SI Joint Dysfunction: The Back Pain Culprit That Often Gets Missed

SI joint dysfunction causes deep, one-sided pain just above the buttock that can spread into the buttock, hip, or upper thigh, and it’s often mistaken for a disc problem or hip issue. It doesn’t show up reliably on standard imaging, so it’s identified through a cluster of hands-on exam tests. Treatment depends on whether the joint is too stiff or too loose: restricted joints often respond to targeted adjustments, while unstable joints need stabilizing exercises and gentler care.

Sacroiliac joint dysfunction is one of the most commonly missed causes of lower back and hip pain. It mimics several other conditions closely enough to be misidentified, and it often gets lumped into general “lower back pain” without being specifically recognized or treated. At Castle Rock Chiropractic, Dr. Dickason identifies and treats SI joint dysfunction regularly, and for patients who’ve been managing lower back and hip pain without lasting relief, it’s often the missing piece of the puzzle.

What the Sacroiliac Joint Is and What It Does

The sacroiliac joints are the two joints connecting your sacrum, the triangular bone at the base of your spine, to the iliac bones of your pelvis, one on each side. You can roughly locate them by pressing your thumbs into the two dimples just above your buttocks on either side of the lower spine.

These joints are large, weight-bearing, and fairly stiff by design. Unlike the spinal segments above them, SI joints move only a small amount. They’re built for stability and load transfer rather than flexibility. They carry force between the upper body and the legs, absorb the impact of walking and running, and play a key role in pelvic stability during single-leg activities like hiking, climbing stairs, and kicking.

Even so, SI joints can become hypomobile (too stiff and restricted) or hypermobile (too loose and unstable), and both can cause pain and dysfunction.

Why SI Joint Problems Get Missed

Several factors make SI joint dysfunction one of the more frequently overlooked sources of pain.

Standard X-rays and MRIs don’t reliably show SI joint dysfunction unless there’s a significant problem like sacroiliitis (inflammation of the joint) or a fracture. A normal MRI doesn’t rule out SI joint involvement. It just means nothing major is visible on the scan, since the joint can be mechanically dysfunctional without showing anything dramatic.

The symptoms of SI joint dysfunction also overlap heavily with lumbar disc problems, hip joint problems, and piriformis syndrome. Pain in the lower back, buttock, hip, and sometimes upper thigh can come from any of these. Without specific testing focused on the SI joint, it’s easy to blame a disc or facet joint and miss the real source.

And because SI joint pain depends on position and activity, often getting worse with long periods of sitting, standing on one leg, climbing stairs, or rolling over in bed, it can show up as a collection of seemingly unrelated complaints rather than one clear pattern.

Who Develops SI Joint Dysfunction in Castle Rock

Certain groups show up more often with SI joint problems.

Post-Pregnancy Women

This is one of the most recognized risk groups. During pregnancy, the hormone relaxin is thought to loosen ligaments throughout the body, including those around the SI joints, to prepare for delivery. That looseness, along with the changed mechanics of carrying a pregnancy and the forces of labor and delivery, can leave the SI joints unstable and painful after birth. Women who had pregnancy-related pelvic and back pain often find the SI joint is a major part of it.

Trail Hikers and Runners

Repetitive single-leg loading, which is exactly what hiking and running involve, stresses the SI joints unevenly. Trail hikers on Castle Rock’s uneven terrain and runners logging serious miles are two of the most common active groups Dr. Dickason sees with SI joint involvement. The joint absorbs every footfall, and uneven terrain adds up over time.

People Who Sit Heavily on One Side

The remote worker who always crosses the same leg, the driver who sits with weight shifted to one side, and the person with a wallet or phone in a back pocket all load the SI joints unevenly over time, which can lead to problems in the more heavily loaded joint.

Patients With Prior Lumbar Spine Problems

When lower back segments are restricted or have lost normal motion from disc problems, facet dysfunction, or prior surgery, the SI joints below them often compensate. That extra load can add to SI joint stress in people who were already dealing with lower back pain from the spine.

How to Recognize SI Joint Dysfunction

No single symptom confirms SI joint dysfunction, which is what an exam is for. But these features together suggest SI joint involvement:

• Deep, achy pain over one or both of the dimples just above the buttocks, off to the side of the spine
• Pain that spreads into the buttock or upper thigh, but usually not below the knee, which helps distinguish it from true sciatica in many cases
• Significant pain when rolling over in bed, getting in and out of a car, or climbing stairs
• Pain with long periods of sitting that eases with walking but returns after extended walking
• A feeling of instability or “giving way” in the pelvis during single-leg activities
• Uneven hip height or pelvic tilt visible during a posture assessment

The overlap with sciatica and hip problems is real. That’s why Dr. Dickason uses a cluster of SI joint provocation tests, such as distraction, compression, thigh thrust, sacral thrust, Gaenslen’s, and FABER, along with hip tests like FADIR to help rule out the hip joint. Several positive SI-specific tests, combined with your history and where you feel symptoms, identify SI joint involvement with more confidence than any single test can.

How Chiropractic Care Treats SI Joint Dysfunction

The treatment approach depends on whether the SI joint is restricted or unstable.

For Restricted SI Joints

When the SI joint has lost its small but important range of motion, usually from uneven loading, posture habits, or compensation patterns, chiropractic adjustments aimed specifically at the sacroiliac joint can help restore that motion. SI joint adjustments are different from lumbar adjustments because they target the joint mechanics of the pelvis. Many restricted SI joints respond fairly quickly, with patients noticing less hip and buttock pain within the first several visits.

For Hypermobile SI Joints

Unstable SI joints, most often seen after pregnancy and in people with naturally loose joints, need a different approach. Aggressive manipulation of an already loose joint can make things worse. Instead, the focus shifts to stability: soft tissue work to calm irritation around the joint, specific exercises to strengthen the glutes and pelvic floor, and a gentler manual approach that supports the joint rather than mobilizing it.

Addressing Lumbar and Hip Contributors

SI joint dysfunction rarely exists on its own. The lower back above and the hips below often have restriction or imbalance that contributes. A complete treatment plan addresses those factors alongside the SI joint, which is why targeted care tends to produce more lasting results than treating the joint alone.

A Common Pattern Worth Knowing

One situation Dr. Dickason sees often in Castle Rock is the patient who was told they had a lumbar disc problem based on imaging, received care for the disc, improved somewhat but never fully recovered, and eventually came in still dealing with lower back and hip pain. In many of these cases, the SI joint was contributing all along but was never specifically assessed or treated. Addressing the SI joint, alongside any remaining lower back findings, is often what finally brings real relief.

When to See a Doctor

Some lower back and pelvic pain needs medical evaluation. See a doctor if you’re a younger adult with back or buttock pain that’s worse in the morning, causes stiffness for more than 30 minutes, wakes you in the second half of the night, and improves with activity, since that pattern can point to an inflammatory condition. Also get checked for pain after a significant fall, pain with fever, or new leg weakness. Loss of bladder or bowel control, or numbness in the groin, needs emergency care right away.

Frequently Asked Questions

How do I know if my pain is SI joint or a disc problem?

SI joint pain usually sits low and off to one side of the spine and rarely travels below the knee, while disc problems more often cause pain or numbness down the leg. A hands-on exam with specific tests is the best way to tell.

Can SI joint dysfunction go away on its own?

Mild flare-ups sometimes settle with rest and movement, but recurring SI joint pain usually needs treatment that addresses the joint mechanics and supporting muscles.

Is SI joint pain common after pregnancy?

Yes. Ligament changes during pregnancy and the forces of delivery make postpartum SI joint pain common, and it usually responds to stabilizing exercises and gentle care.

If you’ve been managing lower back, buttock, or hip pain that hasn’t fully responded to previous care, SI joint dysfunction is worth investigating. Reach out to Castle Rock Chiropractic at 303-688-2300 or visit our new patients page to schedule a consultation. Dr. Dickason’s evaluation will show whether the SI joint is part of your picture and what to do about it if it is.