SI Joint Pain: How to Tell If Your Low Back Pain Is Actually Your Sacroiliac Joint
- Dr. Patrick Thompson, DPT, OCS, Dip. Osteopractic, FAAOMPT
- 10 minutes ago
- 5 min read
Could Your “Low Back Pain” Actually Be Your SI Joint?
I’ve said it many times, and it is worth repeating again. Low back pain is one of the most common conditions in the world, affecting nearly 80% of adults at some point in their life.
But here’s where things get tricky.
Not all low back pain is actually coming from your lower back.
One of the most commonly overlooked sources of pain is the SI Joint (Sacroiliac Joint). And if this gets misdiagnosed or lumped into the general category of “low back pain,” it can lead to frustrating cycles of temporary relief and flare-ups, all without any long-term solution.
So if you feel like you’ve tried everything and your back pain keeps coming back, this might be the missing piece.
What Is the SI Joint?
The SI Joint connects your sacrum (base of your spine) to your pelvis. You have one SI Joint on each side.
Its primary job is to transfer force between your upper body and lower body. Walking, running, lifting, standing on one leg (like getting in your car or stepping into a bathtub), and even simply standing all rely on the SI Joint doing its job efficiently.
The SI Joint is amazingly stable, so it does not move a lot; however, when it does not move correctly or becomes irritated, it creates a surprising amount of pain.
What Does SI Joint Pain Feel Like?
SI Joint pain can be sneaky because it often mimics other conditions.
Common symptoms include:
Pain on one side of the low back
Pain that radiates into the glute or hip
Pain with prolonged sitting or standing
Pain when transitioning from sitting to standing
Discomfort with walking or single-leg activities
Sound familiar?
This is why many people confuse SI Joint pain with sciatica, hip pain, or even a disc issue. And to be fair, there can be overlap as multiple irritants can be present at once.
With that being said, this is exactly why an accurate differential diagnosis matters so much.
Why An Accurate Diagnosis Is Everything
“Low back pain” is not a diagnosis. It is an umbrella term, meaning the term can cover many actual sources of lower back pain.
The SI Joint is just one of many possible sources of lower back pain. Others include discs, joints, muscles, nerves, visceral referred pain, and even the hip itself.
Each of these requires a completely different treatment approach - and some require other specialties outside of Physical Therapy.
This is where a detailed differential diagnosis becomes critical. If you treat the wrong structure, even with good intentions, you can:
Prolong your recovery
Create compensations
Turn a short-term issue into a chronic one
Start the pain relief → flare up → pain relief cycle
This is also why generic exercises you find online may not work. They are never going to be tailored for your specific problem.
Common Causes of SI Joint Pain
SI Joint pain can develop for a variety of reasons, including:
Repetitive stress from running or lifting
Poor load transfer through the pelvis
Previous low back or hip injury
Pregnancy or postpartum changes
Asymmetrical movement patterns or Asymmetrical sustained postures
But one of the most overlooked contributors is glute weakness.
Your glutes play a major role in stabilizing your pelvis - the obvious glute muscular attachment sites being a massive indicator of the glute involvement in pelvic stability. If the glutes are not doing their job, the SI Joint often picks up the slack. Over time, this can lead to irritation and pain.
This is also why addressing the entire system holistically, and not just the painful area, is key.
SI Joint Pain vs Sciatica vs Hip Pain
Let’s clear a few things up.
Just because you have pain in your glute or down your leg does not automatically mean it is sciatica. Similarly, just because your pain feels deep in your hip does not mean it is a hip joint issue. The SI Joint sits right in the middle of all of this, which is why it is often misidentified. Being able to accurately differentiate between SI Joint pain, sciatica, true hip pathology, and lumbar spine issues requires a hands-on, movement-based assessment - not just imaging or guesswork.
And that is correct, imaging often does not tell your whole story.
The Problem With Self-Treatment
I get it. When you are in pain, the first instinct is to Google some exercises or ChatGPT some lower back stretches.
Sometimes these stretches work (which is obviously a good thing ); however, a lot of times, they doesn’t.
Common mistakes I see with SI Joint pain include:
Stretching aggressively when instability is the issue
Resting too much and losing strength
Performing generic core exercises
Ignoring contributing factors like the hips
These approaches may give temporary relief, but they rarely solve the root problem.
And in some cases, they can actually make things worse.
What Actually Works for SI Joint Pain?
The best treatment starts with the right diagnosis. From there, the plan should be specific to you.
At Flow Physical Therapy and Wellness, we take an Osteopractic Physical Therapy approach, which allows us to combine multiple treatment strategies based on your presentation.
Your treatment may include:
Manual therapy to improve joint mobility and reduce pain
Dry needling to address muscular and neuromuscular components
Targeted strengthening, especially for the glutes and pelvis
Movement retraining to improve how you load and move
This is not a one-size-fits-all plan, it is a specific solution to a specific problem.
Why Conservative Treatment Should Be Your First Step
Too many people jump straight to injections, imaging, or even surgery without ever trying a proper conservative approach.
The reality is, many cases of SI Joint pain respond extremely well to hands-on care, targeted strengthening, and movement pattern corrections.
When done correctly, this approach reduces pain, restores function, and limits recurrences - all without relying on medications or invasive procedures.
Do You Have SI Joint Pain? What Next?
If you are reading this and thinking, “This sounds exactly like what I’m dealing with,” you are not alone.
SI Joint pain is common, and it is also commonly missed.
The good news is, when identified correctly, it is very treatable.
If you are in Lafayette, Youngsville, Broussard, or the surrounding Acadiana area, you have access to one-on-one, 60-minute Osteopractic Physical Therapy sessions at Flow Physical Therapy and Wellness.
Just a clear plan to get you out of pain and back to doing what you enjoy.
Ready to Finally Get Answers?
If your low back pain is not improving, or keeps coming back, it is time to figure out why.
Click below to schedule your initial assessment and get a clear answer on whether your SI Joint is the problem and more importantly, how to fix it.
Dr. Patrick Thompson, PT, DPT, OCS, Dip. Osteopractic, FAAOMPT
Owner of Flow Physical Therapy and Wellness
337-366-1703
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