Why Does My SI Joint Hurt? Symptoms of SI Dysfunction Explained

SI joint pain is easy to dismiss at first because it can feel like ordinary back ache. These are the patterns people describe most often.

• A dull or sharp SI joint ache low on one side of the back, close to the base of the spine
• Pain that spreads into the buttock, hip, groin, or the back of the thigh
• Pain that is worse after sitting for a long time, especially on a hard seat
• Pain or a catching feeling when you stand up from sitting
• Pain when climbing stairs, taking long strides, or standing on one leg
• Pain when turning over in bed, or lying on the painful side
• Stiffness in the lower back and pelvis, or a sense that the pelvis is unstable

The table below shows where people tend to feel it and what usually brings it on.

SI dysfunction is the term doctors use when the SI joint is painful because it moves too much, too little, or unevenly. Several things can lead to it.

• Pregnancy and childbirth, when hormones loosen the ligaments around the pelvis and the joint carries extra load
• A fall, a car accident, or a sudden jolt through the pelvis
• Uneven loading over time, such as favouring one leg, a difference in leg length, or repeated one-sided movements like running or carrying a child on one hip
• Wear and tear (arthritis) in the joint
• Previous surgery on the lower back, which can shift extra load onto the SI joints
• Inflammation of the joint, which is covered in its own section below

Sometimes no single cause is found. That does not make your pain any less real, and it does not mean nothing can be done.

If your clues point away from the SI joint, you can read more about facet joint injections, piriformis injections, and epidural steroid injections for nerve related leg pain. None of these clues is a diagnosis on its own, and more than one cause can exist at the same time, which is why a proper assessment matters.

SI dysfunction is a mechanical problem with how the joint moves. Sacroiliitis is inflammation of the joint, and it is more often linked to inflammatory conditions such as ankylosing spondylitis. It tends to cause morning stiffness that lasts longer than half an hour and eases with movement, pain that wakes you in the second half of the night, and it often starts before the age of 40. If this sounds like you, it is worth speaking with Dr Atul Kothare, Private GP and Minor Surgeon, who can assess your symptoms and advise whether blood tests, further investigations or a referral to a rheumatologist is the most appropriate next step. Our rheumatology clinic can help with this.

• Keep moving. Short, gentle walks several times a day help more than resting in bed.
• Break up sitting. Stand up and walk around every 20 to 30 minutes.
• Share your weight evenly. Avoid crossing your legs, standing on one leg, or carrying a bag on one shoulder.
• Sleep with support. Lie on your back with a pillow under your knees, or on your pain free side with a pillow between your knees.
• Move as one unit. When you turn in bed or get out of a car, keep your knees together and turn your whole body at once.
• Use heat or cold. A warm pack or bath for 15 to 20 minutes can ease stiffness, and a cold pack wrapped in a cloth can calm a sharp flare-up. Never place either directly on bare skin.
• Use simple pain relief sensibly. Over the counter pain relief, taken as the pharmacist or the pack advises, can help you stay active. Do not use it for long periods without medical advice.
• Do not push through sharp pain. Pace your activity and stop when it becomes sharp.

A specialist assessment starts with your history, followed by an examination that uses movement tests to see whether they reproduce your pain. Your consultant will review any scans you have and decide whether you need one. An MRI is helpful but not always essential. We do not have an MRI scanner at the clinic. Where a scan is required, you can bring one you already have, obtain one through your GP, or we can recommend a private imaging centre. You pay the imaging centre directly at their own price.

Treatment depends on what is found. For many people it means continuing physiotherapy and changing the activities that aggravate the joint. NICE guidance on low back pain does not recommend spinal injections for general low back pain, which is exactly why confirming the source matters. For some people whose pain has been traced to the SI joint, and who have not had enough relief from simpler steps, an injection of local anaesthetic and anti-inflammatory medicine into the joint can help in two ways. It can show that the joint is the source of the pain, and it can ease the pain enough to let you get on with rehabilitation. You can read how the procedure works on our page about SI joint injections.

At Renew Skin and Health Clinic in Leamington Spa, Mr Amit, Consultant Neurosurgeon, assesses SI joint pain and provides private sacroiliac joint treatment  for patients who need more than home care and physiotherapy.

Renew Skin and Health Clinic at 18 Guy Street, Leamington Spa, is easy to reach from Warwick, Kenilworth, Coventry, Rugby, Stratford upon Avon, Solihull, and Birmingham. Patients looking for back pain treatment in Leamington Spa also travel to us from across the United Kingdom. If you recognise your symptoms in this guide, visit our Sacroiliac Joint Injections page for full details and current pricing, or read about Mr Amit Amit specialist profile.