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Sacroiliac Joint Dysfunction

February 18, 2015

One of the most common causes of low back and pelvic pain occurs with injuries to the sacroiliac (SI) joint and ligaments.  SI joint dysfunction is often difficult to diagnose, as the pain patterns are frequently mistaken for muscle sprains, hip bursitis or nerve irritation in the low back. 

Sacroiliac (SI) Anatomy & Function

The SI joint is located in the pelvis, linking the iliac bone (pelvis) to the sacrum (lowest part of the spine above the tailbone). This joint transfers weight and forces between your upper body and legs. It is an essential component for shock absorption to prevent impact forces during walking from reaching the spine.

The sacroiliac joint is stabilized by a network of ligaments and muscles, which also limit motion. The normal sacroiliac joint has a small amount of normal motion of approximately 2-4 mm of movement in any direction. The sacroiliac ligaments in women are less stiff than in men, allowing the mobility necessary for childbirth.

 Chief Complaints:

  • Low back pain (below L5)
  • Lower extremity pain (numbness, tingling, weakness)
  • Pelvis/buttock pain
  • Hip/groin pain
  • Unilateral leg instability (buckling, giving way)
  • Pain worse when standing and walking and eases when sitting or lying down
  • Pain with movements, such as standing up from a sitting position, turning in bed or twisting/turning

How is it Diagnosed?

When you see your physical therapist, the therapist will ask you questions about your current condition, such as:

  • When did the pain start?
  • What happened to cause the pain?
  • Have you experienced similar symptoms in the past?
  • Where is the pain located?
  • What specific movements/activities cause your pain?

A physical evaluation will then be conducted.  The therapist may examine the position of your spine, conduct strength tests of the hip, pelvic and lower extremity muscles, and gently perform movement tests to assess mobility and flexibility.  Specialized tests will also be performed to rule out any problems requiring other medical intervention. 

How can Physical Therapy Help?

Your physical therapist will then design a personalized treatment plan based on your evaluation and goals.  Treatment will include:

  • Manual therapy – includes soft tissue release or massage for tight/sore muscle groups, muscle energy techniques to correct pelvic/SI joint alignment, joint mobilizations
  • Flexibility exercises – stretching exercises to improve flexibility of tight muscles
  • Strengthening exercises – focused on weak muscles including the abdominals, pelvic floor and buttocks muscles
  • Body mechanics – recommendations for proper body mechanics while sitting, lifting and carrying objects will be made
  • Modalities – hot and cold treatments, electrical stimulation (uses electricity to target nerve fibers that send pain signals to the brain in order to provide pain relief)
  • SI belt – wearing a SI belt will provide support and stability to the SI joint during daily activities as your strength returns and flexibility improves


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