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Common Causes of SIJ & Buttock Pain

John Miller Physiotherapist Erin Runge Physiotherapist
Article by John Miller & Erin Runge
Common causes of SIJ and buttock pain assessed during pelvic weight-shift movement

Assessing pelvic control and buttock pain patterns.

What are the common causes of SIJ and buttock pain?

Common causes of SIJ and buttock pain include sacroiliac joint pain, sciatica, piriformis syndrome, gluteal tendinopathy, pregnancy-related pelvic pain, and less commonly bone stress or fracture problems. Because several conditions can refer pain into the buttock, an accurate assessment is important before choosing treatment.

Buttock pain is often blamed on the SIJ, but the true source may come from the lower back, deep buttock muscles, hip tendons, irritated nerves, or the pelvic bones. This page outlines the main patterns so you can better judge what may be contributing to your symptoms and when to seek help.

Quick summary

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Quick Pattern Check

Buttock pain can come from several nearby structures. Your symptom pattern can give useful clues, but it does not replace an assessment.

  • SIJ pain: often one-sided, close to the low back dimples or upper buttock.
  • Sciatica: more likely when pain travels below the knee with tingling or numbness.
  • Piriformis syndrome: often feels deep in the buttock and may worsen with sitting.
  • Gluteal tendinopathy or GTPS: usually affects the outer hip and can spread into the buttock.
  • Bone stress or fracture: more concerning when pain is constant, severe, or affects walking.

Common causes of SIJ & buttock pain

1. Sacroiliac joint pain

The sacroiliac joints sit between the sacrum and pelvis. When irritated, they can produce one-sided buttock pain, lower back pain, groin discomfort, or pain that feels like a “catch” when turning in bed, climbing stairs, or standing after sitting. Read more about sacroiliac joint pain and our related page on SIJ pain treatment options.

2. Pregnancy-related pelvic or buttock pain

Hormonal changes, altered load through the pelvis, and changing trunk control can all increase stress across the SIJ and surrounding tissues during pregnancy. This can lead to deep buttock pain, pelvic aching, and pain with walking, stairs, or turning in bed. See pregnancy back pain for more detail.

3. Deep buttock muscle pain

Several muscles can refer pain into the buttock. Piriformis syndrome may irritate the sciatic nerve and cause deep buttock pain with sitting or walking. Reduced hip core control or poor trunk control may also overload the buttock region. Some people also notice temporary soreness after unaccustomed exercise due to delayed onset muscle soreness (DOMS).

4. Lateral hip conditions that spread into the buttock

Not all buttock pain comes from the SIJ. Gluteal tendinopathy, greater trochanteric pain syndrome, and trochanteric bursitis commonly cause pain over the outer hip that may spread into the upper buttock. This pattern often worsens with lying on the sore side, walking, hills, or stairs.

5. Nerve-related causes

If your pain shoots down the leg, burns, tingles, or causes numbness, the pain may be nerve-related rather than purely joint-based. Common examples include sciatica, general nerve pain, and a pinched nerve. Healthdirect also provides a helpful overview of sciatica symptoms and causes.

6. Bone-related causes

Bone pain is less common, but it is important to exclude when symptoms are severe or do not settle. Relevant causes include osteoporosis, fractures, and stress fractures involving the pelvis or sacrum. These causes are more concerning when pain is constant, night pain is present, or walking becomes difficult.

SIJ and buttock pain movement screen comparing lower back hip and pelvic control

Checking how the lower back, pelvis and hip work together.

Why can SIJ and buttock pain feel similar?

The lower back, SIJ, hip, deep buttock muscles, and nearby nerves sit close together and can refer pain into similar areas. That is why one-sided buttock pain does not always mean the SIJ is the true source. A physiotherapist may assess your back, pelvis, hip movement, strength, load tolerance, and nerve signs to narrow the cause and guide the right management plan.

When should you seek help for buttock pain?

Seek assessment if your pain lasts more than a few days, keeps returning, travels below the knee, causes pins and needles, or makes walking, sitting, stairs, or sleep difficult. Urgent medical review is sensible if pain follows a significant fall, you cannot weight-bear, you have marked weakness, bladder or bowel changes, fever, or unexplained weight loss.

Not Sure If It Is SIJ Pain?

That is common. SIJ pain, sciatica, piriformis syndrome, gluteal tendinopathy, hip pain and lower back pain can all overlap.

A physiotherapist may assess your lower back, pelvis, hip movement, nerve signs, strength and load tolerance. This helps match treatment to the most likely cause.

SIJ and buttock pain recovery with supported step-up pelvic control exercise

Building confident pelvic control during recovery.

Related articles

Common questions about SIJ and buttock pain

What are the common causes of SIJ and buttock pain?

Common causes include sacroiliac joint pain, sciatica, piriformis syndrome, gluteal tendinopathy, pregnancy-related pelvic pain, and less commonly bone stress or fracture problems. The lower back, pelvis, hip, buttock muscles and nearby nerves can refer pain into similar areas.

Can SIJ pain cause buttock pain?

Yes. SIJ pain commonly causes one-sided buttock pain and may also refer into the lower back, groin, or upper thigh. However, several other conditions can copy this pattern, so an assessment helps separate SIJ pain from hip, back, or nerve-related causes.

Is buttock pain always sciatica?

No. Sciatica is only one possible cause. Buttock pain can also come from the SIJ, piriformis, gluteal tendons, bursitis, pregnancy-related pelvic pain, or bone stress. Sciatica becomes more likely if pain travels down the leg with tingling, numbness, or nerve-type pain.

What is the difference between SIJ pain and piriformis syndrome?

SIJ pain often feels close to the dimples of the low back or upper buttock and may worsen with rolling, stairs, or standing from sitting. Piriformis syndrome usually causes deeper buttock pain and may irritate the sciatic nerve, especially with sitting or prolonged walking.

When is buttock pain more serious?

Buttock pain deserves prompt review if it follows trauma, causes major walking difficulty, is associated with fever, unexplained weight loss, severe night pain, major weakness, or bladder and bowel changes. These patterns need quicker medical assessment.

What to do next

If you are unsure whether your pain is coming from the SIJ, lower back, buttock muscles, or hip, a clear assessment can help. The aim is to identify the real pain source, rule out the more serious possibilities, and match treatment to your symptoms, movement pattern, and daily loads.

Depending on the cause, treatment may include load modification, mobility work, strength and control exercises, nerve symptom management, taping or support, and a staged return to walking, work, exercise, or sport.

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These SIJ support products are commonly used by our physiotherapists to help reduce SIJ pain, improve comfort, and support your recovery at home.

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References

  1. Al-Subahi M, Alayat M, Alshehri MA, et al. The effectiveness of physiotherapy interventions for sacroiliac joint dysfunction: a systematic review. J Phys Ther Sci. 2019;31(12):1018-1024.
  2. Probst D, Stout A, Hunt D. Piriformis Syndrome: A Narrative Review of the Anatomy, Diagnosis, and Treatment. PM&R. 2019;11(S1):S54-S63.
  3. Mellor R, Grimaldi A, Wajswelner H, et al. Exercise and load modification versus corticosteroid injection versus wait and see for gluteal tendinopathy: a randomised clinical trial. BMJ. 2018;361:k1662.
  4. Lee A, Gupta M, Boyinepally K, Stokey PJ, Varlotta G. Sacroiliitis: A Review on Anatomy, Diagnosis, and Treatment. Pain Res Manag. 2022;2022:3283296.
  5. Newman DP, Soto AT. Sacroiliac Joint Dysfunction: Diagnosis and Treatment. Am Fam Physician. 2022;105(3):239-248.

SIJ Pain Treatment: Sacroiliac Joint & Buttock Pain Options

John Miller Physiotherapist Erin Runge Physiotherapist
Article by John Miller & Erin Runge
SIJ pain treatment glute bridge pelvic control exercise

Assessing SIJ load transfer and pelvic control.

SIJ pain treatment works best when it matches the likely source of your symptoms. Buttock pain can come from the sacroiliac joint (SIJ), lower back, hip or nearby soft tissues. A physiotherapist can assess these areas and then match treatment to your symptoms, activity level and goals.

Many people improve with a combination of activity changes, progressive exercise and hands-on treatment when appropriate. However, conditions such as ankylosing spondylitis, hip problems and referred lower back pain can feel similar. For that reason, assessment is useful when symptoms persist or keep returning.

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What’s the Best Treatment for SIJ and Buttock Pain?

There is no single treatment that suits every person with SIJ-region pain. Management usually progresses from reducing an irritable load to rebuilding movement, strength and confidence.

Your physiotherapist may also assess your hips, lower back and nearby muscles because several conditions can produce similar buttock pain. The aim is to identify the most useful starting point rather than assume the SIJ is always responsible.

  1. 1. Settle Symptoms and Adjust Load

    Early treatment aims to reduce pain and sensitivity without unnecessarily stopping all activity. Heat or ice may help some people during a flare-up, particularly after prolonged sitting or activity.

    Some people use pain-relief or anti-inflammatory medicines during a flare-up. Ask your pharmacist or GP whether these are suitable for you, particularly if you take other medicines or have relevant medical conditions.

    If symptoms increase with standing, rolling in bed, stairs or prolonged sitting, your physiotherapist may suggest temporary activity changes and easier ways to manage daily tasks.

    For some people, taping or a sacroiliac belt can provide short-term support. During pregnancy-related pelvic girdle pain, pacing and a support belt may also be considered when appropriate.

  2. 2. Restore Movement and Pelvic Control

    As symptoms settle, rehabilitation usually shifts towards controlled movement around the trunk, hips and pelvis. Exercises may target the gluteal muscles, hip stabilisers, trunk muscles and hamstrings depending on your assessment.

    A core stability program may form part of this stage. You can also review these core stability exercises for examples of commonly used progressions.

    Start at a level you can control and progress gradually. Regular, manageable exercise is usually easier to build on than large increases that repeatedly provoke symptoms.

SIJ pain treatment glute bridge pelvic control exercise

Glute bridge training for hip and pelvic control.

  1. 3. Rebuild Walking, Work, Sport and Training

    Once symptoms are more manageable, the next step is rebuilding tolerance for the activities that matter to you. These may include lifting, longer walks, hills, stairs, running, work tasks or gym training.

    Your physiotherapist may use gait analysis or broader biomechanical assessment when walking or movement patterns appear relevant to your symptoms.

    Progress one variable at a time where practical. For example, increase walking duration, hills or resistance gradually and adjust the next step according to how your symptoms respond.

  2. 4. Maintain Strength and Reduce Future Flare-Ups

    Recurring symptoms may be influenced by changes in activity, strength, movement tolerance or repeated loading. Once you are moving well again, maintaining a manageable amount of strength and activity can help you stay prepared for daily, work and sporting demands.

    If your symptoms tend to appear when training volume increases, you may also find our injury prevention programs useful.

How Do You Know if Your Pain Is Coming From the SIJ?

SIJ-region pain can feel like one-sided buttock or low back pain. Some people notice symptoms during stairs, rolling in bed, walking, standing from sitting or changing position.

However, symptoms in this area can also come from the hip, lumbar spine, nerves or surrounding muscles. For example, piriformis syndrome and gluteal tendinopathy can produce buttock or nearby hip pain.

A physiotherapist combines your history, movement assessment and several SIJ provocation tests. No single clinical test confirms SIJ pain. A negative group of provocation tests can make the SIJ less likely to be the main pain source, while positive tests need to be interpreted alongside the rest of your assessment.

Imaging is not routinely able to confirm mechanical SIJ pain by itself. Your GP may organise imaging or specialist review when your history suggests another cause such as inflammatory disease, fracture, infection or another medical condition.

For another plain-language overview, see Cedars-Sinai’s sacroiliac joint dysfunction guide.

Lower Back Pain

Review common sources of back and buttock pain that may overlap with SIJ symptoms.

Hip Pain

Explore hip conditions that can produce pain around the buttock, pelvis or groin.

Piriformis Syndrome

Learn how deep buttock pain can arise from tissues around the back of the hip.

SIJ pain treatment step-up pelvic control recovery exercise

Step-up training to rebuild strength and load tolerance.

SIJ Pain Treatment FAQs

What causes SIJ pain?

SIJ-region pain may start after a fall, twisting or lifting episode, pregnancy-related pelvic girdle pain, inflammatory joint disease or a change in activity. However, pain from the lower back, hip or nearby soft tissues can feel similar, so persistent symptoms benefit from assessment.

How is SIJ pain diagnosed?

A physiotherapist combines your history, movement assessment and several SIJ provocation tests. No single test confirms SIJ pain. A negative group of tests can make the SIJ less likely to be the main pain source, while positive findings need to be considered alongside the rest of your assessment. Imaging may be useful when another condition is suspected.

What is the best SIJ pain treatment?

Treatment depends on the likely cause and your individual presentation. It may include temporary activity changes, progressive hip and trunk exercise, movement retraining and hands-on treatment when appropriate. Rehabilitation should then build towards the walking, work, exercise or sporting activities that matter to you.

Can exercise help with SIJ pain?

Exercise can help many people with SIJ-region pain. A graded program may improve hip and trunk strength, movement control and tolerance to everyday or sporting loads. The starting level and progression should match your symptoms and assessment findings.

Do SIJ belts help?

An SIJ belt may provide short-term support for some people during walking, standing or position changes. It is usually considered an adjunct rather than a stand-alone treatment and may be combined with exercise and gradual activity progression.

When should I see a GP for buttock or SIJ pain?

Seek medical advice promptly if buttock or SIJ-region pain follows significant trauma, occurs with fever or unexplained weight loss, causes progressive numbness or weakness, or produces severe or worsening night pain. Seek urgent medical assessment for new bladder or bowel control problems, numbness around the saddle area or rapidly worsening leg weakness.

What to Do Next

If SIJ or buttock pain keeps returning, start with an assessment rather than assuming the SIJ is the only possible source. A physiotherapist can assess your lower back, pelvis, hips and movement, then build a treatment plan around the activities you want to return to.

While symptoms settle, stay active within tolerable limits where appropriate and note which movements or loads consistently aggravate the problem. Your rehabilitation can then progress strength, movement control and activity gradually.

For more information about the condition itself, read our Sacroiliac Joint Pain guide.

Choose your clinic and appointment pathway

Select a PhysioWorks clinic to continue to live booking, an appointment request or reception assistance.

Not sure what to choose? Compare appointment types
View all clinic locations and phone numbers

SIJ Support Products

These SIJ support products are commonly used by our physiotherapists to help reduce SIJ pain, improve comfort, and support your recovery at home.

View all SIJ support products

Follow PhysioWorks

Get physiotherapy tips, exercise videos, recovery advice and blog updates.

References

  1. Saueressig T, Owen PJ, Diemer F, Zebisch J, Belavy DL. Diagnostic accuracy of clusters of pain provocation tests for detecting sacroiliac joint pain: systematic review with meta-analysis. J Orthop Sports Phys Ther. 2021;51(9):422-431. doi:10.2519/jospt.2021.10469.
  2. Trager RJ, Baumann A, Rogers H, Tidd J, Orellana K, Preston G, Baldwin K. Efficacy of manual therapy for sacroiliac joint pain syndrome: a systematic review and meta-analysis of randomized controlled trials. J Man Manip Ther. 2024;32(6):1-12. doi:10.1080/10669817.2024.2316420.
  3. Janapala RN, Knezevic E, Knezevic NN, et al. Systematic review and meta-analysis of the effectiveness of radiofrequency ablation of the sacroiliac joint. Curr Pain Headache Rep. 2024;28(5):335-372. doi:10.1007/s11916-024-01226-6.
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