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

Sacroiliac joint dysfunction – SI joint pain – is one of the most commonly missed diagnoses in patients with lower back and hip pain. It doesn’t show up reliably on standard imaging, it mimics several other conditions closely enough to be misidentified, and it often gets lumped into the general category of “lower back pain” without being specifically recognized or targeted. At Castle Rock Chiropractic, Dr. Dickason identifies and treats SI joint dysfunction regularly – and for patients who’ve been managing diffuse lower back and hip pain without lasting relief, it’s often the piece of the puzzle that’s been missing.

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 against the two dimples just above your buttocks on either side of the lower spine – that’s approximately where the SI joints sit.

These joints are large, weight-bearing, and relatively stiff by design. Unlike the spinal segments above them, SI joints don’t move through a large range of motion – they’re designed for stability and load transfer rather than flexibility. They transmit force between the upper body and the lower extremities, absorb and distribute the ground reaction forces from walking and running, and play a critical role in pelvic stability during single-leg activities like hiking, climbing stairs, and kicking.

Despite their designed stability, SI joints can become either hypomobile (too stiff and restricted) or hypermobile (too loose and unstable), and both presentations produce pain and dysfunction.

Why SI Joint Problems Get Missed

Several factors combine to make SI joint dysfunction one of the more frequently overlooked pain generators:

Standard X-rays and MRIs don’t reliably show SI joint dysfunction unless there’s significant pathology like sacroiliitis (inflammation of the joint) or fracture. A normal MRI doesn’t rule out SI joint involvement – it just means there’s no gross structural pathology visible on imaging. The joint can be mechanically dysfunctional without showing anything dramatic on a scan.

The symptom pattern of SI joint dysfunction overlaps considerably with lumbar disc problems, hip joint pathology, and piriformis syndrome. Pain in the lower back, buttock, hip, and sometimes upper thigh – all of which can also be produced by those other conditions – is the typical SI joint presentation. Without specific orthopedic testing focused on the SI joint, it’s easy to attribute those symptoms to a disc or facet joint and miss the actual source.

And because SI joint pain is positional and activity-dependent – worse with prolonged sitting, standing on one leg, climbing stairs, or rolling over in bed – it often presents as a collection of seemingly unrelated complaints rather than a clearly identifiable pain pattern.

Who Develops SI Joint Dysfunction in Castle Rock

Certain patient profiles are disproportionately represented in SI joint dysfunction presentations:

Post-Pregnancy Women

This is the most well-established risk group. During pregnancy, the hormone relaxin loosens ligaments throughout the body – including the SI joint ligaments – to prepare for delivery. That ligament laxity, combined with the changed biomechanics of carrying pregnancy weight and the forces of labor and delivery itself, frequently leaves the SI joints hypermobile and painful postpartum. Women who experienced pregnancy-related pelvic and back pain often find SI joint involvement is a primary component.

Trail Hikers and Runners

Repetitive single-leg loading – which is exactly what hiking and running involve – stresses the SI joints asymmetrically. Trail hikers on Castle Rock’s uneven terrain and runners logging significant miles are two of the most common active adult presentations Dr. Dickason sees with SI joint involvement. The joint absorbs every footfall, and the cumulative asymmetric loading from terrain variation takes a toll.

People Who Sit Heavily on One Side

The remote worker who consistently crosses one leg, the driver who sits with weight shifted to one side, the person whose wallet or phone in a back pocket creates a chronic pelvic tilt – all of these patterns load the SI joints asymmetrically over time and drive dysfunction in the more heavily loaded joint.

Patients With Prior Lumbar Spine Problems

When lumbar spine segments are restricted or have lost normal motion – from disc problems, facet dysfunction, or prior surgery – the SI joints below them are asked to compensate for the lost motion above. That compensatory loading accelerates SI joint stress and dysfunction in patients who were already managing lower back pain from spinal sources.

How to Recognize SI Joint Dysfunction

No symptom pattern is diagnostic on its own – that’s what an examination is for. But the following features together suggest SI joint involvement:

• Deep, achy pain centered over one or both of the sacral dimples (the lower back just above the buttocks, off the midline)
• Pain that radiates into the buttock or upper thigh – but typically not below the knee, which distinguishes it from true sciatica in many cases
• Significant pain with rolling over in bed, getting in and out of a car, or climbing stairs
• Pain with prolonged sitting that improves with walking but worsens again after extended walking
• A feeling of instability or “giving way” in the pelvis with single-leg activities
• Asymmetric hip height or pelvic tilt visible in posture assessment

The overlap with sciatica and hip joint pathology is real. Dr. Dickason uses a cluster of specific orthopedic provocation tests – FABER, FADIR, Gaenslen’s, distraction and compression tests – to identify SI joint involvement with more confidence than any single test allows. The combination of positive findings on multiple SI-specific tests, along with the clinical history and symptom distribution, points clearly enough to drive treatment decisions.

How Chiropractic Care Treats SI Joint Dysfunction

The treatment approach depends on whether the SI joint is hypomobile (restricted) or hypermobile (unstable):

For Restricted SI Joints

When the SI joint has lost its small but important range of motion – typically from asymmetric loading, postural habits, or compensation patterns – chiropractic adjustments targeted specifically to the sacroiliac joint restore that motion. SI joint adjustments are distinct from lumbar adjustments – they target the joint mechanics of the pelvis specifically. Most restricted SI joints respond relatively quickly to appropriate adjustment technique, with patients noticing significant improvement in hip and buttock pain within the first several visits.

For Hypermobile SI Joints

Unstable SI joints – most commonly seen in postpartum patients and some hypermobile individuals – need a different approach. Aggressive manipulation of an already-lax joint is counterproductive. The focus shifts to stabilization: soft tissue work to reduce inflammation around the joint, specific exercises to strengthen the gluteal and pelvic floor stabilizers, and a more conservative manual approach that supports rather than mobilizes the joint.

Addressing Lumbar and Hip Contributors

SI joint dysfunction rarely exists in isolation. The lumbar segments above and the hip joints below almost always have contributing restriction or imbalance. A complete treatment plan addresses those contributing factors alongside the SI joint itself – which is why targeted SI joint care tends to produce more durable results than treating the joint in isolation.

A Common Pattern Worth Knowing

One presentation Dr. Dickason sees frequently in Castle Rock is the patient who was told they had a lumbar disc problem based on imaging, received care for the disc, got some improvement but never fully resolved, and eventually ended up in the office still carrying lower back and hip pain. In many of these cases, the SI joint was contributing all along and was never specifically assessed or treated. Addressing the SI joint component – alongside any residual lumbar findings – is often what finally produces complete resolution.

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 tell you whether the SI joint is part of your picture – and what to do about it if it is.