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.

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.

3. 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.

4. 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.

SIJ Pain Treatment FAQs

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.

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.