SI Joint Pain & Back Pain: Causes, Symptoms, and Best Non-Surgical Treatments

by | Mar 23, 2025

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Do you have nagging lower back pain that just won’t go away? Many people assume their pain is coming from the spine, but in some cases, the sacroiliac (SI) joint is the real culprit. The SI joint plays a crucial role in connecting the spine to the pelvis, providing stability and absorbing shock as we move. When this joint becomes irritated, unstable, or inflamed, it can cause significant pain in the lower back, buttocks, hips, and even down the legs.

Understanding the causes, symptoms, and most effective non-surgical treatments for SI joint pain is key to finding lasting relief.

What Is the SI Joint and Why Does It Matter?

The sacroiliac joint connects the sacrum (the lowest part of the spine) to the ilium (the large pelvic bone). Strong ligaments hold the joint together, ensuring stability and proper function. When the SI joint is working correctly, we don’t even notice it. However, when dysfunction occurs—whether due to inflammation, instability, or misalignment—it can cause persistent pain that is often mistaken for a spinal issue.

How Is SI Joint Pain Different from Other Back Pain?

Not all lower back pain originates from the spine. SI joint pain has distinct characteristics that set it apart:

  • Location of Pain – SI joint pain is usually felt on one side of the lower back, near the dimple at the base of the spine. It can also radiate into the buttocks, groin, and hips.
  • Pain with Movement – Activities like climbing stairs, standing on one leg, getting out of a car, or rolling over in bed can trigger pain.
  • Not Nerve Pain – Unlike sciatica, SI joint pain does not stem from a pinched nerve. This means there is typically no numbness or tingling in the feet.
  • Pain Worsens with Sitting – If prolonged sitting causes discomfort, especially a dull ache in the pelvis, the SI joint could be the problem.

Common Causes of SI Joint Pain

SI joint pain can result from various factors, including:

  • Injury or Trauma – Falls, car accidents, or sports injuries can damage the joint or surrounding ligaments.
  • Pregnancy and Hormonal Changes – During pregnancy, hormones loosen the ligaments around the SI joint to allow for childbirth. This increased laxity can sometimes lead to long-term instability and chronic pain.
  • Uneven Pelvis or Leg Length Discrepancy – If one leg is slightly longer than the other, it can put excess stress on one SI joint, leading to pain and dysfunction.
  • Inflammatory Conditions – Autoimmune diseases like ankylosing spondylitis can inflame the SI joint and contribute to chronic pain.
  • Weak Core and Poor Posture – A lack of stability in the core and pelvis can cause strain on the SI joint, leading to irritation and discomfort.

How Is SI Joint Pain Diagnosed?

SI joint pain is often misdiagnosed as a spine issue, so an accurate diagnosis is crucial. Physicians use several methods to confirm SI joint dysfunction:

  • Physical Examination – Tests like the FABER test or sacral thrust test help reproduce pain and identify SI joint involvement.
  • Imaging – X-rays, MRIs, and CT scans can rule out other spine-related conditions. However, SI joint dysfunction does not always show up on imaging unless significant arthritis or inflammation is present.
  • Diagnostic Injections – Injecting a numbing agent into the SI joint can temporarily relieve pain. If this provides relief for several hours or days, it confirms that the SI joint is the pain source.

Best Non-Surgical Treatments for SI Joint Pain

Most cases of SI joint pain can be managed without surgery. The most effective treatment options focus on improving stability, reducing inflammation, and restoring function.

1. Physical Therapy and Strengthening Exercises

Strengthening the muscles around the pelvis and hips helps stabilize the SI joint and prevent future pain. The most effective exercises include:

  • Core Strengthening – Movements like bridges, planks, and dead bugs help support the pelvis and reduce strain on the SI joint.
  • Hip Mobility Work – Stretching the hip flexors and piriformis muscle can help relieve tension and improve movement.
  • Pelvic Alignment Techniques – Manual therapy from a physical therapist can help improve posture and correct misalignment.

2. Posture and Movement Modifications

Making small changes in daily habits can significantly reduce SI joint pain:

  • Avoid Prolonged Sitting – Stand up and move every 30 minutes to prevent stiffness.
  • Use Proper Lifting Techniques – Bend at the knees and keep the back straight when lifting heavy objects.
  • Optimize Sleep Positioning – If you sleep on your side, placing a pillow between your knees can help maintain proper pelvic alignment.

3. Regenerative Medicine and Injections

For patients who need additional pain relief, regenerative treatments can provide longer-lasting benefits than traditional steroid injections:

  • Prolotherapy – A dextrose (sugar water) injection helps strengthen the ligaments that support the SI joint.
  • Platelet-Rich Plasma (PRP) – This treatment uses healing factors from your own blood to reduce inflammation and promote tissue repair.
  • Bone Marrow-Derived Stem Cells – In severe cases, stem cells can help regenerate damaged tissue and improve joint function.

4. Supplements for Joint Health

Nutritional support can aid in recovery and long-term joint health:

  • Omega-3 Fatty Acids – Help reduce inflammation in the body.
  • Collagen and Vitamin C – Support ligament and cartilage repair.
  • Magnesium – Helps relax muscles and prevent cramping.

5. Bracing and Supportive Devices

Wearing an SI joint belt can provide extra stability, especially for individuals with significant joint laxity. However, it should be used in combination with strengthening exercises, not as a substitute for proper movement and stability training.

When Is Surgery Needed?

Surgery is rarely required for SI joint pain. In some cases, a surgeon may recommend SI joint fusion, a procedure that permanently locks the joint to reduce pain. However, this can create additional problems, such as reduced pelvic mobility and increased stress on the surrounding joints, including the lower back and hips. Because of these risks, non-surgical treatments should always be explored first.

Final Thoughts

SI joint pain is a common but frequently overlooked cause of lower back pain. It can mimic spinal conditions, but its symptoms and triggers are distinct. Fortunately, most cases can be effectively treated with non-surgical options, including physical therapy, regenerative medicine, and lifestyle modifications.

If you’ve been struggling with persistent back pain that hasn’t improved with traditional treatments, your SI joint could be the root cause. A proper diagnosis and targeted treatment plan can help you find relief and restore function.

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