Root Causes of SIJ Pain: Why Your Sacroiliac Joint Hurts & How to Fix It
Key insights: 60-second read
- 15-30% of low back pain involves the SI joint – but treating the SIJ alone often fails if hidden causes are missed.
- Hidden cause #1: Hip joint restrictions – when hips lack mobility, the SIJ compensates and becomes irritated.
- Hidden cause #2: Lower back (thoracolumbar) dysfunction – stiff segments can refer pain directly to the SIJ area.
- Test and retest – always check your SIJ symptoms before and after addressing hips or back to confirm the connection.
- Mobility exercises for hips and lower back – targeted stretches and ball work can relieve SIJ pain without touching the joint.
If you're struggling with sacroiliac joint (SIJ) pain, you've likely tried any number of different SIJ-specific stretches and exercises. But what if the real cause of your pain isn't in your SI joint at all? Understanding potentially hidden root causes of SIJ dysfunction is crucial for lasting relief.
Research shows that 15-30% of people with mechanical low back pain may actually have sacroiliac joint dysfunction as their primary issue. In this comprehensive guide, we'll explore the often-overlooked factors contributing to SIJ pain and provide practical exercises to address these root causes.
On this page
Understanding Sacroiliac Joint (SIJ) Pain
The sacroiliac joints are located where your spine connects to your pelvis and act as crucial shock absorbers to transfer forces between your trunk and lower limbs.
It's important to distinguish between different types of SIJ issues:
- Sacroiliitis refers specifically to inflammation in the SI joint, often caused by inflammatory conditions like ankylosing spondylitis or arthritis.
- SI joint dysfunction is a broader term describing pain stemming from abnormal motion (either too much or too little) or poor loading of the joint.
Many people make the mistake of only treating their local SIJ symptoms without addressing the potential underlying biomechanical issues that may have caused the problem in the first place.
Primary Causes of SIJ Pain
SIJ pain can stem from various sources, but it typically falls into several key categories:
| Cause | Description | Common Symptoms |
|---|---|---|
| Arthritis | Both osteoarthritis (wear-and-tear) and inflammatory arthritis, like ankylosing spondylitis, can affect the SI joint. | Morning stiffness, progressive pain, limited mobility |
| Gait Problems | Uneven walking patterns, leg length discrepancies, hip/knee issues, or previous injuries. | Pain that worsens with walking or standing |
| Injury or Trauma | Falls, car accidents, or sudden heavy lifting can damage SI joint ligaments and tissue. | Sharp, sudden pain following a specific incident |
| Pregnancy | Hormonal changes loosen ligaments and altered gait alter stress on SI joints. | Pain during and after pregnancy, worse with certain positions |
| Inflammatory Conditions | Conditions like Crohn's disease, psoriasis, or reactive arthritis can cause SI joint inflammation. | Systemic symptoms, flare-ups, other joint involvement |
Aggravating factors for SIJ pain typically include prolonged sitting or standing, climbing stairs, running, or positions that place uneven stress on the pelvis.
The Hidden Cause #1: Hip Joint Restrictions
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, leading to the potential for irritation and pain.
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 shoulders and hips aligned. Shift your entire trunk (shoulders and hips together) toward the side you're stretching until you feel gentle pressure at 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 in 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 Hidden Cause #2: Lower Back Dysfunction
Dysfunction in your lower back, particularly at the base of your rib cage and upper lumbar spine, can refer pain to your SI joint area. When these spinal segments become stiff, restricted or overloaded through poor postures, they can refer pain to your sacroiliac joints.
This connection exists because the nerves in these areas supply the SI region, creating what's known as "referred pain" - where a problem in one area is perceived as pain in another area.
Thoracolumbar Mobilisation with a Ball
As shown in the video above, this exercise helps identify and address any restrictions at the base of your ribcage area that may be contributing to SIJ pain:
- 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. Note 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, hunting for other restricted areas, always comparing left and right sides.
The goal isn't to find the most tender spots, but rather the areas with the most restricted mobility.
Key Takeaways for Addressing SIJ Pain Root Causes
Successfully managing SIJ pain requires a broader perspective than simply treating the painful area:
- Think beyond the SI joint - consider how adjacent areas like hips and lower back might be contributing
- Test and retest - always check your SIJ symptoms before and after each exercise to measure effectiveness
- Focus on mobility restrictions rather than just pain locations
- Address sitting-related issues - prolonged sitting is a common contributor to both hip and spinal restrictions
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 often feels very localised to the dimple area below your back, while hip pain tends to be felt deeper in the buttock or groin. The exercises above can help you test: if working on your hip changes your SIJ symptoms, there's likely a connection.
Can sitting too much cause SIJ pain?
Yes. Prolonged sitting can stiffen your hips and lower back, which in turn loads the SI joint abnormally. 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 intensity and consult a 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."
Need Personalised Guidance?
If you'd like help trying to uncover the underlying cause of your pain or dysfunction, consider booking an online Telehealth consultation with Grant!
