Sacroiliac joint pain is more common than most people realise, yet it is frequently missed or misdiagnosed. Research estimates that between fourteen and twenty-two percent of all low back pain presentations are related to the sacroiliac joint. Understanding where it comes from, what drives it, and how the condition is treated can make a real difference for people who have been struggling with persistent low back, pelvic or gluteal pain.
What Is the Sacroiliac Joint?
The sacroiliac joint, or SIJ, is the largest axial joint in the body. It connects the sacrum, the triangular bone at the base of the spine, to the two iliac bones of the pelvis. It is a large, irregularly shaped joint stabilised by some of the strongest ligaments in the body, and its primary job is to act as a shock absorber for the spine while transmitting load between the trunk and the lower limbs. When the ligaments that stabilise it are compromised or the area becomes irritated, SIJ pain can develop.
Who Gets Sacroiliac Joint Pain?
A range of factors can contribute to developing this condition. Pregnancy is a well-known trigger, as hormonal changes loosen the pelvic ligaments and alter load distribution. Lumbar spinal fusion surgery changes the mechanics of the lower back in ways that can stress the SIJ. Prolonged vigorous exercise, a fall or motor vehicle accident, leg length discrepancy, arthritis, hip pathology and infection are all recognised risk factors. In many cases, an abrupt change in training load or activity is what initially irritates the area.
What Sacroiliac Joint Pain Feels Like
The pain pattern can vary considerably between individuals. It is typically felt over the lower back and buttock, often on one side, and can refer into the groin, the outer hip, or down towards the sit bone. Some people describe a sharp pain with specific movements, while others notice more of a deep ache. Actions that involve rotation through the pelvis are often the most provocative: running, lateral movements, hopping, walking downstairs or uphill, and prolonged sitting are all common aggravating activities. Muscle spasm in the gluteal region is a frequent response to SIJ irritation.
How the Sacroiliac Joint Is Diagnosed
Diagnosis relies on a thorough history and a specific cluster of clinical tests. The SIJ test battery consists of five provocation tests: sacral compression, sacral distraction, thigh thrust, sacral thrust and the Gaenslen test. SIJ pain is considered likely when three or more of these tests are positive, and research shows this cluster approach has high sensitivity of ninety-four percent and specificity of seventy-eight percent. Imaging is used when red flags such as infection, fracture or malignancy need to be excluded, rather than as the primary diagnostic tool.
Acute Management: What to Do First
In the early, irritable phase, activity modification is the priority. Avoiding movements that place excessive twisting, shearing or rotation through the pelvis helps protect the SIJ while inflammation settles. This typically means modifying running, single-leg loading, heavy lifting and prolonged stair climbing. Anti-inflammatories, heat and soft tissue treatment can help manage pain and spasm in this phase. The goal is to find a level of activity that does not provoke symptoms, rather than stopping all movement.
Rehabilitation: Building Strength Around the Joint
Once acute irritation settles, progressive strengthening is central to lasting recovery. The target muscles are those that stabilise the pelvis and control movement at the SIJ: the deep core, the gluteal muscles, the hamstrings and the back extensors. Early exercises focus on building stability with minimal shear or rotational forces. A good starting point includes plank variations, banded glute bridges and side-lying clam exercises, all of which build core and hip strength in a controlled way. Once foundational strength is established and symptoms have settled, split-stance loading such as the Bulgarian split squat can be introduced progressively, starting with small ranges and monitoring how the patient responds. Our lower back pain physiotherapy and hip pain physiotherapy are both built around exactly this kind of graduated progression.
Common Questions
Is Sacroiliac Joint Pain the Same as Lower Back Pain?
Not exactly. It falls under the umbrella of lower back pain, but it has a specific source — the joint between the sacrum and the pelvis — rather than the lumbar spine or discs. Distinguishing it from other causes of low back pain matters because the treatment differs.
How Long Does It Take to Settle?
Recovery varies with the irritability of the SIJ and how consistently management is followed. Many people improve over several weeks to months with physiotherapy, activity modification and a progressive exercise programme. Flare-ups are common along the way and do not necessarily mean things are going backwards.
Can SIJ Pain Come Back?
Yes, especially if the contributing factors such as load management, training habits and movement patterns are not addressed. Building strength around the SIJ and managing load sensibly reduces the risk of recurrence.
Do I Need a Scan for Sacroiliac Joint Pain?
Not usually to make the diagnosis. A thorough clinical assessment with the provocation test battery is the primary diagnostic tool. Imaging is used to rule out red flag conditions rather than to confirm the source of symptoms.
How BeFit Can Help
At BeFit Training Physiotherapy, our physiotherapists assess and treat sacroiliac joint pain at our Edgecliff and Coogee clinics. We take a thorough history, apply the clinical test battery to confirm the diagnosis, and build a phased programme of activity modification and progressive strengthening tailored to your stage and goals. Every initial consultation runs for forty-five minutes, one-on-one, with a thorough assessment and a clear plan. No referral is required to book.
Book an appointment at BeFit Training Physiotherapy — no referral needed.
Edgecliff: (02) 9327 7749 | Coogee: (02) 7205 2805 | befittrainingphysio.com/book-now
Related Services
Learn more about our lower back pain physiotherapy, hip pain physiotherapy and physiotherapy in Sydney.
Further Reading
For more on managing back pain, see How to Get Rid of Low Back Pain for Good.
References
Falowski S, et al. A review and algorithm in the diagnosis and treatment of sacroiliac joint pain. J Pain Res. 2020.
Hoy D, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014.
Simopoulos TT, et al. Systematic review of the diagnostic accuracy and therapeutic effectiveness of sacroiliac joint interventions. Pain Physician. 2015.
Australian Physiotherapy Association. Clinical guidelines. physiotherapy.asn.au.
