Relief for SI Joint Pain: Physical Therapy Strategies That Make a Difference

Medically reviewed by Misty Seidenburg

If you’ve ever experienced sharp or aching pain near your lower back, just off to one side, the source might not be your spine. It could be your sacroiliac (SI) joint. SI joint dysfunction is a common but often under-recognized contributor to low back pain. Fortunately, physical therapy offers a range of approaches that can help alleviate SI joint pain, enhance mobility, and support a return to everyday activities. Continue reading to discover why SI joint physical therapy works and how it can be a crucial step to achieving lasting relief.

What Is the Sacroiliac (SI) Joint?

You have two SI joints that connect the sacrum (the base of your spine) to your pelvis on either side. These joints play a crucial role in transferring weight from the upper body to the legs. While they don’t allow a lot of movement, they’re vital for stability and shock absorption during activities like walking, running, and jumping.

SI joints can become painful due to being sensitized, being overly mobile, or being stiff, which can cause localized pain in the lower back, buttocks, groin, and even radiate into the legs. This is often referred to as SI joint pain or SI joint dysfunction.

SI Joint Pain: Causes and Risk Factors

SI joint dysfunction has several possible causes. Some of the most common include:

• Trauma or injury: A fall, car accident, or sudden twist can sprain the ligaments surrounding the SI joint.
• Repetitive stress: Certain activities (like running or lifting) can strain the joint over time.
• Arthritis: Inflammatory conditions such as arthritis can cause SI joint pain and inflammation.
• Anatomical differences: Leg length discrepancies or spinal alignment issues can overload one side of the pelvis.
• Pregnancy: Hormonal changes and altered posture can lead to increased joint laxity.

Keep in mind that not everyone with these risk factors will experience SI joint discomfort. Yet, being aware of them can help with early detection and intervention.

Recognizing Symptoms of SI Joint Dysfunction

Signs of SI joint involvement can vary, but some common symptoms include:

• Dull or sharp pain in the lower back or buttocks, typically on one side
• Pain that worsens with standing, walking, or transitioning from sitting to standing
• Discomfort while climbing stairs or getting out of a car
• A feeling of instability in the pelvis or hips

While these symptoms can resemble other conditions, such as sciatica or lumbar disc problems, physical therapists are trained to assess and differentiate SI joint issues during evaluation.

How Physical Therapists Diagnose SI Joint Dysfunction

SI joint physical therapy typically begins with a comprehensive evaluation. Because imaging tests, like X-rays or MRIs, often fail to reveal problems with the SI joint, diagnosis is primarily based on clinical assessment.

A physical therapist begins by analyzing your posture and movement patterns to identify any impairments that could contribute to your pain. They also use a hands-on technique called palpation to check for tenderness or inflammation around the SI joint itself.

SI joint diagnosis is considered a diagnosis of exclusion. After ruling out the low back as the source or a contributor of symptoms, specific provocative tests, such as the  , may be performed to see if they reproduce your symptoms, helping to confirm the SI joint as the likely source. Functional assessments allow the therapist to observe how the joint responds during everyday movements, such as walking, bending, or lifting.

By combining information from these different approaches, your physical therapists can develop a clearer understanding of what contributes to your symptoms and create a personalized treatment plan based on your unique needs and goals.

SI joint pain is typically categorized into 1 of 3 categories.

• SI joint pain with mobility deficits: symptoms that arise from stiff joints
• SI joint pain with movement control deficits: symptoms that arise from hypermobility, typically seen in pregnant and post-partum individuals or those with hypermobility disorders
• SI joint pain with cognitive and affective tendencies: chronic SI issues that have a pain-processing component

Physical Therapy Approaches for SI Joint Pain Relief

Once SI joint dysfunction is identified, your physical therapist tailors a treatment plan to address your specific needs. Determining the underlying cause of symptoms allows your therapist to choose an approach that will work best for your specific needs, whether that is mobility or stability. Physical therapy for SI joint pain might include:

Stabilization and Strengthening Exercises

Building strength around the SI joint is essential for long-term stability. Common SI joint exercises focus on:

• Core strengthening: activating the deep abdominal and back muscles
• Glute activation: bridges, clamshells, and step-ups help support the pelvis
• Hip and leg control: exercises like bird-dog, wall sits, or side steps with resistance bands
• Pelvic floor coordination: when the pelvic floor has been identified as a contributor, ensuring these muscles appropriately contract and lengthen helps reduce stress on the SI joint

These movements are typically introduced in stages, starting with low-impact, supported positions and progressing to more dynamic, functional exercises as stability improves.

Joint Stretches and Mobility Work

In addition to strength work, flexibility and mobility are key components of SI joint physical therapy. Here are a few SI joint stretches that may be recommended.

Figure-4 Stretch

This movement targets the piriformis muscle, which can contribute to pelvic imbalance.

• Sit in a chair with your feet touching the ground.
• Bend your right leg and place your right foot over your left knee.
• Keep your back straight as you gently lean forward, noticing a gentle stretch along the back of your hip.
• Hold this position 20-30 seconds. Repeat 3 times on both sides.

Knee-to-Chest Stretch

Helps release tension in the lower back and glutes.

• Lie on your back with your knees bent and feet flat on the floor.
• Slowly bend and raise your right knee in toward your chest.
• Interlace your fingers or clasp your wrists and wrap your arms around your lower leg.
• Gently pull your bent knee toward your body, keeping your low back, pelvis, and legs as relaxed as possible.
• Hold 5 seconds before releasing the bent leg back to the floor.
• Repeat on the other side.
• Do this stretch 10-15 times per day.

Spinal Rotation Stretch

This stretch gently increases mobility in the lumbar spine and hips.

• Sit on the floor with your legs out straight in front of you.
• Bend your right knee and cross it over your left leg, resting your right foot next to your outer left thigh.
• Now, place your left elbow on the outside of your right thigh as you gently and slowly twist toward the right, looking back at your right shoulder.
• Hold this position for 20-30 seconds before releasing and repeating on the other side.

These stretches should be performed slowly and mindfully, never pushing into pain. Your physical therapist will guide you in selecting the most suitable stretches for your individual needs.

Manual Therapy Techniques

Joint and soft tissue mobilization, as well as other hands-on therapies, can be used at the SI joint and surrounding regions to reduce stiffness, improve joint mechanics, and release surrounding tight muscles that may be contributing to symptoms. Some physical therapists also use muscle energy techniques (METs), which involve gentle muscle contractions to help improve function and movement.

Pain Management and Supportive Tools

Along with hands-on care and exercise, other supportive strategies may help ease SI joint discomfort during recovery:

• Ice or heat therapy: Ice may reduce inflammation after activity; heat can relax tight muscles.
• TENS units: Some individuals find relief from electrical stimulation, which helps reduce pain signals.
• SI belts: Worn around the pelvis, these belts provide temporary stabilization during activity.
• Education: Learning about posture, body mechanics, and activity pacing empowers you to avoid re-irritating the joint.

Many people with SI joint pain experience noticeable relief with conservative care. However, if progress is limited or symptoms are severe, your provider may recommend further medical evaluation. Interventions like injections or minimally invasive procedures can be considered, often in conjunction with ongoing physical therapy.

Flare-Up Prevention Tips

Even after symptoms begin to improve, it’s essential to continue supporting the health and stability of your SI joints. Maintaining a routine of core and glute strengthening exercises can help keep the surrounding muscles strong and balanced.

It’s also wise to avoid staying in one position—whether sitting or standing—for extended periods, as this can place unnecessary strain on the joint. Gentle, low-impact activities, such as walking or swimming, can support joint mobility and overall function without overloading the affected area.

Additionally, being mindful of your posture and proper lifting techniques can make a significant difference. Together, these habits can help reduce the risk of recurring SI joint pain and support long-term pelvic stability.

Take Control of Your Recovery: Schedule Physical Therapy Evaluation Today

Low back pain treatment isn’t one-size-fits-all, and SI joint dysfunction is a prime example of how targeted care can make a big difference. With the support of a skilled physical therapist, many people find that a combination of SI joint stretches, strengthening, and manual therapy can help them feel and move with less pain.

If you suspect your SI joint may be contributing to your discomfort, consider exploring SI joint physical therapy as a proactive step toward relief. With patience and the right approach, movement can become more comfortable and enjoyable once again. Schedule an appointment at a physical therapy clinic near you.