The sacroiliac joints (SI joints) connect the sacrum — the base of the spine — to the iliac bones of the pelvis.
They play a crucial role in transmitting forces between the upper body and lower limbs, providing both stability and a small degree of movement to absorb stress during walking, lifting, or twisting.
Sacroiliac pain (often called SI joint dysfunction) occurs when this joint becomes irritated, restricted, or overloaded.
It may cause sharp, aching, or radiating pain in the lower back, buttock, or groin, and is frequently confused with lumbar disc or hip pain.
SI dysfunction is common, accounting for up to 25–30% of all low back pain cases.
It can affect both men and women but is particularly prevalent in pregnancy and postpartum women, where hormonal and postural changes increase joint mobility and strain.
Localised pain near one or both dimples of the lower back.
Pain radiating into the buttock, groin, or posterior thigh (usually not past the knee).
Pain aggravated by standing, climbing stairs, rolling in bed, or getting up from sitting.
Feeling of instability or “locking” in the pelvis.
Asymmetry in pelvic movement during walking.
Functional impact:
SI joint pain can limit bending, walking, or prolonged standing and often creates secondary tension in the lumbar spine, hips, or gluteal muscles.
In chronic cases, it may lead to compensatory strain higher up the spine or in the opposite leg.
Red flags:
Severe or radiating neurological symptoms, unexplained weight loss, fever, or history of trauma should prompt medical assessment before manual therapy.
Sacroiliac pain usually results from mechanical imbalance or joint irritation, rather than structural damage.
Common contributing factors include:
Pelvic asymmetry or leg length difference.
Postural imbalance: prolonged sitting, standing, or one-sided activity.
Pregnancy and postpartum changes: hormonal relaxation of pelvic ligaments (relaxin).
Repetitive loading: lifting, twisting, or uneven gait mechanics.
Trauma: falls onto the buttocks or pelvis.
Muscle imbalance: tight hamstrings, weak gluteals, or overactive hip flexors.
Visceral tension: e.g. bowel, bladder, or gynaecological restrictions influencing pelvic tone.
From an osteopathic perspective, the SI joint is part of a functional unit with the lumbar spine, hips, and sacrum — imbalance in one region often creates compensatory dysfunction in the others.
Osteopathic treatment for sacroiliac pain focuses on restoring balanced movement, reducing irritation, and improving load transfer through the pelvis and spine.
An osteopathic assessment may include:
Postural and gait analysis to identify asymmetries and compensatory strain.
Palpation of SI joint motion, sacral base alignment, and soft tissue tension.
Gentle mobilisation and articulation of the sacrum, lumbar spine, and hips.
Myofascial release for gluteal, piriformis, and iliolumbar regions.
Indirect or functional techniques to reduce pain and muscle guarding.
Breathing and diaphragm work to support lumbopelvic stability.
Advice on activity modification, ergonomics, and movement awareness.
When inflammation or instability is present (e.g. postpartum), techniques are applied gently and safely, often combined with exercises or pelvic belts as adjuncts.
The aim is to improve functional stability and reduce mechanical irritation, helping the pelvis move freely and comfortably again.
Recent research supports manual therapy, stabilisation exercises, and multimodal conservative care as first-line treatments for SI joint dysfunction.
Evidence shows that osteopathic and physiotherapy-based interventions can reduce pain, restore mobility, and improve quality of life, particularly when combined with education and functional retraining.
Cohen SP. Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment. Anesth Analg. 2005;101(5):1440–1453. Link
Vleeming A, Schuenke MD, Masi AT, Carreiro JE, Danneels L, Willard FH. The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat. 2012;221(6):537–567. Link
Szadek KM, et al. Diagnostic validity of criteria for sacroiliac joint pain: a systematic review. J Pain. 2009;10(4):354–368. Link
Hungerford BA, Gilleard WL, Hodges PW. Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac joint pain. Spine. 2003;28(14):1593–1600. Link
Degenhardt BF, Johnson JC, Fossum C, et al. Osteopathic care for patients with sacroiliac and pelvic pain: a pragmatic pilot study. J Bodyw Mov Ther. 2017;21(4):857–865. Link
Franke H, Fryer G, Ostelo RWJG, et al. Osteopathic manipulative treatment for low back and pelvic pain: systematic review and meta-analysis. Pain Physician. 2021;24(3):205–216. Link
Laslett M. Evidence-based diagnosis and treatment of the painful sacroiliac joint. J Man Manip Ther. 2008;16(3):142–152. Link
Xie Y, Chen Z, Yang Z, et al. Comparative efficacy of manual therapy interventions for sacroiliac joint dysfunction: a network meta-analysis. Front Pain Res. 2024;15:1507342. Link
Stay connected and explore insights on osteopathy, health, and wellbeing. Discover tips, updates, and guidance for your body’s balance.
© 2025 Nicolai Salmonsen • All Rights Reserved