If you’ve been struggling with nagging low back pain and have either self-diagnosed or been told by a healthcare provider that you’re suffering from sacroiliac (SI) joint pain, you’re not alone. Many people live with persistent discomfort, even after physical therapy, chiropractic care, or injections. The frustration grows when symptoms return — or never fully go away in the first place.
But here’s the truth: what feels like SI joint pain is often not actually coming from the SI joint itself. Understanding the real root of your pain — and how to address it — is the first step to lasting relief.
What Is the SI Joint, and Why Does It Hurt?
The sacroiliac (SI) joints are located at the back of your pelvis, where the sacrum (the triangular bone at the base of your spine) meets the ilium (the large pelvic bones on either side). You have two SI joints — one on the left and one on the right.
These joints allow for a small amount of movement and absorb shock between the upper body and the legs. When they become inflamed or irritated, it’s referred to as sacroiliac joint dysfunction or SI joint pain.
SI joint pain often presents as:
- A dull, aching pain on one side of the lower back
- Pain that radiates into the buttock, hip, or upper thigh
- Discomfort while sitting or standing for long periods
- Pain that worsens with transitional movements, like going from sitting to standing
The Hidden Reason Why Your SI Joint Pain Keeps Coming Back
Many patients come into physical therapy clinics saying they’ve been diagnosed with SI joint dysfunction and have tried everything — yet the pain keeps returning. Often, they’ve received targeted treatments focused only on the SI joint itself.
But here’s the critical insight: in about 70% of these cases, the pain isn’t truly originating from the SI joint. Instead, it’s referred pain caused by muscular imbalances, joint misalignment, or nerve irritation elsewhere in the body.
So why is this so often misdiagnosed? Because the SI joint sits at a central junction in the body — where forces from above (spine and rib cage) and below (hips, knees, feet) converge. Pain in this area is easy to misinterpret.
Understanding the Pelvis and Its Moving Parts
To understand the deeper cause of your pain, let’s break down the anatomy:
- The pelvis consists of two ilium bones on each side, the sacrum in the center, and the pubic symphysis at the front.
- Inside the pelvis are pelvic floor muscles (about 14 in total) that support the organs and stabilize movement.
- Surrounding the pelvis are key muscles — glutes, hip flexors, abdominals, spinal extensors, and deep rotators — that work together to allow movement and maintain balance.
All these muscles and joints need to move harmoniously. But when one area is tight, weak, or misaligned, the body compensates. This compensation pulls on the pelvis, often rotating or tilting it. Even slight pelvic misalignments can trigger pain that mimics SI joint dysfunction.
Common Muscle Imbalances That Mimic SI Joint Pain
A major culprit in recurring SI joint pain is myofascial trigger points — tight, irritable bands within a muscle that can refer pain elsewhere. For example:
- Tight gluteal muscles can send pain signals deep into the pelvis.
- Hip rotators (like the piriformis) can compress nerves and cause deep buttock pain.
- Abdominal muscles, especially when weak or imbalanced, fail to stabilize the pelvis, allowing unwanted motion.
- Low back extensors or hamstrings may compensate for weak hip muscles, pulling on the pelvis from below.
These muscular issues can create tension that the body mistakenly interprets as joint pain — when in fact, it’s more like a domino effect of muscle dysfunction.
Why Traditional Treatments Often Fail
Most conventional treatments for SI joint pain — like stretching, core strengthening, or even corticosteroid injections — are often only addressing symptoms, not the underlying causes.
If therapy focuses only on loosening a tight SI joint without evaluating why it’s under stress, the root issue remains unresolved. This is why symptoms tend to return, sometimes worse than before.
A Smarter, More Holistic Approach to SI Joint Pain
In clinics where SI joint pain is successfully treated, providers take a whole-body approach, examining the pelvis as part of a dynamic system connected to the rest of the body.
Here’s how a comprehensive treatment strategy works:
1. Postural and Alignment Assessment
- Examine the pelvic tilt, rotations, and leg length discrepancies
- Look at how the rib cage, spine, and hips are aligning and moving
2. Muscle Testing and Mobility Screening
- Evaluate strength and flexibility of deep core muscles, glutes, hamstrings, and hip rotators
- Check for trigger points, spasms, or muscle guarding
3. Hands-On Release Techniques
- Myofascial release to reduce soft tissue restrictions
- Trigger point therapy to deactivate pain-referring knots
- Dry needling to target deep muscle spasms and improve circulation
4. Functional Strengthening and Rebalancing
- Stabilize the core and pelvis using guided movement exercises
- Retrain muscle firing patterns to ensure proper pelvic motion
5. Addressing Distant Contributors
- Foot and ankle alignment (flat feet or poor footwear can affect the pelvis)
- Thoracic spine or shoulder imbalances that transmit force through the lower back
By treating the entire kinetic chain, not just the SI joint, patients often experience relief that lasts — and doesn’t keep returning like a boomerang.
The Importance of Individualized Treatment
No two people’s pain is the same. For one person, pelvic floor tightness might be the problem. For another, it’s a stiff ankle throwing off gait mechanics. That’s why individualized evaluation is critical.
Is It Time to Rethink Your SI Joint Pain?
If you’ve tried traditional routes and your SI joint pain still returns, the problem might not be in the joint at all. Instead, it may be a complex interplay of muscle imbalances, pelvic misalignment, and compensation patterns.
Here’s what you can do:
- Seek a provider who assesses the full body and not just the pain site.
- Ask about techniques like trigger point therapy, dry needling, and alignment correction.
- Focus on long-term movement retraining, not just temporary relief.
Final Thoughts
Persistent SI joint pain doesn’t mean you’re stuck with it forever — but it does require a more informed and integrated approach to treatment. Addressing the muscles, joints, and movement patterns that affect your pelvis can be the missing link to getting you back to living without discomfort.
You don’t have to live with recurring SI joint pain. You just need to treat the right problem — not the wrong one.
Also Read: Why You Have Pelvic Pain After a “Simple” Vasectomy?
I’m Hina Sheth. I have been treating complex orthopedics, sports and pelvic floor physical problems for over 25 years with amazing results. Now I want to bring my knowledge to the global community so I can spread my knowledge to you.
Our bodies are complex systems of 600 muscles and organs intertwined in a fascial system that all work together. Imbalances in this system such as trigger points, visceral and myofascial restrictions can lead to joint, pelvic, and organ issues.
Factors like nutrition, exercise, sleep, and stress play a crucial role. Unfortunately, our current healthcare model does not look at our bodies as a whole and oftentimes compartmentalize musculoskeletal injuries and dysfunctions.
At Rebalance, our goal is to holistically treat this complex system to restore harmony in the body. By addressing these imbalances, we help clients improve their overall health and well-being. Our vision is to empower individuals to create a healthier lifestyle for themselves.
