1. Introduction / Plain Theory

Sacroiliac joint dysfunction refers to pain or restriction arising from the sacroiliac joint (SIJ) — the paired joints connecting the sacrum (base of the spine) with the iliac bones (pelvis).
These joints play a critical role in transferring load between the upper body and lower limbs during standing, walking, and movement.

The SIJ is supported by strong ligaments and small degrees of motion (usually less than 4° rotation and 2 mm translation).
However, even subtle dysfunctions can disrupt normal load transfer, leading to pain in the lower back, buttock, or thigh.

SIJ pain accounts for 15–30% of chronic low back pain cases and is more common in women, due to increased joint mobility during hormonal and postural changes such as pregnancy or childbirth.

While the joint itself is rarely inflamed or “out of place,” it can become mechanically irritated or overloaded by surrounding muscular or postural imbalances.

2. Typical Symptoms and Functional Impact

• Deep, aching pain in the buttock, often one-sided.

• Pain that may radiate into the groin, thigh, or occasionally down to the knee.

• Pain aggravated by standing, walking, climbing stairs, or turning in bed.

• Discomfort when moving from sitting to standing.

• Possible feeling of “instability” or unevenness in the pelvis.

Functional impact:
SIJ pain often limits walking and prolonged standing and may lead to compensatory strain in the lumbar spine, hips, or legs.
In chronic cases, patients may report fatigue or discomfort that shifts sides, reflecting adaptive changes in posture and gait.

Red flags:
Severe pain after trauma, radiating symptoms below the knee, or neurological deficits (numbness, weakness) should be evaluated for lumbar disc pathology or fracture.

3. Contributing Factors / Underlying Causes

SIJ dysfunction often results from asymmetric load or mobility between the pelvis and spine.
Common contributors include:

• Pelvic torsion or leg-length discrepancy (functional or structural).

• Pregnancy and postpartum ligamentous laxity.

• Repetitive strain (lifting, twisting, running).

• Weak gluteal or core muscles, reducing pelvic stability.

• Previous trauma or falls on the buttocks.

• Lumbar spine stiffness or scoliosis altering pelvic load.

• Foot or ankle dysfunction, influencing kinetic-chain mechanics.

From an osteopathic viewpoint, the sacroiliac joint rarely acts alone.
It is part of an integrated system — influenced by lumbar motion, hip mobility, and lower-limb alignment — making holistic evaluation essential.

4. Osteopathic Approach

Osteopathic care focuses on restoring balance, mobility, and load distribution throughout the pelvis and surrounding structures.

An osteopathic assessment may include:

• Observation of posture, gait, and pelvic symmetry.

• Palpation of joint motion and ligamentous tension.

• Gentle articulation or mobilisation of the SIJ, lumbar spine, and hips.

• Myofascial release for gluteal, piriformis, and iliopsoas muscles.

• Functional and indirect techniques to reduce local irritation.

• Breathing and diaphragm work to normalise intra-abdominal pressure.

• Guidance on posture, ergonomics, and stabilising exercises.

Treatment is adapted to the individual — supporting both mobility where restricted and stability where laxity is present.
The goal is to restore efficient load transfer between the upper and lower body, reducing strain and improving movement quality.

5. Scientific Evidence & References

Evidence supports manual therapy, exercise, and stabilisation training for SIJ-related pain.
Studies highlight that a multimodal approach — combining mobilisation, strengthening, and movement re-education — is more effective than isolated interventions.

Osteopathic treatment aligns closely with these principles, addressing both local mechanics and global compensatory patterns.

References

1. Vleeming A, Schuenke MD, Masi AT, et al. The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat. 2012;221(6):537–567. Link

2. Cohen SP. Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment. Anesth Analg. 2005;101(5):1440–1453. Link

3. Laslett M. Evidence-based diagnosis and treatment of the painful sacroiliac joint. J Man Manip Ther. 2008;16(3):142–152. Link

4. Kamali F, Shokri E. The effect of two manipulative therapy techniques on sacroiliac joint pain and functional disability: a randomized controlled trial. J Bodyw Mov Ther. 2012;16(1):29–35. Link

5. Tozzi P. A unifying neuro-fasciagenic model of somatic dysfunction — underlying mechanisms and treatment. J Bodyw Mov Ther. 2015;19(2):254–265. Link

6. Degenhardt BF, Johnson JC, Fossum C, et al. Osteopathic manipulative treatment for sacroiliac and pelvic pain: pragmatic pilot study. J Bodyw Mov Ther. 2017;21(4):857–865. Link

7. Visser LH, Nijssen PG. Treatment of the sacroiliac joint in patients with low back pain: a randomized-controlled trial. Eur Spine J. 2013;22(10):2310–2317. Link

8. Xie Y, Chen Z, Yang Z, et al. Comparative efficacy of manual therapy interventions for sacroiliac joint pain: network meta-analysis. Front Pain Res. 2024;15:1507461. Link