Sacroiliac (SI) Joint Dysfunction

UW Health's Sports Medicine doctors in Madison, Wisconsin, treat a wide range of common athletic injuries, including sacroiliac (SI) joint dysfunction, which causes about 15 percent of low back pain.


About Low Back Pain and the Sacroiliac Joint


Low back pain is extremely common, affecting about 70 percent of the population. The sacroiliac (SI) joint is responsible for about 15 percent of all low back pain. Many factors can contribute to SI joint dysfunction including trauma, pelvic asymmetry, as well as a sprain to the ligaments surrounding the SI joint.


Individuals with SI joint dysfunction usually complain of a debilitating, aching and sometimes sharp pain in their low back. Typically this condition is treated conservatively with physical therapy, but in some cases injections and surgery may be needed.




The SI joint is a moderately stable, synovial joint that is located where the sacrum and pelvis articulate, which causes the joint to absorb forces from the spine and transmit these forces to the legs. Strong ligaments surround the joint which restricts the amount of motion that occurs.




SI joint dysfunction has many potential causes, including a minor traumatic event such as falling on the buttocks, accidentally slipping or twisting, or getting pushed by an opponent during athletic activities. Stress can also be placed on the surrounding SI joint ligaments when the pelvis rotates on one side (unilateral pelvic rotation) either in an anterior (top of the pelvis rotates forward) or posterior (top of the pelvis rotates backwards) direction. This pelvic asymmetry can be found by comparing the left and right sides of the pelvis or by measuring leg lengths.


SI pain may also be caused by inflammatory arthritis. For patients with chronic SI joint pain that does not respond to rehabilitation, diagnostic tests may be necessary to evaluate other causes.


Signs and Symptoms


Signs and symptoms of SI joint dysfunction vary depending on the individual. Activities that may be bothersome include getting up from a chair, walking up stairs, getting out of a car or rolling over while sleeping. Athletes that are involved in sports that require one-sided (unilateral) movements, such as kicking and throwing, and asymmetrical loading, such as gymnastics and golf, are at an elevated risk for experiencing pain in the SI joint. Individuals usually complain of pain and tenderness on one side of their low back (over the SI joint) that sometimes radiates into the buttock, groin and/or thigh.




Treatment for SI joint dysfunction includes:

  • Acute phase: Icing and resting can decrease symptoms
  • Sub-acute or chronic phase: Rehabilitation is indicated to help with pain control and to optimize movement patterns and function. Rehabilitation will focus on exercise for mobility and strength, manual therapy to improve movement and techniques/strategies to correct leg length discrepancies that are not due to true differences in bone length. Most people respond well to conservative treatment. Other treatment options may include corticosteroid injection therapy or surgery.