Sacroiliac Joint Pain: Symptoms, Causes & Treatment

Woman holding her lower back with sacroiliac joint pain in a physiotherapy clinic

Sacroiliac joint pain may cause discomfort around the lower back, buttock and posterior pelvis.

Sacroiliac joint pain, often called SIJ pain, can cause discomfort around the lower back, pelvis, buttock, groin or upper thigh. The sacroiliac joints connect the sacrum at the base of your spine to the two sides of your pelvis.

SIJ pain can feel similar to lower back pain, sciatica or hip pain. A physiotherapy assessment can help determine whether the SIJ region is a likely contributor and identify other possible sources of your symptoms.

Choose your clinic or appointment pathway

Appointment Options View Phone Numbers

Physiotherapy · Remedial Massage · Exercise Physiology · Private health funds and HICAPS

Quick Answer

Sacroiliac joint pain usually causes discomfort near one side of the belt line or buttock. Symptoms may increase with walking, stairs, standing on one leg, rolling in bed, rising from a chair or remaining in one position for too long. Because several back and hip conditions can cause similar pain, a careful assessment matters.

Common SIJ Pain Patterns

Buttock or low back pain, often stronger on one side
Pain near the dimples at the back of the pelvis
Symptoms during walking, stairs or single-leg loading
Pain when rolling in bed, turning or rising from a chair
Discomfort after prolonged sitting or standing
Pain that may spread towards the groin, hip or upper thigh

What Is Sacroiliac Joint Pain?

Sacroiliac joint pain describes pain thought to arise from, or be strongly associated with, the sacroiliac joint region. Each SIJ sits between the sacrum and one side of the pelvis.

The joints move only a small amount. However, they help transfer load between your trunk and legs during walking, bending, lifting and changes of direction. Pain may develop when this region becomes irritated or when the surrounding muscles and movement patterns do not manage load well.

SIJ-region pain does not mean that the pelvis is permanently “out of place”. Symptoms often reflect a combination of local sensitivity, movement, muscular capacity, activity load and other health factors.

What May Contribute to Sacroiliac Joint Pain?

There is rarely one cause. Symptoms may begin after a clear event or build gradually as several factors combine.

A fall, collision or direct impact involving the pelvis
Awkward lifting, twisting or a sudden change of direction
Repeated uneven loading during work, walking or sport
A rapid increase in exercise or activity volume
Reduced hip, trunk or lower-limb capacity
Poor tolerance for prolonged sitting or standing
Pregnancy-related changes in load and ligament support
Previous lumbar spine, hip or pelvic symptoms
Inflammatory conditions affecting the sacroiliac joints

Finding a contributing factor does not always prove that it caused the pain. Your assessment should consider the full symptom pattern rather than relying on one posture, muscle or movement finding.

What Are the Symptoms of Sacroiliac Joint Pain?

The most common symptom is pain near the back of the pelvis or upper buttock. It may feel like a deep ache, a sharp catch or a localised area of tenderness.

Pain close to one side of the belt line
Buttock pain that is more noticeable on one side
Discomfort when walking or taking longer steps
Pain during stairs or standing on one leg
Symptoms when rolling in bed or getting out of bed
Pain after sitting or standing for a long time
Discomfort with bending, lifting or twisting
Pain extending towards the groin, outer hip or upper thigh

Pain, tingling, numbness or weakness that travels well below the knee may suggest greater involvement of a lumbar nerve and needs careful assessment.

Why Can SIJ Pain Feel Like Sciatica?

Both conditions can cause buttock and upper-leg pain. However, sciatica usually involves irritation or sensitivity of a lumbar nerve root. It may produce pain, pins and needles, numbness or weakness further down the leg.

SIJ-region pain is often more localised near the posterior pelvis. It may increase with rolling in bed, stairs, walking, standing on one leg or moving between sitting and standing.

These patterns can overlap. Therefore, symptoms alone may not identify the source with certainty.

How Is Sacroiliac Joint Pain Assessed?

A physiotherapist assesses whether the SIJ region is a likely contributor by considering your history, symptom location and response to movement. No single physical test confirms SIJ pain.

An assessment may include:

Lumbar spine and hip movement testing
A cluster of sacroiliac pain-provocation tests
Walking, stair and single-leg tasks
Hip, trunk and lower-limb strength testing
Balance and pelvic load-control tasks
Neurological tests when leg symptoms are present
Screening for trauma, inflammatory disease or other warning signs

The assessment should also compare other possible sources, including the lumbar spine, hip joint, gluteal tendons and nearby muscles.

Will I Need a Scan?

Imaging is not needed for most uncomplicated SIJ-region pain. A scan may be considered when there has been significant trauma, symptoms are unusual or persistent, inflammatory disease is suspected, or the result could change medical management.

Standard imaging does not always identify the source of common mechanical pain. Your clinical assessment remains important even when imaging has already been completed.

Sacroiliac joint pain single-leg pelvic load test with physiotherapist

Single-leg testing can help assess how the trunk, pelvis and hip manage load.

Why the Differential Diagnosis Matters

SIJ pain can overlap with lower back, hip, gluteal and nerve-related conditions. A careful assessment helps avoid treating the wrong area or relying on an exercise, stretch or support that does not match the main problem.

What Else Can Feel Like Sacroiliac Joint Pain?

Several conditions can cause similar pain around the buttock, pelvis, hip or upper thigh.

Lower back pain with referred pain into the buttock
Sciatica or lumbar nerve irritation
Hip joint pain
Gluteal tendinopathy
Greater trochanteric pain syndrome
Proximal hamstring or deep gluteal pain
Pregnancy-related pelvic girdle pain
Sacral stress injury or fracture after relevant trauma or loading
Inflammatory sacroiliitis or axial inflammatory disease

When Could Inflammatory Back Pain Be Involved?

Medical assessment may be appropriate when buttock or lower back pain occurs with prolonged morning stiffness, regular night pain, alternating buttock pain or symptoms that improve after getting up and moving.

Other relevant features include psoriasis, inflammatory bowel disease, a history of eye inflammation or a family history of inflammatory spinal disease.

How Can Physiotherapy Help SIJ Pain?

Physiotherapy treatment depends on the likely pain source, the activities that trigger symptoms and the factors found during assessment. Care should match the individual rather than follow one standard SIJ program.

Settle Pain and Maintain Useful Movement

Early management may include temporary changes to aggravating activities while maintaining comfortable movement. Complete rest is rarely the best long-term strategy.

Modify painful walking, lifting or exercise loads
Use comfortable positions and frequent position changes
Continue gentle movement within a tolerable range
Apply heat or cold when it provides short-term relief
Use manual therapy when it improves movement or comfort

Build Trunk, Hip and Lower-Limb Capacity

Exercise may help improve confidence and the ability to manage load through the pelvis. The program should reflect your symptoms and current capacity.

Core and trunk strengthening
Gluteal and hip strengthening
Single-leg balance and control exercises
Walking and stair progressions
Graded lifting and work-specific exercise
Gradual return to gym, running or sport

Retrain Aggravating Tasks

Your physiotherapist may modify how you approach walking, stairs, lifting, turning or prolonged positions. Small changes can reduce irritation while your capacity improves.

The aim is not to maintain one perfect posture. Instead, treatment should improve your tolerance for a range of positions and activities.

Can an SIJ Belt Help?

An SIJ belt may help some people by providing firm compression around the pelvis. It may be useful during painful walking, pregnancy-related pelvic girdle pain or activities that feel less comfortable without support.

A belt should sit low around the pelvis rather than around the waist. It should feel supportive without causing numbness, skin irritation or increased pain.

Woman wearing a Serola SIJ belt low around the pelvis

The Serola SIJ Belt sits low around the pelvis and provides adjustable compression.

An SIJ belt is usually one part of management rather than a complete solution. Exercise, activity progression and treatment of other contributing factors may still be needed.

How Long Does Sacroiliac Joint Pain Take to Improve?

Recovery time varies. A recent and uncomplicated episode may improve over several weeks. Persistent symptoms, pregnancy-related pelvic girdle pain, inflammatory disease, major trauma or overlapping back and hip conditions may take longer.

Progress often follows three broad stages:

1. Settle Irritation

Adjust painful loads, maintain comfortable movement and improve sleep or daily positioning.

2. Rebuild Capacity

Develop strength, control and tolerance through the trunk, hips and lower limbs.

3. Return to Activity

Progress walking, stairs, lifting, work, gym or sport according to symptoms and goals.

Progress is rarely perfectly linear. Short flare-ups can occur when activity changes. Your overall trend and function are usually more useful than one painful day.

What Can You Do at Home?

Change position regularly rather than staying still for long periods
Continue comfortable walking if symptoms do not steadily increase
Temporarily reduce tasks that clearly flare the pain
Use shorter strides or shorter walks if walking is painful
Keep loads close to your body when lifting
Avoid repeatedly testing painful movements throughout the day
Build activity gradually rather than returning at full volume

Generic stretches do not suit everyone. Stop an exercise if it causes sharp pain, increasing leg symptoms, numbness or weakness.

When Should You Seek Urgent Medical Care?

Seek urgent medical assessment if back, pelvic or buttock pain occurs with:

Loss of bladder or bowel control
Numbness around the groin or saddle area
Progressive leg weakness
A major fall, collision or other significant trauma
Fever, chills or feeling seriously unwell
Unexplained weight loss
Severe and constant night pain
A history of cancer with new and unexplained pain

People with osteoporosis, prolonged steroid use or a recent increase in high-impact loading should seek assessment after sudden severe pelvic or lower back pain.

Related Sacroiliac Joint Information

Sacroiliac Joint Pain FAQs

Can sacroiliac joint pain feel like sciatica?

Yes. SIJ pain can spread into the buttock or upper thigh and may feel similar to sciatica. Sciatica is more likely to include nerve-related pain, tingling, numbness or weakness that travels further down the leg.

Is walking good for SIJ pain?

Gentle walking is often suitable when symptoms remain manageable. Shorten the distance or reduce your stride if pain increases. Stop and seek advice if walking causes progressive leg pain, numbness or weakness.

Should I wear an SIJ belt?

An SIJ belt may provide short-term support for some people, including those with pregnancy-related pelvic pain or discomfort during walking. It should sit low around the pelvis and should not cause numbness, skin irritation or increased pain.

How long does SIJ pain take to settle?

Recovery varies. Some recent episodes improve within several weeks, while persistent pain or symptoms linked with trauma, pregnancy, inflammatory disease or overlapping hip and back conditions may take longer.

When should I see a physiotherapist?

Consider an assessment when pain affects walking, sleep, work, exercise or daily tasks, or when symptoms are not improving. Seek medical care sooner if significant trauma, fever, progressive weakness or bladder or bowel symptoms are present.

Can exercise help sacroiliac joint pain?

Exercise may help improve strength, load tolerance and confidence. The right exercises depend on your symptoms, current ability and whether the main contributor comes from the SIJ region, lumbar spine, hip or another structure.

What To Do Next

If pelvic or buttock pain is affecting walking, sleep, work or exercise, a physiotherapy assessment can help identify the most likely source and guide a practical treatment plan.

Book an assessment if symptoms persist, recur or limit normal activity.
Seek medical care promptly if you have significant trauma, fever, progressive weakness or bladder or bowel changes.
Discuss an SIJ belt when pelvic compression makes walking or daily activity feel more comfortable.