Physical Therapist's Guide to
Sacroiliac Joint Dysfunction
Sacroiliac joint (SIJ) dysfunction occurs when the sacroiliac joints of the pelvis become stiff or weak. The condition can develop at any age. Symptoms typically are felt on one side of the back. SIJ dysfunction is found in 10% to 25% of people who complain of low back pain. It is most often diagnosed in females. Physical therapists treat SIJ dysfunction to help reduce pain and restore movement.
What is Sacroiliac Joint Dysfunction?
The SIJ is a joint between the sacrum (a large bone at the base of the spine) and the ilium (a bone in the upper part of the pelvis.) The two sides of the sacroiliac joint normally work together. SIJ dysfunction can occur when:
- One side of the joint becomes stiff, causing a lack of coordination.
- One side of the joint becomes too loose (lax). This condition may occur in women of childbearing years due to hormonal changes.
- Muscle imbalances and hip problems develop.
- Arthritis is present, causing inflammation.
- One or both sides of the joint are injured.
Causes of SIJ injury can include:
- A fall where you land on one side of the body, altering the position of the joint
- Over-training by an athlete, causing too much stress on the joint
How Does it Feel?
If you have SIJ dysfunction, you may feel:
- Sharp, stabbing, or dull pain on one side of your pelvis/low back, groin, or tailbone
- Pain that radiates down to the knee
- Pain with standing from a sitting position, turning in bed, bending, or twisting
- Muscle tightness and tenderness in the hip/buttock region
- Pain with walking, standing, and prolonged sitting
- Pain that is worse when standing and walking, and eases when sitting or lying down
How Is It Diagnosed?
If you see a physical therapist first, he or she will conduct a thorough evaluation, and take your health history. Sometimes, SIJ dysfunction is caused by a single injury. Most often, however, it is a condition that develops due to repeated irritation. Your physical therapist will gather information about your condition from the forms you fill out and an interview.
The interview will be specific to you, to help your physical therapist understand what you are experiencing. Questions may include:
- Did an injury occur?
- How have you taken care of the condition until now?
- Have other health care practitioners ordered imaging (eg, MRI or CT scan) or other tests?
- What are your current symptoms, and how do they affect your day?
- If you have pain, what is the location and intensity of your pain?
- Does your pain vary during the day?
- What activities, if any, do you find hard to complete?
- What activities are you unable to complete since your injury?
- What activities or positions ease your pain?
- (For women): Are you pregnant or have you recently given birth? (SIJ dysfunction can be related to pregnancy and childbirth).
After the interview, your physical therapist will complete a physical examination. He or she may:
- Watch how you walk, step onto a stair, squat, or balance on one leg
- Check the mobility (movement) and strength of your spine, pelvis, and hip, to determine where treatment can improve your condition
- Gently and skillfully touch the front, side, and back of your spine, pelvis, and hip, to determine where symptoms are present
Following the interview and physical exam, your physical therapist will discuss the findings with you. He or she will work with you to develop a personalized treatment program to begin your recovery.
How Can a Physical Therapist Help?
Your physical therapist will design a targeted treatment program to restore your maximum strength and function. Your treatment will help in your safe return to daily activities. Your program may include:
Patient education. Your physical therapist will work with you to identify and change any outside factors causing your pain. The type and amount of exercises you perform, your athletic activities, or your footwear may be discussed. He or she will suggest improvements to your daily activities.
Pain management. Your physical therapist will develop a treatment plan to address your pain that includes applying ice to the affected area. They may use ultrasound, electrical stimulation, and/or other methods to help control your pain. Your physical therapist may recommend decreasing some activities that cause pain. Physical therapists are experts in prescribing pain-management techniques that reduce or eliminate the need for medicine, including addictive opioids.
Braces. Your physical therapist may recommend the use of a brace, such as a sacroiliac belt. The belt provides stability during daily activities, as your strength returns and flexibility improves.
Body mechanics. How you use your body for daily work and other activities can contribute to your SIJ dysfunction and pain. Your physical therapist will teach you ways to improve your unique movement (body mechanics). He or she may help you improve the way you sit, lift, or carry objects.
Manual therapy. Hands-on (manual) therapy, such as massage, can help correct SIJ dysfunction. Your physical therapist will choose what techniques work best to improve your condition.
Flexibility exercises. Your physical therapist will design a personalized exercise program to fit your specific needs. Stretching exercises may be prescribed to improve muscle flexibility, and your movement.
Strengthening exercises. Strengthening exercises improve the stability of the sacroiliac and spinal joints. They also help reduce pain. Your physical therapist will teach you exercises to treat any weak muscles, including those in your stomach or buttocks.
Functional training. Once your pain, strength, and motion improve, you will need to safely transition back to your full sport and/or daily activity levels. To reduce the stress and tension on the sacroiliac joint, you will need to learn safe, controlled movements. This training also will reduce your risk of repeated injury. Your physical therapist will teach you how to use and move your body correctly based on your unique physical condition.
Can this Injury or Condition be Prevented?
To avoid SIJ dysfunction, it is important to maintain correct posture and a healthy activity level, and prevent falls. Your physical therapist will work with you to strengthen and stretch the right joints and muscles to prevent conditions like SIJ dysfunction from ever occurring. Physical therapists are experts at training people to reach and maintain their peak strength and functional levels.
To prevent a return of SIJ dysfunction after physical therapy treatment is completed, you must maintain your strength and flexibility. To do so, you will need to continue doing the home-exercise program your physical therapist designs for you. Improved muscle strength provides stability for the sacroiliac joint and the low back.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat SIJ dysfunction. However, you may want to consider:
- A physical therapist who is experienced in treating patients with SIJ dysfunction. Some physical therapists have a practice with an SIJ dysfunction focus.
- A physical therapist who is a board-certified clinical specialist, certified manual therapist, or has completed a residency or fellowship in pelvic health or orthopedic physical therapy. This person has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, an online tool provided by the American Physical Therapy Association. You can search for physical therapists with specific clinical expertise in your geographic area.
General tips when you are looking for a physical therapist (or any other health care provider) include:
- Ask family, friends, and other health care providers to recommend a PT.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience helping people with SIJ dysfunction.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and explain what makes your symptoms worse.
The American Physical Therapy Association (APTA) believes you should have access to information to help you make health care decisions and prepare for your visit with a health care provider.
The following articles provide some of the best scientific evidence related to physical therapy treatment of sacroiliac joint dysfunction. The articles report recent research and give an overview of the standards of practice both in the United States and around the world. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Foley BS, Buschbacher RM. Sacroiliac joint pain: anatomy, biomechanics, diagnosis, and treatment. Am J Phys Med Rehabil. 2006;85(12):997–1006. Article Summary on PubMed.
Bronlinson PJ, Kozar AJ, Cibor G. Sacroiliac joint dysfunction in athletes. Curr Sports Med Rep. 2003;2(1):47–56. Article Summary on PubMed.
Cibulka MT. The treatment of the sacroiliac joint component to low back pain: a case report. Phys Ther. 1992;72:917–922. Free Article.
*PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine's MEDLINE database.
Authored by Kristin Dryden, PT, DPT, board-certified clinical specialist in orthopaedic physical therapy.
Revised by Susan Reischl, PT, DPT, board-certified clinical specialist in orthopaedic physical therapy.
Reviewed by Steve Reischl, PT, DPT, board-certified clinical specialist in orthopaedic physical therapy on behalf of the Academy of Orthopaedic Physical Therapy.