When Back Pain Is Caused by Your Sacroiliac Joint: Signs and Treatment Options

Lower back pain is one of the most common reasons people seek medical care, yet identifying its exact cause can be challenging. While many people assume their discomfort comes from a herniated disc or arthritis in the spine, the sacroiliac (SI) joint is often an overlooked source of pain. Research suggests that the sacroiliac joint may account for up to 15-30% of chronic lower back pain cases, making it an important consideration for patients whose symptoms have not improved with traditional treatments.

Understanding the signs of sacroiliac joint dysfunction and knowing which treatment options are available can help patients find lasting relief while avoiding unnecessary procedures. Advances in minimally invasive pain management have also expanded the number of effective treatments available for SI joint pain.

What Is the Sacroiliac Joint?

What is the sacroiliac joint, and why is it important?

The sacroiliac joint is where the sacrum, the triangular bone at the base of the spine, connects to the iliac bones of the pelvis. There is one SI joint on each side of the body. These joints play a vital role by transferring weight and forces between the upper body and the legs while providing stability during walking, standing, bending, and lifting.

Although the SI joints move only slightly, they absorb shock and help maintain balance throughout everyday movements. When the joints become inflamed, injured, or unstable, they can become a significant source of lower back pain.

What Causes Sacroiliac Joint Pain?

What causes sacroiliac joint dysfunction?

Sacroiliac joint dysfunction occurs when the joint becomes irritated or no longer moves normally. Several conditions can contribute to SI joint pain, including:

• Arthritis
• Degenerative joint changes due to aging
• Pregnancy-related ligament stretching
• Falls or traumatic injuries
• Repetitive lifting or twisting
• Uneven leg length
• Previous lumbar spine surgery
• Inflammatory conditions such as ankylosing spondylitis

Sometimes SI joint dysfunction develops gradually over time, while in other cases it begins suddenly after an injury.

What Are the Signs That Your SI Joint May Be Causing Your Back Pain?

What symptoms commonly indicate sacroiliac joint dysfunction?

The signs of sacroiliac joint dysfunction often resemble other causes of lower back pain, making diagnosis difficult without a thorough evaluation.

Common symptoms include:

• Pain on one side of the lower back
• Pain over the buttock
• Pain that radiates into the hip or groin
• Discomfort extending into the upper thigh
• Pain that worsens after standing for long periods
• Increased pain when climbing stairs
• Difficulty transitioning from sitting to standing
• Pain when rolling over in bed

Unlike sciatica caused by nerve compression, SI joint pain usually does not extend below the knee, although some patients experience symptoms that feel similar to nerve pain.

How Is SI Joint Pain Different From Sciatica?

How can sacroiliac joint pain be distinguished from sciatica?

Because both conditions can cause pain near the buttocks and legs, they are frequently confused. However, SI joint pain typically originates directly over one side of the pelvis and often worsens with standing, walking, or climbing stairs.

Sciatica, on the other hand, is usually caused by compression of the sciatic nerve from a spinal condition such as a herniated disc. Sciatica often produces numbness, tingling, or burning pain that travels below the knee and into the foot.

A comprehensive physical examination helps physicians determine which condition is responsible for a patient’s symptoms.

How Is Sacroiliac Joint Dysfunction Diagnosed?

How do physicians diagnose SI joint pain?

Diagnosing SI joint dysfunction begins with reviewing the patient’s medical history and performing specialized physical examination maneuvers that place stress on the SI joint.

Additional diagnostic tools may include:

• X-rays
• MRI scans
• CT scans
• Diagnostic SI joint injections

Diagnostic injections are often considered the most reliable method for confirming the SI joint as the primary pain source. During the procedure, a local anesthetic is injected into the joint using image guidance. Significant temporary pain relief strongly suggests the SI joint is responsible for the symptoms.

What Non-Surgical Treatments Are Available?

What conservative treatments can help relieve SI joint pain?

Many patients improve without surgery through a personalized treatment plan.

Common non-surgical treatments include:

• Physical therapy focused on pelvic stabilization
• Anti-inflammatory medications when appropriate
• Activity modification
• Ice and heat therapy
• SI joint support belts
• Home stretching programs
• Lifestyle modifications to reduce joint stress

Improving core strength and hip stability often reduces excessive movement around the SI joint and helps prevent future flare-ups.

When Are SI Joint Injections Recommended?

How do SI joint injections help treat pain?

If conservative treatments do not provide sufficient relief, image-guided SI joint injections may be recommended.

These injections typically contain a corticosteroid and local anesthetic to reduce inflammation within the joint. Many patients experience weeks or months of improved function and decreased pain following treatment.

In addition to relieving symptoms, SI joint injections also provide valuable diagnostic information by confirming whether the joint is the source of pain.

What Happens If Injections No Longer Work?

What advanced treatment options are available for persistent SI joint pain?

Patients whose pain returns after injections may benefit from additional minimally invasive procedures.

Depending on the underlying cause, treatment options may include:

• Radiofrequency ablation for pain generated by surrounding nerves
• Platelet-rich plasma (PRP) therapy for carefully selected patients
• Minimally invasive SI joint fusion for severe joint instability that has not responded to conservative treatment

These procedures are generally considered only after comprehensive evaluation and failure of non-surgical therapies.

When Should You See a Pain Management Specialist?

When is it time to seek professional evaluation for SI joint pain?

Patients should consider seeing a pain management specialist if lower back pain:

• Persists longer than several weeks
• Interferes with walking or daily activities
• Continues despite rest and home care
• Frequently returns after temporary improvement
• Develops following an injury
• Limits work or recreational activities

Early diagnosis may prevent chronic pain from developing and allows treatment to begin before the condition worsens.

The Bottom Line

Why is recognizing sacroiliac joint pain important?

Recognizing when the sacroiliac joint is causing back pain is important because SI joint dysfunction often responds well to targeted treatment once properly diagnosed. While many patients assume all lower back pain originates from the spine, the SI joint is a common and treatable source of discomfort.

A comprehensive evaluation by an experienced pain management specialist can identify whether the SI joint is contributing to symptoms and help develop an individualized treatment plan. From physical therapy and injections to advanced minimally invasive procedures, today’s treatment options offer many patients significant pain relief and improved quality of life without the need for major surgery.