SI Joint Pain vs. Low Back Pain: How Can You Tell the Difference?
SI joint pain and low back pain can feel similar. Learn how to tell the difference, common causes, treatment options, and when to seek care.
Dr. Jeff Verenski
9/15/20267 min read
SI Joint Pain vs. Low Back Pain: How Can You Tell the Difference?
Pain in the lower back or buttock can make it difficult to sit, stand, walk, exercise, or sleep comfortably.
One common question is whether the pain is coming from the low back or the sacroiliac (SI) joint. The two can feel very similar, and the location of pain alone usually isn't enough to determine the source.
The SI joints connect the sacrum at the base of the spine with the pelvis. They transfer forces between the upper body and legs and provide stability during activities such as walking, lifting, running, and changing positions.
At Resolve Chiropractic in Brookfield, WI, patients with low back, hip, and buttock pain are evaluated individually to determine what may be contributing to their symptoms and whether chiropractic care is appropriate.
What Does SI Joint Pain Feel Like?
SI joint pain is commonly felt in the lower back or buttock, often more prominently on one side. Some people describe it as aching, sharp, stiff, or deep.
Pain may also extend into the:
Buttock
Hip
Upper thigh
Certain movements can aggravate symptoms, including getting out of a chair or car, climbing stairs, walking, running, turning in bed, or standing for long periods.
These symptoms aren't unique to the SI joint, however. The lumbar spine, hip, muscles, and nerves can produce similar patterns.
SI Joint Pain vs. Low Back Pain
There can be significant overlap between SI joint and lumbar spine pain, but some patterns can provide clues.
SI joint-related pain is often concentrated around the buttock or the area just beside the lower spine. It may be aggravated by weight-bearing activities, stairs, walking, or transitions such as getting up from a chair.
Low back pain may be more centralized around the lumbar spine and can be influenced by bending, lifting, sitting, standing, or repetitive movements.
Lumbar problems can also cause pain into the buttock or leg. When symptoms travel farther down the leg or are accompanied by numbness, tingling, or weakness, nerve irritation may need to be considered.
Because these patterns overlap, an examination is more useful than trying to diagnose the problem based solely on where it hurts.
Can SI Joint Pain Feel Like Sciatica?
Sometimes.
SI joint-related pain can extend into the buttock or thigh and may resemble sciatic-type pain. However, true sciatica generally involves irritation or compression of a nerve root in the lower back.
Symptoms such as pain extending below the knee, numbness, tingling, or weakness make nerve involvement more important to consider.
If you're unsure whether your symptoms are coming from the SI joint or lumbar spine, a proper examination can help narrow down the possibilities.
What Causes SI Joint Pain?
SI joint symptoms can develop for several reasons.
Injury
A fall, sports injury, collision, or sudden force through the pelvis can irritate the SI joint or surrounding tissues.
Repetitive Stress
Running, lifting, physical work, or a sudden increase in activity can place repeated stress on the lower back and pelvis.
Changes in Movement
Strength, mobility, coordination, previous injuries, and activity habits can all influence how forces are distributed through the pelvis.
This doesn't necessarily mean that the pelvis is "out of alignment." The body is more complicated than a joint simply moving out of place and needing to be put back.
Pregnancy
Pregnancy can change pelvic loading and movement and may contribute to SI-region or pelvic pain in some women.
Previous Injuries
A previous hip, back, or leg injury can temporarily or persistently change how someone moves, potentially affecting the loads placed on the pelvis.
Is SI Joint Pain Caused by a "Misaligned Pelvis"?
You've probably heard that SI joint pain happens because the pelvis is "out of alignment."
It's a common explanation, but it's an oversimplification.
The SI joints normally have very small amounts of movement. Pain in the area can involve the joint, surrounding ligaments and muscles, movement patterns, load tolerance, and other structures in the lower back and pelvis.
For that reason, treatment shouldn't be based solely on the idea that one side of the pelvis is "out."
A better approach is to evaluate the entire region and determine which findings are relevant to the patient's symptoms.
How Is SI Joint Pain Diagnosed?
There isn't one test that can definitively diagnose every case of SI joint pain.
An evaluation typically combines your history with a physical examination. A chiropractor or other healthcare professional may assess the lumbar spine, hips, pelvis, strength, mobility, neurological function, and response to specific orthopedic tests.
Several SI joint provocation tests may also be used.
This broader approach is important because pain near the SI joint can actually originate from the lumbar spine, hip, muscles, or nerves.
Do You Need an MRI?
Not necessarily.
Imaging isn't automatically required for uncomplicated low back or SI-region pain. In many cases, the history and physical examination provide enough information to begin conservative care.
MRI or other imaging may become appropriate when there are concerning findings, significant neurological symptoms, persistent symptoms that aren't improving as expected, significant trauma, or another reason to investigate a more serious condition.
Can a Chiropractor Help SI Joint Pain?
For some patients, conservative chiropractic care can be an appropriate treatment option for SI-region and low back pain.
Treatment should be individualized rather than assuming everyone with SI joint pain needs the same adjustment.
Depending on the examination, care may include:
Chiropractic adjustments: Spinal or pelvic manipulation may be used when areas of restricted mobility appear relevant to the patient's symptoms.
Soft-tissue therapy: Muscles around the low back, hips, and pelvis may become sensitive or tense when pain is present. Manual therapy can be used when appropriate.
Exercise and rehabilitation: Treatment may include exercises targeting hip mobility, core strength, glute strength, and movement control.
The goal isn't simply to "put the SI joint back in place." Instead, treatment is directed toward the factors that appear to be contributing to the patient's symptoms.
What Exercises Are Good for SI Joint Pain?
There isn't one exercise that works for everyone.
Depending on the individual, rehabilitation might include exercises such as glute bridges, bird dogs, dead bugs, squats, hip mobility exercises, or core stabilization work.
The appropriate exercises depend on what's contributing to the pain and how the person responds to movement.
An exercise that helps one person may aggravate another. If an exercise significantly increases pain or produces new symptoms traveling down the leg, it should be reassessed.
How Long Does SI Joint Pain Last?
Recovery varies from person to person.
Some episodes improve relatively quickly, while persistent symptoms may take longer. Factors such as how the problem started, how long you've had symptoms, activity demands, previous injuries, and response to treatment can all influence recovery.
Rather than focusing on an exact number of days or visits, meaningful progress may include being able to sit, walk, sleep, exercise, work, or perform normal activities with less discomfort.
If symptoms aren't improving as expected, the diagnosis and treatment plan should be reconsidered.
When Should You Get SI Joint or Low Back Pain Evaluated?
An evaluation may be worthwhile if pain is persistent, keeps returning, interferes with exercise or work, affects sleep, or limits normal activities.
More importantly, not every case of low back or pelvic pain is appropriate for routine chiropractic care.
Seek prompt medical evaluation for symptoms such as:
New loss of bladder or bowel control
Difficulty urinating
Numbness around the groin or saddle region
Significant or rapidly worsening weakness
Severe unexplained pain
Fever or other signs of systemic illness
Significant trauma
Rapidly worsening neurological symptoms
These findings can indicate a condition requiring medical evaluation rather than routine conservative treatment.
What Happens During an SI Joint Evaluation at Resolve Chiropractic?
At Resolve Chiropractic, the first step is understanding how your symptoms began and how they behave.
Your evaluation may consider where you feel the pain, what movements aggravate it, whether symptoms travel into the leg, and whether you've noticed numbness, tingling, or weakness.
The physical examination can then help distinguish between possible sources, including the SI joint, lumbar spine, hip, muscles, and nerves.
The goal isn't simply to find the most painful spot. It's to determine what may be contributing to your symptoms and whether chiropractic care is appropriate.
SI Joint Pain Treatment in Brookfield, WI
Pain around the low back, pelvis, or buttock can have several possible causes. SI joint pain is one possibility, but similar symptoms can come from the lumbar spine, hip, muscles, or nerves.
At Resolve Chiropractic in Brookfield, WI, care is individualized based on your symptoms, examination findings, activity level, and goals.
When appropriate, treatment may include chiropractic adjustments, soft-tissue therapy, mobility work, and therapeutic exercise.
If you're dealing with SI joint pain, buttock pain, hip pain, or low back pain in Brookfield, WI, contact Resolve Chiropractic to schedule an evaluation.
Frequently Asked Questions
How do I know if my pain is coming from my SI joint?
You generally can't determine the source based on location alone. An examination of the SI joint, lumbar spine, hips, muscles, and neurological system can help identify the most likely source.
Can SI joint pain cause pain down the leg?
Yes. SI-region pain can extend into the buttock or thigh. Pain extending below the knee, particularly with numbness, tingling, or weakness, may indicate nerve involvement instead.
Can a chiropractor adjust the SI joint?
A chiropractor may use spinal or pelvic manipulation when clinically appropriate. Treatment should be based on examination findings rather than assuming the SI joint is simply "out of alignment."
What is the best exercise for SI joint pain?
There isn't one best exercise for everyone. A program may include core and glute strengthening, hip mobility, or movement-control exercises depending on the individual.
Does sitting make SI joint pain worse?
It can. Some people notice more pain with prolonged sitting, while others have more difficulty with standing, walking, or transitions. Your individual pattern matters.
How long does SI joint pain take to go away?
Recovery varies depending on the cause, severity, duration, activity demands, and response to treatment. Persistent or worsening symptoms should be reassessed.
The Right Diagnosis Matters
Pain in the SI region doesn't necessarily mean the SI joint is the problem.
Because the SI joint, lumbar spine, hips, muscles, and nerves can produce overlapping symptoms, determining the likely source is an important first step.
If you're experiencing SI joint or low back pain in Brookfield, WI, Resolve Chiropractic can evaluate your symptoms and determine whether conservative chiropractic care may be appropriate.
This article is intended for general educational purposes and is not a substitute for an individualized medical evaluation or diagnosis.