Sacroiliac Joint Pain, Dysfunction and SI Joint Stretches
Treatment and prevention tips plus stretching and strengthening exercises for sacroiliac dysfunction and sacroiliac joint pain.
by Brad Walker | First Published August 12, 2007 | Updated May 5, 2020
Sacroiliac joint dysfunction is often described as pain that is focused in the lower portion of the back and hip, which may also radiate out to the buttocks and lower back.
In some cases Sacroiliac joint pain (sometimes referred to as SI joint pain) may travel down the legs or around to the front, in the groin area. Some males may feel pain in the testicles as well.
Pain is often felt in one side or the other, depending on which side is affected. It can affect both sides at once, although more commonly, it will affect one side first and then, due to compensation, the other side may become involved.
Anatomy of the Sacroiliac Joint
The Sacroiliac joint is the connection of the lower part of the spine (the sacrum) and the pelvis (at the ilium). The bones are held together by strong ligaments just like other joints; however, this is generally considered an immovable joint.
The sacroiliac joint is subjected to twisting forces when the hips are moved or the spine twists. It is also under compression forces when standing or walking, and extreme forces when landing during a jump or running. The hips are designed to absorb these forces of compression before they reach the spine. This joint is an integral part of this function.
The ligaments may become inflamed causing pain. The bones may be subject to stresses during athletic activities and could fracture, either from repetitive stress or acute trauma.
Pressure, from swelling of the tissues in and around the joint, may cause pain impulses from the spinal nerves in the area. Nerves leave the spinal column and travel to the legs and outwardly to the muscles of the hips. If these nerves are compressed they will cause pain, and possible limitation of function.
What Causes Sacroiliac Joint Pain?
Sacroiliac Joint Pain may be the result of many injuries or disease processes. Arthritis, ankylosing spondylitis, postural problems, trauma to the hip, improper lifting, or chronic dynamic bending and twisting (such as those involved in sports activities,) are all possible causes of pain in this joint. Stress fractures from chronic overuse or dislocations from acute trauma, such as a car accident, may cause pain as well.
Pain in the Sacroiliac joint may be a result of a subluxation of the joint. This is a partial dislocation. The bones are slightly displaced, which stresses the ligaments that hold it together and put pressure on the surrounding structures.
Inflammation in the joint from trauma, chronic overuse, illness or infection may also cause SI joint pain. This inflammation can be in the ligaments or surrounding tissue. This will cause swelling and put pressure on the nerves. Degenerative arthritis is another common cause of inflammation in this joint.
Research is still out on whether the pain comes from the joint surfaces or from the ligaments that hold the joint together. This area is rich in nerve endings, and therefore any inflammation or injury to this area results in pain. The pain may radiate because the nerves that travel through the joint area continue on to the legs and hips.
Signs and Symptoms
Pain in the lower back, often radiating out to the buttocks or back of the thigh, may be a sign of Sacroiliac joint involvement. The pain may increase during movement or weight bearing on the affected side. Sneezing, coughing, rolling over in bed and stooping may increase the pain. Pain may radiate to the groin area, sometimes resembling a groin strain or trauma to the testicles. A feeling that the leg or hip is rotated may also accompany this condition.
Inflammation in the joint will cause additional pain and swelling, creating an unpleasant cycle. Numbness and a cold feeling may also accompany this condition. Stiffness in the lower back may be experienced as well. In severe cases, weakness and functional limitations may result, due to the nerve involvement.
If a fracture is the cause of the pain a grinding sensation in the joint or a total inability to bear weight may be experienced.
Treating Sacroiliac Joint Pain
Initially, ice over the painful area and rest will help alleviate the pain. Non-steroidal anti-inflammatory medications will help as well. Later, as part of ongoing treatment, deep heat may provide temporary relief of pain. It may also serve to pre-warm the area before activities.
Massage and chiropractic manipulation of the SI joint may help, especially when the pain is a result of the joint being displaced. Exercise, specifically stretching, can be used to manipulate this area and reduce pain and the underlying causes. Resting the joint and discontinuing activities that cause pain, until the inflammation and pain subsides will help prevent the development of chronic pain.
Sacroiliac joint injections are often used to treat pain in this area. The injection contains a pain relieving medication and can be used to rule out, or rule in, back pain from a sacroiliac joint condition. Cortisone injections may help reduce inflammation in the joint as well. Bipolar Radiofrequency Neurotomy is another possible treatment for SI joint pain. This involves placing two needles into the joint area and, using an electrical current, creating a lesion in the pain transmitting nerves. Both of these methods are invasive techniques. Many people prefer non-invasive treatments such as anti-inflammatory medications and rest.
In very rare cases, surgical interventions may be needed to correct the underlying problems causing the pain.
Preventing Sacroiliac Joint Pain
Prevention of sacroiliac joint pain should be the goal. Once the pain starts it requires intervention to reverse it.
- It is important to warm-up properly before beginning any activity. To prevent SI joint pain it is very important to warm-up the muscles surrounding the hips before weight bearing and high-impact activities. This will ensure adequate shock absorption and strong support for the joints.
- Identifying activities that cause pain will help in preventing future discomfort. Avoiding those activities that immediately cause pain, or eventually lead to pain, may also help identify the causes of the pain.
- Allowing adequate rest to allow full recovery from the day to day damage this joint is subjected to (from simply walking or running), will help ensure the health of the joint. Avoid overtraining of the muscles in this area. Recovery and repair happens during rest times.
- Maintaining the proper posture will help ensure SI joint health. Stress on the muscles along the spine due to poor posture can lead to SI joint pain. Misalignment of the spine from poor posture may also cause pain in the sacroiliac region as well.
- Use proper lifting form to prevent injury to the muscles and intervertebral discs in the back. Injury to these structures increases the chance of developing pain in the sacroiliac joint.
- Exercises that help strengthen the muscles around the hips will provide support for the sacroiliac joint, especially the gluteus maximus. Stronger muscles, tendons and ligaments help hold a joint together and prevent subluxations and dislocations. Stronger muscles also provide additional shock absorption and transfer less of the impact to the spine.
- Stretching the muscles around the sacroiliac joint will help prevent chronic overuse conditions from pain and inflammation in the joint. It will also prevent an uneven pull on the joint leading to additional complications. Stretches for the piriformis muscle, among others, will help prevent SI joint dysfunction. To keep the muscles around your sacroiliac joint flexible and supple, I’ve included two effective SI joint stretches below.
Squatting Adductor and Groin Stretch (1:22) Stand with your feet wide apart. Keep one leg straight and toes facing forward while bending the other leg and turning your toes out to the side. Lower your groin towards the ground and rest your hands on the bent knee or the ground. Increase the intensity of this stretch by lowering yourself towards the ground. Hold the stretch position for a minimum of 20 seconds and then repeat with the opposite leg.
Sitting Foot-to-chest Buttocks Stretch (1:22) Sit with one leg straight and hold onto your other ankle. Pull it directly towards your chest. Use your hands and arms to regulate the intensity of this stretch. The closer you pull your foot to your chest, the more intense the stretch. Hold the stretch position for a minimum of 20 seconds and then repeat on the opposite side.
Want more Sacroiliac Joint stretches?
Research and References
- Added, M. de Freitas, D. Kasawara, K. Martin, R. Fukuda, T. (2018). Strengthening The Gluteus Maximus In Subjects With Sacroiliac Dysfunction. International Journal of Sports Physical Therapy, 13(1): 114–120.
- Al-subahi,M. Alayat, M. Alshehri,M. Helal, O. Alhasan, H. Alalawi, A. Takrouni, A. Alfaqeh, A. (2017). The effectiveness of physiotherapy interventions for sacroiliac joint dysfunction: a systematic review. Journal of Physical Therapy Science, 29(9): 1689–1694.
- Bahr, R. Maehlum, S. (2004) Clinical Guide to Sports Injuries, 1st Edition (ISBN: 978-0736041171)
- Barros, G. McGrath, L. Gelfenbeyn, M. (2019). Sacroiliac Joint Dysfunction in Patients With Low Back Pain. Federal Practitioner, 36(8): 370–375.
- Hamidi-Ravari, B. Tafazoli, S. Chen, H. Perret, D. (2014). Diagnosis and Current Treatments for Sacroiliac Joint Dysfunction: A Review. Current Physical Medicine and Rehabilitation Reports, 2, 48–54.
- Laslett, M. (2008). Evidence-Based Diagnosis and Treatment of the Painful Sacroiliac Joint. Journal of Manual Manipulative Therapy, 16(3): 142–152.
- Martini, F. Tallitsch, R. Nath, J. (2009) Human Anatomy, 9th Edition (ISBN: 978-013432076X)
- Nejati, P. Safarcherati, A. Karimi, F. (2019). Effectiveness of Exercise Therapy and Manipulation on Sacroiliac Joint Dysfunction: A Randomized Controlled Trial. Pain Physician, 22:53-61.
- Tortora, G. Derrickson, B. (2009) Principles of Anatomy and Physiology, 14th Edition (ISBN: 978-1118866096)
- Walker, B. (2018). The Anatomy of Sports Injuries, 2nd Edition (ISBN: 978-1623172831)
- Wikipedia contributors. (2019, July 7). Sacroiliac joint dysfunction, In Wikipedia, The Free Encyclopedia.
About the Author: Brad Walker is often referred to as the "Stretch Coach" and has even been called the Stretching Guru. Magazines such as Runners World, Bicycling, Triathlete, Swimming & Fitness, and Triathlon Sports have all featured his work. Amazon (author page) has listed his books on five Best-Seller lists. Google cites over 100,000 references to him and his work on the internet. And satisfied customers from 122 countries have sent 1,000's of verified customer reviews. If you want to know about stretching, flexibility or sports injury management, Brad Walker is the go-to-guy.
Disclaimer: The health and fitness information presented on this website is intended as an educational resource and is not intended as a substitute for proper medical advice. Please consult your physician or physical therapist before performing any of the exercises described on this website, particularly if you are pregnant, elderly or have any chronic or recurring muscle or joint pain.