Sacroiliac (SI) Joint Dysfunction/Pain

Sacroiliac (SI) joint dysfunction refers to pain arising from the joints that connect the pelvis to the lower spine. Pain occurs when these joints move too much (hypermobility) or too little (hypomobility), leading to inflammation, stiffness, and altered load transfer. Symptoms often mimic sciatica, making diagnosis challenging.

Common Symptoms

Pain Characteristics

  • Location:
    Lower back, buttocks, hips, groin, thighs, and occasionally radiating down the leg to the foot

  • Type of pain:
    Dull ache, sharp or stabbing pain, or tingling/numbness

  • Radiation/Referred Pain:
    In few cases it may spread into the buttock, hip, or thigh

Aggravating Factors

  • Prolonged sitting or standing

  • Transitioning from sitting to standing

  • Climbing stairs

  • Bending forward or twisting

  • Sleeping on the affected side

  • During menstruation

     

Other Features

  • Morning stiffness lasting more than one hour

  • Feeling of instability, weakness, or leg buckling

  • Stiffness after prolonged rest or inactivity

     

Causes & Risk Factors

  • Trauma: Falls, road traffic accidents, or direct pelvic injuries

  • Muscle imbalances: Weak core, gluteal, or pelvic stabilisers

  • Leg length discrepancy

  • Pregnancy and childbirth: Hormonal laxity and increased pelvic load

  • Repetitive strain: Occupations or sports involving repetitive loading

  • Obesity: Increased mechanical stress on the SI joints

  • Underlying conditions:

    • Osteoarthritis

    • Inflammatory arthritis

       

Diagnosis

Diagnosis is primarily clinical, based on:

  • Detailed history

  • Physical examination

  • SI joint provocation tests

 

Blood test: Your clinician might request for Blood test if any Rheumatoid Arthritis or Inflammatory Arthritis is suspected to rule out ankylosing spondylitis.

Imaging (X ray/MRI) can be considered if any Sacroiliitis is suspected.

Treatment Options

First-Line (Conservative Management)

  • Patient education and activity modification

  • Physiotherapy:

    • Core and gluteal strengthening

    • Pelvic and hip mobility work

  • Pelvic stabilisation belts (selected cases)

  • Anti-inflammatory medications (as prescribed)

  • Hot water bottle/Topical pain relief gel for relaxing muscles.

  • Soft Tissue Release or massage help in reducing secondary muscle stiffness.

Advanced Treatments (If Symptoms Persist)

  • Image-guided diagnostic or therapeutic injections

  • Radiofrequency ablation (nerve pain modulation)

Surgical Treatment: SI joint fusion (arthrodesis): Rare and reserved for severe, refractory cases where conservative and interventional treatments fail

Physiotherapy Rehab Exercises

Consider Pregnancy Pillow for better positioning at night