Sacroiliac Joint Pain (SIJ): Causes, Symptoms & Treatment

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Sacroiliac joint pain (SIJ pain) is a common cause of back pain affecting the lower back, pelvis, buttock, groin, or upper thigh. The sacroiliac joints connect your spine to your pelvis and help transfer load during walking, standing, bending, and lifting.

When irritated or overloaded, sacroiliac joint pain can feel similar to lower back pain, sciatica, hip pain, or gluteal tendinopathy. A physiotherapist can help work out whether the sacroiliac joint is the main source of your symptoms and guide the right treatment plan.

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Quick Answer

Sacroiliac joint pain happens when the joint between the sacrum and pelvis becomes irritated, stiff, or unstable. It often causes buttock or low back pain and may feel similar to sciatica or hip pain, especially during walking, stairs, bending, or rolling in bed.

Common SIJ Pain Signs

Buttock or low back pain, often on one side
Pain with walking, stairs, standing on one leg, or rolling in bed
Symptoms that mimic sciatica, hip pain, or gluteal pain
Discomfort after prolonged sitting, standing, or twisting
Pain that settles when load and movement are better controlled

Sacroiliac joint pain location shown over the back of the pelvis — Typical Sacroiliac Joint Pain Location.

What Is Sacroiliac Joint Pain?

Sacroiliac joint pain occurs when the joint between the sacrum and pelvis becomes irritated, inflamed, stiff, or unstable. Even though the SIJ only moves a small amount, poor load transfer through this area can create significant pain with everyday movement.

The sacroiliac joints help absorb and transmit force between your trunk and legs. That is why SIJ pain often becomes more obvious during walking, single-leg loading, twisting, rising from a chair, or rolling in bed.

What Causes Sacroiliac Joint Pain?

Sacroiliac joint pain usually develops from either hypermobility (too much movement or poor control) or hypomobility (stiffness and reduced movement). In some people, both factors contribute over time.

Hypermobility and load-control problems

Weak core control
Weak gluteal and deep hip rotator muscles
Poor pelvic control during walking or single-leg tasks
Pregnancy-related ligament laxity
Sudden twisting, awkward lifting, falls, or sporting trauma

Hypomobility and stiffness

Joint stiffness or reduced pelvic rotation
Muscle tightness around the hips and lower back
Pelvic asymmetry
Inflammatory conditions such as ankylosing spondylitis

Common Symptoms of Sacroiliac Joint Pain

Sacroiliac joint pain commonly causes a deep ache or sharp pain in the buttock or lower back. Some people also feel pain in the groin, outer hip, or upper thigh, which is why it is sometimes confused with lumbar spine or hip conditions.

Deep buttock pain, often on one side
Lower back pain near the belt line
Pain with walking, climbing stairs, or standing on one leg
Pain when rolling in bed or turning
Discomfort after prolonged sitting or standing
Groin, hip, or lateral thigh referral
Symptoms that may worsen around menstruation in some people

Why Does Sacroiliac Joint Pain Feel Like Sciatica?

Sacroiliac joint pain can refer into the buttock or upper leg, so it may feel similar to sciatica. However, SIJ pain is usually more localised and does not always follow a clear nerve pattern below the knee.

This overlap is why a careful assessment matters. Your physiotherapist will compare the lumbar spine, pelvis, hip, and surrounding muscles to work out which structure is most likely responsible.

How Is Sacroiliac Joint Pain Diagnosed?

A physiotherapist diagnoses SIJ pain by combining your symptom history with movement testing and a cluster of sacroiliac provocation tests. They will also assess pelvic control, posture, gait, hip strength, and lower back movement.

Movement and loading tests
Pelvic stability and strength assessment
Postural and gait analysis
Palpation of the SIJ, hip, and lumbar region
Comparison with other causes of posture-related pain, disc pain, or hip pain

Imaging is not always required. It is more likely to be considered if symptoms persist, red flags are present, trauma is significant, or inflammatory disease is suspected.

Why Accurate Diagnosis Matters

Sacroiliac joint pain can overlap with lower back pain, sciatica, hip pain, and gluteal tendinopathy. Treatment works best when the main pain source and movement pattern are identified early.

How Is Sacroiliac Joint Pain Treated?

Most people respond well to a combination of pain reduction, exercise-based rehabilitation, load management, and movement retraining. Research suggests that manual therapy works best when combined with strengthening rather than used in isolation.

1. Pain reduction and symptom settling

Hands-on therapy to improve comfort and movement
Soft tissue treatment for surrounding muscle tension
Heat, ice, taping, or pacing strategies where appropriate
Short-term activity modification

2. Strength and stability rehabilitation

Core strengthening to improve pelvic control
Gluteal strengthening and hip rotator training
Pelvic floor activation where relevant
Functional movement retraining for walking, bending, and lifting

3. Load management and movement coaching

Improved sitting and standing posture
Safer bending and lifting mechanics
Walking pattern correction
Gradual return to work, sport, or exercise

4. External support when indicated

An SIJ belt may help some people with instability or pregnancy-related pelvic pain. You can view suitable SIJ braces and sacroiliac supports if external compression is likely to help.

How Long Does Sacroiliac Joint Pain Take to Settle?

Many people improve within 4 to 12 weeks when the diagnosis is accurate and treatment addresses both pain and load control. Recovery may take longer if symptoms have been present for months, if several body regions are involved, or if the underlying problem includes inflammatory disease, pregnancy-related change, or repeated overload.

Early treatment often helps reduce the risk of recurrent episodes. A guided program usually progresses from settling pain to rebuilding control, then restoring full activity tolerance.

What Else Can Be Mistaken for SIJ Pain?

Sacroiliac joint pain commonly overlaps with other conditions, especially when symptoms spread into the buttock, hip, or thigh. Related conditions that may need to be ruled in or out include:

What To Do Next

If your pain is affecting walking, sleep, work, exercise, or daily tasks, an assessment can help confirm whether the sacroiliac joint is involved and identify the best next steps. Early treatment may help reduce ongoing irritation and prevent repeated flare-ups.

Sacroiliac Joint Pain FAQs

Can sacroiliac joint pain feel like sciatica?

Yes. SIJ pain can refer into the buttock or upper leg and may feel similar to sciatica. The difference is that sacroiliac pain is often more localised and is commonly aggravated by pelvic loading, rolling in bed, or standing on one leg.

Is walking good for SIJ pain?

Gentle walking is often helpful because it keeps the area moving and may reduce stiffness. However, if walking triggers increasing pain, you may need load modification, stride changes, or specific rehabilitation before building your tolerance again.

Should I wear an SIJ belt?

An SIJ belt may help some people with hypermobility, instability, or pregnancy-related pelvic pain. It is usually a short-term support rather than a complete solution, and it works best when combined with strengthening and movement retraining.

How long does SIJ pain take to settle?

Many people improve within 4 to 12 weeks with the right diagnosis, exercise, load management, and movement coaching. Recovery can take longer if symptoms are persistent, recurrent, or linked to multiple contributing factors.

When should I see a physiotherapist?

You should seek assessment if pain affects walking, standing, sleep, work, sport, or daily function, or if symptoms continue for more than a few days. Early assessment helps rule out other causes and can speed up the right treatment.

Can exercise help sacroiliac joint pain?

Yes. Exercise is one of the most useful long-term strategies because it improves pelvic control, hip strength, and load transfer. A tailored program is usually more effective than generic stretching alone.