Pain low in your back, just off to one side near the dimple above your buttock, can make rolling over in bed, climbing stairs or getting out of the car surprisingly hard. That spot sits right over the sacroiliac (SI) joint, a common and often overlooked source of low back pain.
The good news is that SI joint pain relief usually comes from conservative care: calming the joint, then building the strength that supports it.
What the SI joints do
You have two sacroiliac joints, one on each side, where the base of your spine (the sacrum) meets the pelvis. Strong ligaments hold them tightly together, so they move only slightly. Their job is to transfer weight between your upper body and your legs and to absorb force when you walk, run and lift.
When an SI joint becomes inflamed or moves too much or too little, the problem is sometimes called SI joint dysfunction.
How sacroiliac joint pain feels
Sacroiliac joint pain has a few telltale features:
- Pain on one side of the low back or buttock, often just below the belt line
- Pain that may spread into the hip, groin or thigh, and occasionally farther down the leg
- Pain when standing up from sitting, climbing stairs or rolling over in bed
- Discomfort standing on one leg, such as when putting on pants
- Stiffness after sitting or lying still
These symptoms overlap with disc, nerve and hip problems, so a hands-on exam matters. Clinicians usually combine several movement tests, since no single test settles it. Our lower back pain page covers other common causes.
What irritates the SI joint
Common contributors include:
- A fall onto the buttock, or a jolt such as missing a step or a car accident
- Pregnancy, when hormones loosen ligaments and weight and posture shift
- Repetitive one-sided loading, such as running, golf or lifting on one side
- Arthritis of the joint
- A difference in leg length or the way you walk
- A past lower back fusion, which can add stress to the SI joints
Inflammatory arthritis such as ankylosing spondylitis can also affect these joints, often starting in early adulthood with morning stiffness that eases with movement.
SI joint pain relief you can try at home
For a mild flare, these steps often help:
- Stay gently active. Walking on level ground usually helps more than bed rest.
- Use ice or heat. Ice may calm a fresh flare, and heat may ease stiffness. Use whichever feels better.
- Avoid lopsided positions for now. Stand with weight on both feet, don’t sit cross-legged, and keep your knees together getting in and out of the car.
- Sleep with support. A pillow between your knees on your side, or under your knees on your back, can ease strain.
- Try a sacroiliac joint belt. Worn snugly around the hips, it may give short-term relief, especially during pregnancy.
- Consider short-term medicine, if your doctor or pharmacist says an over-the-counter pain reliever is safe for you.
Treatment options for SI joint pain
If home care isn't enough, lasting SI joint pain relief usually comes from combining a few approaches.
Physical therapy. Physical therapy builds strength in the glutes, core and hip muscles that stabilize the pelvis, along with exercises to restore comfortable movement.
Chiropractic care. Chiropractic for SI joint pain may include manipulation or mobilization of the joint, soft tissue work and home exercises. Some studies suggest manipulation may ease SI joint pain in the short term, though evidence is limited.
Medical massage. Easing tension in surrounding muscles may help you move more comfortably while you rebuild strength.
Physician care. For persistent pain, a physiatrist may recommend an image-guided injection, which can reduce pain for a period of time and help confirm the source. Surgery to fuse the joint is reserved for a small number of people with severe, lasting pain.
Physical Medicine & Rehabilitation of NY & CT (PMR) offers physical therapy, chiropractic care, medical massage and physiatry in one practice, so your plan can change as you improve. Learn more about our pain management and physiatry care.
When to see a doctor right away
Some symptoms can signal pressure on the nerves at the base of the spine. Call 911 or go to an emergency room if you have:
- New trouble controlling your bladder or bowels
- Numbness in the saddle area: the groin, buttocks or inner thighs
- One or both legs growing weaker
See a doctor the same day if back pain comes with fever. Make a prompt appointment if it follows a hard fall, wakes you at night or occurs with a history of cancer.
Frequently asked questions
What exercises should I avoid with SI joint pain?
During a flare, many people do better avoiding moves that load one leg at a time or twist the pelvis, such as deep lunges, step-ups and the breaststroke kick. Heavy lifting and high-impact exercise can also aggravate it. These usually aren't off-limits for good, and a therapist can help you add them back as your strength improves.
How long does SI joint pain last?
A flare often settles within a few days to a few weeks, especially with gentle activity and home care. Pain that keeps returning or lasts more than a few weeks deserves an exam, since targeted strengthening is often needed to address what keeps irritating the joint.
What helps SI joint pain during pregnancy?
A support belt, pelvic stabilizing exercises and gentle hands-on care may all help. The pain is common, because loosened ligaments, a growing belly and shifting posture put extra stress on the pelvis. Talk with your OB or midwife about new or severe pain, and learn more about our prenatal chiropractic care.
Request an appointment at PMR
If one-sided low back pain is making it hard to sit, sleep or stay active, our team can help find the source and build a plan around your goals. Request an appointment and we will contact you to schedule a visit at PMR of Danbury or PMR of Brewster.