Sacroiliac joint pain is pain coming from the joints that connect the base of the spine to the pelvis, usually felt low in the back or buttock on one side. It is one cause of low back pain and is linked with pregnancy, falls and changes in walking. Care usually follows NICE low back pain guidance, centred on staying active and exercise.
Also known as SIJ pain, sacroiliac joint dysfunction, pelvic girdle pain, SI joint pain
Symptoms
- Pain low in the back or buttock, usually on one side, below the belt line
- Pain that can spread into the groin or back of the thigh
- Pain when standing on one leg, climbing stairs or turning in bed
- Pain getting in and out of a car or rising from a chair
- Tenderness over the dimple at the back of the pelvis
- In pregnancy, pain at the front of the pelvis (pubic bone) as well
Causes and risk factors
- Pregnancy and the months after giving birth
- A fall onto the buttock or a sudden jarring injury
- Changes in walking pattern, such as from a leg length difference or limp
- Previous lower back surgery, especially spinal fusion
- Inflammatory arthritis such as axial spondyloarthritis
- Increasing age
What the evidence says helps
- NICE guidance for low back pain recommends tailored advice, encouragement to keep up normal activities and an exercise programme suited to your needs.1
- NICE suggests manual therapy, such as manipulation, mobilisation or soft tissue techniques, may be considered only as part of a package of care that includes exercise. It advises against acupuncture and paracetamol alone for low back pain.1
- No single examination test can confirm the sacroiliac joint as the source of pain. Groups of pain provocation tests are better at ruling it out than ruling it in.3
- A review found that exercise during pregnancy reduced the severity of pelvic girdle and low back pain, although it did not stop it from happening.4
- Specialist reviews recommend conservative care, including exercise and rehabilitation, as first-line treatment. For persistent pain, a specialist may consider injections or other procedures, though evidence quality varies.5
Things you can try at home
- Keep moving and stay as active as you can within comfort
- Take shorter strides and avoid standing with your weight on one leg
- Keep your knees together when getting in and out of a car or bed
- Use a pillow between your knees when lying on your side
- Try gentle walking, swimming or pregnancy-safe exercise classes
When to get urgent help
Contact your GP urgently, call NHS 111, or call 999 in an emergency if you have:
- Numbness around the genitals or buttocks, or new problems controlling your bladder or bowel – go to A&E or call 999
- Back or pelvic pain with fever or feeling generally unwell – get same-day medical help or call NHS 111
- In pregnancy, pelvic pain with bleeding, fluid loss, regular tightenings or reduced baby movements – contact your maternity unit straight away
- Pain with unexplained weight loss or a history of cancer – see your GP urgently
- Morning back stiffness lasting more than 30 minutes that eases with exercise, especially under 45 – see your GP, as this may need tests for inflammatory arthritis
How Apollo can help
We assess your lower back, pelvis and hips to work out the most likely source of your pain, and we explain what we find clearly. Your osteopath may use hands-on care as part of a package with exercise, in line with NICE guidance, and we can support you during and after pregnancy. Our team can also guide supervised exercise or clinically informed Reformer Pilates, and we refer to your GP or maternity team when further tests are needed.
No GP referral needed. Clinics in Sheringham, Coltishall and Norwich.
Related reading
Frequently asked questions
Is my sacroiliac joint out of place?
The sacroiliac joint moves only a small amount, and research suggests tests that claim to detect a joint 'out of place' are not reliable between examiners. Tests that reproduce your familiar pain are more useful for working out where pain is coming from.
How do you know the pain is coming from the sacroiliac joint?
There is no single test. Clinicians look at where the pain is, your history and a group of pain provocation tests. These are better at ruling the joint out than confirming it, so the picture as a whole matters.
Is pelvic pain in pregnancy normal?
Pelvic girdle and low back pain are very common in pregnancy, but you do not have to just put up with it. Staying active and exercise can reduce how severe it is. Tell your midwife if it is affecting daily life.
References
- National Institute for Health and Care Excellence (2016, updated 2020). Low back pain and sciatica in over 16s: assessment and management (NG59). NICE. View source
- Cohen SP, et al. (2013). Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment. Expert Review of Neurotherapeutics. View source
- Saueressig T, et al. (2021). Diagnostic accuracy of clusters of pain provocation tests for detecting sacroiliac joint pain: systematic review with meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 51(9), 422–431. View source
- Davenport MH, et al. (2018). Exercise for the prevention and treatment of low back, pelvic girdle and lumbopelvic pain during pregnancy: a systematic review and meta-analysis. British Journal of Sports Medicine. View source
- Szadek K, et al. (2023). Sacroiliac joint pain. Pain Practice. View source
- Wu WH, et al. (2004). Pregnancy-related pelvic girdle pain (PPP), I: terminology, clinical presentation, and prevalence. European Spine Journal. View source
This page is general information, not a diagnosis or a substitute for medical advice. If you are worried about your symptoms, speak to your GP or a registered healthcare professional. Content prepared from the sources above, November 2026.
