength
Strength in the lateral and posterior hip muscles is built systematically, with extra loading on the weaker side. This is the decisive phase of treatment — the joint settles once the surrounding muscles share the load.
Weeks 6–10
Single-leg control
Capacity to hold pelvic position during walking, stairs and single-leg standing is trained. Movements that provoke pain in daily life are reintroduced into the programme in a controlled way.
Maintenance
Maintaining symmetry
When the strength difference returns, so do the symptoms. A short gluteal programme two or three times a week is the most practical way to preserve the symmetry gained.
How long does it take?
Sacroiliac pain generally responds well; the programme usually runs 8–12 sessions with clear relief beginning in the first two to four weeks. In pregnancy or postnatal cases the process can take longer depending on hormonal status, and the goal there is not complete resolution but making daily life sustainable.
When to see a doctor
The findings below fall outside the scope of physiotherapy and require medical assessment.
- Pain not relieved by rest at night, worse toward morning and causing stiffness
- Joint pain accompanied by fever, eye inflammation or bowel symptoms
- Inflammatory-type pain beginning insidiously under age 45 and lasting over three months
- Progressive weakness or numbness in the leg
- Severe pain after a fall that prevents weight bearing
Frequently asked questions
Has the joint gone out of place?
No. The sacroiliac joint is wrapped in strong ligaments and does not go out of place. The phrase 'the joint has slipped' is common but inaccurate; the problem lies not in the joint's position but in how the surrounding muscles distribute load. Treatment is therefore built on strength and control.
It started in pregnancy — will it resolve after birth?
It usually reduces markedly, but may not resolve completely on its own. As the ligaments that loosened in pregnancy regain tension, symptoms persist if muscular support has remained weak. A gluteal programme in the postnatal period speeds that transition considerably.
Is it advisable to use a pelvic belt?
During very painful periods and in pregnancy a pelvic belt can give clear relief. It is useful when used short term and alongside exercise; used alone and long term it delays the development of muscular support.
Why is it always the same side?
Because the problem is usually a difference in strength and control between the two sides. The weaker side takes slightly more load with every step and irritation accumulates there. Measurement identifies the difference, and the programme is weighted toward that side.
Methods used
Related conditions
Articles on this topic
Articles covering the topic in detail: symptoms, treatment, exercise and daily life.
- Diagnosis and symptoms· 6 min readSacroiliac joint pain: the point beside the tailbone
- Treatment course· 6 min readTreatment and programme for sacroiliac joint pain
- Exercise· 6 min readSacroiliac joint exercises: a stability-focused programme
- Treatment decision· 6 min readWhen is inflammatory disease investigated in sacroiliac pain?
- Daily living· 6 min readSleep, sitting and daily movement in sacroiliac pain
The content on this page is for information only and does not replace medical diagnosis or treatment. Always consult a healthcare professional about your symptoms.
Assessment appointment
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