Sacroiliac Joint Dysfunction

What Is Sacroiliac Joint Dysfunction?

Sacroiliac joint dysfunction refers to irritation, restriction, or altered movement in the joints where the sacrum meets the two iliac bones of the pelvis. These joints are commonly called the SI joints. They sit at the back of the pelvis and play an important role in transferring force between the spine and the legs.

Every time you walk, stand, climb stairs, bend, lift, or shift weight from one leg to the other, force travels through the pelvis. The sacroiliac joints help manage that force. They are not designed for large movement like the shoulder or hip, but they do require small, coordinated motion to help the pelvis absorb and transfer load.

When SI joint movement becomes restricted, irritated, compressed, or uneven, discomfort may develop in the lower back, pelvis, buttock, hip, or upper leg. Some people describe this as SI joint pain, pelvic pain, lower back and hip pain, or pain near the “dimples” at the back of the pelvis.

The sacrum can also become torsioned between the two iliac bones. This means the sacrum may rotate or twist in relation to the pelvis, altering how the spine sits on top of the pelvic bowl. Because the sacrum is the base of the spine, even small changes in sacral mechanics can influence posture, spinal loading, hip movement, and lower-body mechanics.

Sacroiliac joint dysfunction is often not only a local joint issue. It may involve the lumbar spine, pelvis, hips, pelvic floor, deep core system, glutes, hamstrings, diaphragm, and nervous system regulation.

Individuals May Experience

• Pain in the lower back or buttock region

• Pain near one side of the back of the pelvis

• Discomfort when standing or walking for long periods

• Pain when transitioning from sitting to standing

• Stiffness in the lower back or pelvis

• Pain that may radiate into the hip or upper leg

• Discomfort when climbing stairs

• Pain when rolling in bed

• A feeling of pelvic imbalance or one side being “stuck”

• Tightness through the glutes, hips, or lower back

• Pain after lifting, bending, or prolonged sitting

• Difficulty standing evenly on both legs

• Discomfort during pregnancy or postpartum recovery

• Pain that worsens with single-leg loading

• Lower back tightness that keeps returning despite stretching

Symptoms should be assessed by a licensed healthcare provider if pain is severe, follows trauma, travels below the knee with neurological symptoms, causes progressive weakness, or is associated with numbness, bladder or bowel changes, fever, or unexplained weight loss.

What Contributes to Sacroiliac Joint Dysfunction?

Several factors may influence sacroiliac joint irritation or altered pelvic mechanics, including:

• Previous lower back injuries

• Repetitive lifting or bending

• Muscle imbalances in the hips

• Reduced mobility in the lumbar spine

• Pregnancy-related changes in pelvic stability

• Postpartum pelvic changes

• Sacral torsion between the iliac bones

• Hip mobility restrictions

• Glute weakness or poor pelvic control

• Tight hip flexors, hamstrings, or piriformis region

• Prolonged sitting or uneven posture

• Gait abnormalities or uneven weight transfer

• Leg length differences or functional asymmetry

• Core weakness or poor deep stabilizer activation

• Repetitive sport, running, or single-leg loading demands

• Protective muscle guarding after pain or injury

These factors may influence how forces move through the pelvis during activity.

The SI joints sit at the centre of load transfer between the upper and lower body. If the sacrum is torsioned or the iliac bones are not moving well, forces may not travel evenly through the pelvis. One side may become compressed, while another becomes strained. The lumbar spine may adapt above the pelvis, and the hips may compensate below it.

This can create a chain reaction. A pelvic restriction may contribute to lower back tension. Hip restriction may increase stress through the SI joint. Poor core or glute control may reduce pelvic stability during walking, stairs, lifting, or running. Over time, the body may build compensation patterns around the pelvis that keep the area irritated.

Why Sacral Torsion Matters

The sacrum sits between the two iliac bones like a keystone at the base of the spine. When it is moving well, it helps distribute load between the spine and legs. When it becomes torsioned, rotated, or mechanically restricted, the entire foundation of the spine may be affected. A torsioned sacrum can influence:

• How the lumbar spine sits on the pelvis

• How weight transfers through each leg

• How the hips rotate during walking

• How the pelvis absorbs force during lifting

• How the lower back responds to standing or sitting

• How muscles around the pelvis tighten or compensate

• How the pelvic bowl holds tension

This does not mean the sacrum is permanently “out of place.” A better way to view it is that the sacrum and pelvis may be moving with altered mechanics. Osteopathic assessment can help determine whether the sacrum is rotating, side-bending, compressing, or restricting movement in a way that contributes to symptoms.

The goal is to improve how the sacrum, iliac bones, lumbar spine, and hips work together so the pelvis can transfer force more efficiently.

The SI Joint, Pelvic Bowl, and Nervous System

The sacroiliac region is important because of its relationship to the pelvic bowl and the parasympathetic nervous system. The sacrum is not only a mechanical structure. It is also closely related to nerves, fascia, pelvic organs, pelvic floor tissues, and autonomic regulation.

The parasympathetic nervous system includes sacral contributions that influence pelvic and lower abdominal function. From an osteopathic perspective, tension or restriction through the sacrum, pelvis, pelvic floor, or surrounding fascia may affect how the pelvic region feels and functions mechanically.

This does not mean SI joint treatment directly treats internal medical conditions. Instead, it means the sacrum and pelvis are assessed as part of a larger system involving:

• Pelvic alignment

• Sacral mobility

• Pelvic floor tension

• Lower back mechanics

• Hip movement

• Fascial tension

• Nervous system tone

• Breathing and diaphragm mechanics

• Load transfer through the pelvic bowl

When the pelvis is guarded or restricted, the body may hold tension through the pelvic bowl. Improving movement and reducing mechanical strain may help support comfort, relaxation, and better coordination through the region.

How Manual Therapy May Help

Manual therapy and rehabilitation may help assess and address mechanical contributors to SI joint discomfort. The goal is not simply to “adjust the pelvis,” but to understand why the SI joint is being irritated and how the spine, pelvis, hips, and surrounding tissues are contributing.

Care may focus on improving pelvic mobility, reducing fascial tension, supporting better spinal-pelvic alignment, strengthening stabilizing muscles, and reducing compensation patterns.

Osteopathic Manual Therapy

Osteopathic Manual Therapy may evaluate how the sacroiliac joints move in relation to the spine, hips, sacrum, iliac bones, pelvic floor, and surrounding fascia. Since the sacrum acts as the base of the spine, osteopathic care often considers how sacral mechanics influence the entire spinal column above and the hips below.

Treatment may include:

• Assessing pelvic alignment and mobility

• Improving movement in the sacroiliac joints

• Assessing sacral torsion between the iliac bones

• Addressing fascial tension in the pelvis

• Supporting coordinated movement between the spine and hips

• Reducing tension in the glutes, hip flexors, hamstrings, and lower back

• Improving lumbar spine and hip mobility when contributing to pelvic strain

• Supporting more balanced load transfer through the pelvis

• Addressing pelvic bowl tension where relevant

• Improving movement patterns that influence SI joint loading

Osteopathic care often focuses on improving the mechanical relationship between the spine and pelvis. If the sacrum is torsioned or the ilia are restricted, treatment may aim to reduce tension around the area and restore more balanced motion through the pelvic ring.

The goal is to help the pelvis function as a stable but adaptable foundation for the spine and lower limbs.

Physiotherapy

Physiotherapy rehabilitation may focus on strengthening the muscles that stabilize and control the pelvis. This is especially important because the SI joint requires both mobility and stability. Too much rigidity may cause compression and discomfort, while poor control may create irritation during movement.

Treatment may include:

• Core stabilization exercises

• Hip strengthening

• Glute strengthening

• Pelvic stability training

• Movement retraining during lifting and walking

• Single-leg control exercises

• Mobility work for the hips and lumbar spine

• Breathing and deep core coordination

• Gradual progression of activity levels

• Return-to-running or return-to-sport programming when appropriate

• Education on posture, lifting, and sitting strategies

These exercises help support stability of the pelvis during everyday movement. Strengthening the core, glutes, hips, and deep stabilizers may help reduce repeated stress through the SI joint.

Physiotherapy may also help retrain how the body loads the pelvis during walking, stairs, lifting, squatting, or athletic activity.

Massage Therapy

Massage therapy may help relieve muscular tension around the pelvis. When the sacroiliac joint is irritated, the body may tighten surrounding muscles to protect the area. This may include the glutes, piriformis region, hip flexors, hamstrings, quadratus lumborum, and lower back muscles.

Treatment may include:

• Reducing tightness in the gluteal muscles

• Addressing tension in the lower back muscles

• Supporting circulation in surrounding tissues

• Relaxing protective muscle guarding

• Reducing hip and pelvic soft tissue tension

• Addressing compensatory tightness from uneven loading

• Supporting comfort during movement and recovery

Massage therapy may help relieve muscular tension that develops around the sacroiliac joints. It is often most effective when combined with pelvic stability work, mobility exercises, and manual therapy assessment.

Book an Assessment

If lower back pain, pelvic discomfort, buttock pain, hip tightness, or stiffness is affecting your ability to walk, stand, sit, lift, or move comfortably, our team can assess sacroiliac joint mechanics and guide appropriate care.

A comprehensive assessment can help identify whether your symptoms may be influenced by sacral torsion, pelvic alignment, SI joint restriction, hip mobility, core stability, pelvic bowl tension, muscle guarding, or compensation patterns through the spine and lower body.