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Where are the sacroiliac joints located?
The sacrum is the bone located at the base of the spine. On each side, it joins a pelvic bone at the level of a sacroiliac joint, often abbreviated SI. Strong ligaments surround these joints, whose movements are of low range of movement. They participate in the transfer of loads between the trunk and the legs.
Nearby are the lower back joints, muscles, tendons and nerves. Pain felt in this region can therefore have several explanations. The term sacroiliac pain can correspond to an assessment hypothesis; it should not be inferred solely from a tender point, a photograph of the pelvis or a comparison of hip heights.
Chapter sources [1]
Understand the picture
Neighbors, not synonyms
SI joints
They connect the sacrum to the pelvic bones.
Lumbar region
It can cause pain in the buttock or leg.
Deep buttock
This region contains muscles and the pathway of the sciatic nerve.
How can pain in this region present?
The discomfort may be felt on one side of the lower back, in the buttock or around the pelvis. Some people have pain when turning over in bed, walking, standing, or going from sitting to standing. These activities involve several structures at the same time; their painful nature does not automatically locate the source.
Specify whether it is local pain, burning, an electric-shock sensation or numbness. The presence of leg symptoms, weakness or urinary changes changes the orientation. Trauma, pregnancy, inflammatory disease or previous surgery may also be important. Your complete story is more useful than a label given to a painful movement.
Is the pelvis blocked or displaced?
A feeling of stiffness or blockage can be real without a bone having left its place. Small differences in body position and manual measurements alone cannot demonstrate a displacement responsible for pain. Relief after a manual technique also does not prove that a bone has been put back into place.
This nuance avoids becoming dependent on constant monitoring of alignment. A dislocation or significant fracture of the pelvis arises from another context, generally traumatic and medical. For common pain, the goal is to understand capabilities, irritants and progression, then build a program that helps you function with more confidence.
How does the professional assess a sacroiliac origin?
He examines your history, back, hip, movements and sometimes several tests designed to reproduce familiar pain. A set of results can provide guidance, but there are limits and no single maneuver provides complete certainty. Recent recommendations highlight these diagnostic difficulties and the differences between tissues in this region.
An X-ray or MRI can help with certain questions, including an inflammatory cause, fracture, or other illness. A normal picture does not prove that the pain is made up. Diagnostic injections and other tests belong to specialized situations and also have limitations. Ask what is probable enough to guide care and what remains uncertain.
When to think about an inflammatory disease?
Persistent back or buttock pain that appeared relatively young, associated with prolonged stiffness, nighttime awakenings and improvement with movement may lead to the search for an inflammatory cause. Psoriasis, eye inflammation, certain intestinal diseases or family history can provide useful information.
None of these isolated signs is sufficient to make a diagnosis. Sacroiliitis refers to inflammation of the joint and is not synonymous with a simple mechanical blockage. If several elements correspond to your situation, talk to the doctor. The existing guide on axial spondyloarthritis develops this subject and the possible role of rheumatology, and explains how assessment and treatment may differ.
Chapter sources [3]
What about the deep pain in the buttock or the piriformis?
The sciatic nerve passes through the buttock area after leaving the pelvis. Irritation can sometimes be located in this region, outside the spine: this is called deep gluteal syndrome. The piriformis is one of the neighboring muscles, but it is not the only possible structure. This problem is distinct from sacroiliac pain.
Buttock pain worsened when sitting, with radiation or tingling, also requires consideration of the back and other nerve-related causes. The sciatica guide explains the lumbar origin. Do not conclude that the piriformis is responsible because a ball or stretch reproduces the pain. Strong, repeated pressure on a sensitive nerve may be poorly tolerated.
Chapter sources [2]
In everyday life
Track a difficulty with sitting
Describe
Note the duration, area of pain and possible symptoms in the leg.
Try
Break up long periods of sitting and look for more comfortable support.
Take stock
Check the effect; a weakness or neurological change requires an opinion.
What signs immediately change the course of action?
New difficulty urinating, loss of sensation between the legs, loss of control of bowel movements or new significant weakness with back or leg pain requires urgent evaluation. Do not try exercises or manipulation to “unlock” the pelvis first. Intense pain after an accident or an inability to bear weight on the leg must also be assessed.
A fever, an altered general condition or new pain in the context of cancer require rapid medical advice. During pregnancy, abdominal pain or bleeding needs advice from the maternity team. A list of signs cannot exclude all emergencies: if your condition changes significantly or worries you, seek medical advice.
What can physiotherapy offer?
After the assessment, it can combine explanation, gradual resumption of activities, strength work and improvement of certain tasks. The goals are chosen with you: sit more comfortably, walk or turn around more easily. A manual technique can be discussed as a complement, but should not be accompanied by a promise of definitive realignment.
The level of evidence is not the same for all methods nor for all causes of pelvic pain. The professional must explain the purpose of the treatment and how to verify its benefit. When the program does not help you, we review the hypothesis and the choices. A repetition of passive movements without measurable progress is not an obligation.
How to adapt activities without fearing each movement?
Choose a concrete problem. If sitting for a long time triggers the pain, try breaking up the duration and varying the support. If carrying a load is difficult, bring it closer to you or spread it out. For walking, start from a tolerated distance and watch the reaction afterwards, instead of constantly testing the symmetry of the pelvis.
A change should be a useful experiment, not a rigid new rule. The body does not need a perfectly identical position for every movement. Keep the movements that work for you, then gradually expand. If an exercise causes more leg symptoms or weakness, stop it and seek advice rather than increasing the stretch.
How to decide on a reassessment?
Tracking compares pain and activities important to you. A reduction in symptoms is not the only result: being able to work, sleep or walk more easily also counts. Progress may be uneven, but the program must have direction and a review point.
Consult sooner if the nature of the pain changes, if weakness appears or if your independence decreases. If the difficulties remain significant, a new examination can look for another origin or seek a specialist opinion. The lack of improvement does not prove that your pelvis is impossible to stabilize; it indicates that explanations and care must be reexamined.
Your questions
Does a leg that appears shorter confirm an SI joint problem?
No. A visual or manual comparison alone does not identify the source of the pain. Position variations and measurement limits matter. A real difference, when suspected, must be evaluated in the full context.
Chapter sources [1]
Why was I relieved after a manipulation?
Relief may occur after various interventions. It does not demonstrate that the pelvis was moved and then put back in place. Its benefit is also judged on its duration, your activities and the possibility of progressing with less dependence on care.
Chapter sources [1]
Are piriformis syndrome and sacroiliac pain the same?
No. Piriformis syndrome is a term used for certain pains related to the deep tissues of the buttock and the sciatic nerve. The SI joint is another structure. The symptoms may look similar; the examination and its limitations must be explained.
Sources and references
- [1] International working group — Sacroiliac joint complex pain
- [2] Royal National Orthopaedic Hospital · Deep gluteal syndrome
- [3] NICE NG65 — Spondyloarthritis
- [4] NHS — Hip pain in adults
- [5] NHS — Pelvic pain
- [6] NICE NG201 — Antenatal care
- [7] NHS — Sciatica and urgent neurological symptoms
Text updated on
Medical review: awaiting Hasib Selimovic.