SIJ Pain: Why Your Hips & Lower Back May Be the Real Cause
Key insights: 60-second read
- 15-30% of low back pain involves the SI joint - but treating the SIJ alone can sometimes miss other important contributors.
- Hidden cause #1: Hip joint restrictions - when your hips lack mobility, your SIJ may compensate and become irritated.
- Hidden cause #2: Lower back dysfunction - stiff or overloaded segments can refer pain into the SIJ region.
- Test and retest - checking your symptoms before and after addressing the hips or back can give you useful information about what may be contributing.
- Mobility exercises for the hips and lower back - targeted stretches and ball work may help reduce SIJ symptoms without directly treating the joint.
If you're dealing with sacroiliac joint (SIJ) pain, you may have already tried a range of stretches, exercises or treatments aimed directly at the painful area.
And if you're still struggling, it's completely understandable to wonder whether you're missing something.
One thing I've found particularly useful in clinical practice is looking beyond the SI joint itself. Sometimes, the hips or lower back can be contributing to the way the area is moving and being loaded.
Research suggests that the SI joint can be a significant contributor to low back pain, with estimates commonly falling somewhere around 10-30% depending on the population and diagnostic method used.
But identifying the SI joint as a pain source can be challenging because pain from this region can overlap with symptoms coming from the lumbar spine, hip and surrounding tissues.
So in this article, I'll show you how I think about two commonly overlooked areas - the hips and lower back - and some simple ways you can assess whether they may be contributing to your symptoms.
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Understanding Sacroiliac Joint (SIJ) Pain
The sacroiliac joints are located where your spine connects to your pelvis and help transfer forces between your trunk and lower limbs.
It's also worth understanding that not all problems around the SI joint are the same:
- Sacroiliitis refers specifically to inflammation in the SI joint, which can occur with inflammatory conditions such as ankylosing spondylitis or arthritis.
- SI joint dysfunction is a broader clinical term used to describe pain associated with the SI joint and problems with how the joint and surrounding tissues are functioning or being loaded.
When you're experiencing pain around this area, it can be tempting to focus entirely on the painful joint. That's completely understandable.
However, sometimes the more useful question is: what else could be contributing to the way this area is moving and being loaded?
What Can Cause SIJ Pain?
SIJ pain can have a number of different contributors. Some of the more common ones include:
| Cause | Description | Common Symptoms |
|---|---|---|
| Arthritis | Both osteoarthritis and inflammatory arthritis, such as ankylosing spondylitis, can affect the SI joint. | Morning stiffness, progressive pain, limited mobility |
| Gait Problems | Changes in walking patterns, leg length differences, hip or knee issues, or previous injuries can alter how forces are transferred through the pelvis. | Pain that worsens with walking or standing |
| Injury or Trauma | Falls, car accidents, or sudden heavy lifting can irritate or injure SI joint ligaments and surrounding tissues. | Sharp, sudden pain following a specific incident |
| Pregnancy | Pregnancy-related changes, including altered loading and movement patterns, can increase stress around the SI joints. | Pain during and after pregnancy, worse with certain positions |
| Inflammatory Conditions | Conditions such as ankylosing spondylitis and other inflammatory diseases can involve the SI joints. | Systemic symptoms, flare-ups, other joint involvement |
Aggravating factors for SIJ pain can include prolonged sitting or standing, climbing stairs, running, turning in bed, or positions that place uneven stress through the pelvis.
The important thing to remember is that where you feel your pain doesn't always tell you exactly where the contributing problem is.
Could Hip Restrictions Be Contributing to Your SIJ Pain?
Your hip joint is the next major mobile joint below your SI joint. If your hip lacks normal range of motion, your SI joint may be forced to compensate more than it should, creating the potential for irritation and pain.
This is one of the areas I commonly look at clinically when someone presents with what appears to be SIJ pain.
The good news is that you don't necessarily need to guess whether your hip is contributing. You can often get some useful information by testing your movement or symptoms, addressing the hip, and then testing again.
Hip Joint Capsule Stretch
As shown in the video above, this three-part stretch addresses different aspects of hip mobility that may be contributing to your SIJ pain:
- Basic Setup: Begin on hands and knees. Extend the opposite leg back while keeping your shoulders and hips aligned. Shift your entire trunk, shoulders and hips together toward the side you're stretching until you feel gentle pressure around the side of your hip.
- External Rotation Variation: From the same starting position, rotate the working leg so your foot travels underneath you. Drop the back leg to stabilise, then shift your entire trunk toward the working side. You should feel this more around your back pocket area.
- Internal Rotation Variation: With the working leg extended back, rotate it so your foot moves away from you. Maintain trunk stability as you shift toward the working side. You'll typically feel this stretch more toward the front of your hip.
Pro Tip: Use the contract-relax technique: tense the muscles for 5-10 seconds, then relax to allow deeper stretching. Hold each position for 30 seconds to 2 minutes.
The important part isn't simply performing the stretch. Test and retest your symptoms. If your SIJ pain or movement changes after improving hip mobility, that gives you useful information that your hip may be contributing to the problem.
Could Your Lower Back Be Contributing to SIJ Pain?
Another area I commonly assess is the lower back, particularly around the base of the rib cage and upper lumbar spine.
Dysfunction in this region can sometimes refer pain into the SIJ area. When these spinal segments become stiff, restricted or overloaded through poor sustained postures and movement patterns, they may contribute to pain that is felt lower down around the sacroiliac region.
This is one reason I don't like to automatically assume that pain around the SI joint is coming exclusively from the SI joint itself.
Pain referral from the lumbar and thoracolumbar regions can overlap with the location of SIJ pain, so looking at the area as a whole can sometimes provide a much clearer picture.
Thoracolumbar Mobilisation with a Ball
As shown in the video above, this exercise helps identify and address areas around the base of your rib cage that may be contributing to SIJ symptoms:
- Positioning: Use a lacrosse ball or foam roller placed at the base of your rib cage, just to the side of the bony bumps down the middle. You can perform this lying on the floor or standing against a wall.
- Comparison: Compare both sides at the same spinal level. Notice which side feels stiffer, thicker or more restricted - not necessarily which is more painful.
- Mobilisation: Spend 1-2 minutes on the restricted side, allowing the ball to sink into the tissue. Use gentle breathing and occasional muscle tension followed by relaxation to encourage release.
- Systematic Approach: Move the ball slightly up or down your spine, looking for other restricted areas and continuing to compare left and right sides.
The goal isn't to find the most tender spots. Instead, look for areas that feel particularly restricted compared with the other side.
And once again, use the test-and-retest approach. Check your SIJ symptoms before the mobilisation, perform the technique, and then reassess the movement or symptom that was bothering you.
If there's a noticeable change, this could be a useful clinical clue worth addressing.
Key Takeaways for Managing SIJ Pain
If you're dealing with SIJ pain, you don't necessarily need to keep attacking the painful area with more and more exercises.
Sometimes, taking a step back and looking at how the hips, lower back, and pelvis are working together can provide a different perspective.
- Think beyond the SI joint - consider how adjacent areas such as the hips and lower back might be contributing.
- Test and retest - check your symptoms before and after each exercise to see whether it produces a meaningful change.
- Focus on mobility restrictions - don't assume that the most painful area is necessarily the area that needs to be treated.
- Address sitting-related issues - prolonged sitting can contribute to stiffness and reduced movement through the hips and spine.
- Look at the whole movement system - the SI joint doesn't function in isolation from the hips, lumbar spine and pelvis.
If you found this guide useful, please consider subscribing to the Your Wellness Nerd YouTube channel for more evidence-based insights on low back and pelvic health.
- Grant
Frequently Asked Questions
How do I know if my pain is from the SI joint or my hip?
A physiotherapist can perform specific tests, but a clue is that SIJ pain is often felt around the dimple area below your back, while hip pain may be felt deeper in the buttock or groin. The exercises above can also be useful as a test-and-retest approach: if working on your hip changes your SIJ symptoms, there may be a meaningful connection.
Can sitting too much cause SIJ pain?
Prolonged sitting can contribute to stiffness in the hips and lower back, which may alter how the pelvis and SI joint are loaded. Regular movement breaks and the stretches shown above can help counteract this.
How often should I do these exercises?
Start with once daily, focusing on the side that feels more restricted. Consistency matters more than duration. If symptoms worsen, reduce the intensity and consult a physiotherapist or other appropriate health professional.
One profound insight from this post
"If your hip lacks normal range of motion, your SI joint may be forced to compensate more than it should, leading to irritation and pain."
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