Introduction

If you’ve landed on this page, there’s a good chance you’ve been dealing with pain around one side of your lower back, buttock or pelvis and you’re struggling to work out why it keeps returning.

Perhaps you’ve been told it’s your sacroiliac joint (SI joint). Perhaps you’ve had treatment that helped for a few days or weeks before the pain returned. Or perhaps you’re still trying to figure out exactly what’s causing the problem.

One thing I’ve noticed over the years is that patients with sacroiliac joint problems will often arrive at the clinic saying:

“My back keeps going every few months.”
“It’s always the same side.”
“It feels like something is stuck.”
“Stretching helps, but it always comes back.”

If that sounds familiar, read on.

What Is The Sacroiliac Joint?

The sacroiliac joints sit at the base of the spine where the sacrum (the triangular bone at the bottom of your spine) meets the pelvis (ilium). You have two of them, one on each side. They don’t move as much as other joints, but are extremely important for transferring forces between the upper body and the legs.

Think of them as shock absorbers and force transmitters between the spine and pelvis. In particular, they will be taking the load when:

Walking
Climbing stairs
Running
Bending and twisting at the same time
Lifting

Although the joints are incredibly strong, problems can sometimes develop when movement becomes uneven, when surrounding muscles aren’t providing enough support, or when the joints become irritated.

What Are The Most Common Symptoms Of Sacroiliac (SI) Joint Pain?

Sacroiliac joint (SIJ) pain is an underappreciated source of mechanical low back pain, affecting between 15 and 30% of individuals with chronic, nonradicular pain (Pubmed). One of the biggest challenges with SI joint pain is that it can mimic several other lower back conditions. Patients will often ask me whether their symptoms are coming from the SI joint, a Disc Problem or Sciatica.

Although a professional assessment is often needed for an accurate diagnosis, there are several symptom patterns that commonly point towards the sacroiliac joint as a possible source of pain. These include:

Pain on one side of the lower back
Pain around the dimples at the base of the spine
Pain that spreads into the buttock
Discomfort when turning over in bed
Pain getting out of the car
Pain going from sit to stand
A feeling that one side of your pelvis isn’t moving properly
Recurrent episodes of lower back pain that keep returning

The challenge is that SI joint pain can sometimes mimic other conditions.

For example, symptoms can overlap with:

In order to work out if the SI joint is causing your pain, I highly recommend you read the related pages above, and if in doubt, seek a professional assessment.

What Are The Most Common Causes Of Sacroiliac (SI) Problems?

After assessing hundreds of patients with recurrent lower back and pelvic pain, I’ve found that SI joint problems are rarely caused by a single event.

More often, it’s the result of several factors gradually building up over time. In my experience, the most common contributing factors include:

Poor posture/prolonged sitting
Repetitive loading (especially bending/twisting movements)
Muscle imbalances
Weakness
Pregnancy

Man gardening with sacroiliac joint pain

📖 Clinic Story

I had a gentleman called Jamie recently who presented with recurrent sacroiliac joint problems. His most recent episode had started after clearing out some trees from the garden (repetitive loading).

He informed me that he’d spent several hours on this task which was not a normal activity for him. His day job was office based. On further questioning, he often crossed his legs when sitting.

When we looked more closely, it became clear that one side of the pelvis wasn’t moving particularly well, his gluteal muscles were doing very little work and his lower back muscles were trying to compensate for everything.

The solution wasn’t stretching.

It was gradually improving movement, rebuilding stability and strengthening the muscles that should have been doing the work in the first place.

Over time, the flare-ups became less frequent and less severe.

I give this example to demonstrate how each piece of the puzzle can result in an SI joint problem.

Why Does My Sacroiliac Joint Pain Keep Coming Back?

One of the most frustrating aspects of SI joint pain is that it often improves temporarily before returning again.

In many cases, the pain settles but the underlying issues remain. Restricted movement, reduced stability, muscle weakness and prolonged sitting habits can all continue to place stress on the area long after the initial symptoms have improved.

This is one of the reasons why treatments that focus solely on pain relief often provide short-term benefit but fail to prevent future flare-ups.

To reduce the likelihood of recurrence, it’s important to address the factors that contributed to the problem in the first place.

What Helps Sacroiliac Pain?

This is perhaps the most important section on the page. One thing I’ve noticed repeatedly in clinic is that many people focus entirely on relieving pain.

That’s understandable.

When your back hurts, all you want is for it to stop.

The problem is that pain relief and long-term recovery are not always the same thing.

Easing symptoms still has its place while you do the longer-term work. Many of my patients find a reusable hot and cold pack useful for settling an irritable SI joint, used for around 15 minutes at a time with a layer between the pack and the skin.

In order for an SI joint to stay pain-free long-term, there is one particularly important aspect that is often more important than any other—stability:

Imagine straightening a leaning fence post without improving the ground around it.

It may look better for a while.

But if the support underneath remains weak, the problem often returns.

The same thing can happen around the pelvis and lower back.

Best Exercises for Sacroiliac Joint Pain: My Three-Step Approach to SI Joint Recovery

Most successful recoveries seem to involve three key stages.

Step 1: Restore Balanced Movement

The goal isn’t to make the joint hypermobile. The goal is to help the pelvis, hips and lower back move more evenly.

I normally start my patients off with the following exercises which you can also try:

When one side becomes noticeably stiffer than the other, the body often starts compensating elsewhere.

Improving movement is often the first step towards breaking that cycle.

Step 2: Build Stability and Control

This is where many people stop too early. Just because something moves better doesn’t mean it can control that movement.

At this stage, I often focus on exercises that improve coordination and stability around the pelvis and trunk. You can give the following exercises a try once you are feeling more mobile:

Step 3: Build Strength and Resilience

The final stage is making the improvements stick. I commonly prescribe the following two exercises at this stage:

I also recommend gradually increasing walking, lifting and normal daily activities.

This is the stage many people miss, yet it’s often the stage that prevents future flare-ups.

Recovery Doesn’t Stop When Exercise Finishes

Many people spend 30 minutes exercising and then 8 hours sitting. If your daily habits continue to load the same tissues repeatedly, recovery becomes much harder.

This is why when I’m treating people with SI joint issues, my focus is also bringing their attention to their daily postural habits. This is vital for long-term recovery.

Could Your Work Station Set-Up Be Keeping You In Pain?

One of the most common aggravating factors I see isn’t necessarily poor posture. It’s prolonged posture. Many people spend 8–10 hours a day sitting.

The body generally tolerates movement better than it tolerates being held in one position for hours at a time.

This is particularly relevant if you work at a desk. Patients will often tell me:

“I’m okay when I’m moving around, but I stiffen up when I sit.”

That observation is often worth paying attention to.

The Simple Desk Upgrade That Could Ease Your SI Joint Pain

I’m a fan of standing desks, but perhaps not for the reason many people think.

A standing desk won’t magically fix your SI joint.

What it does do is make it easier to change position throughout the day.

That constant variation can reduce the amount of time spent loading the same tissues in the same way.

Recovery starts with the things we do on a daily basis. If you want to help reduce flare-ups and speed up recovery time, purchasing a stand-up desk is a sensible option. For many office-based workers, the single biggest change is reducing prolonged sitting. That’s why a standing desk is often one of the first recommendations I make when recurrent SI joint flare-ups are linked to desk work.

I’ve listed the standing desks I recommend on my Product Recommendations Page. It’s the exact one I use myself in clinic (picture below).

Dr Chris using standing desk in treatment room

👉 Read My Standing Desk Recommendation (Discount Code Available)

Don’t Let Your Chair Undo Your Progress

If you’re sitting for several hours a day, your chair matters too. No chair can compensate for sitting still all day.

However, a supportive and adjustable chair can make it easier to maintain comfortable working positions and reduce unnecessary strain.

Features worth looking for include:

Adjustable seat height
Lumbar support
Adjustable arm rests
Good pelvic support

When people combine the benefits of using a standing desk with the support of a properly adjusted chair, that’s when improvements compound and result in long-term recovery.

I’ve reviewed my most popular options to help you find the right one for your needs.

👉 Read My Ergonomic Chair Review

Final Thoughts

In my experience, SI joint pain is rarely a problem with the joint itself. More often, it’s a reflection of how the surrounding muscles, movement patterns and daily habits are interacting with the pelvis. When those factors improve, the joint often settles down and stays settled.

If you want to give yourself the best chance of recovery, try to look at the biggest factors in your day-to-day life that may be contributing to your problem.

Next Steps

Review your work set-up if appropriate and consider investing in a Standing Desk and Ergonomic Chair.
Read the related guides below if you are not sure of your diagnosis.
Get started with the recommended Exercises from the plan above.

References

Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment Steven P Cohen 1, Yian Chen, Nathan J Neufeld Pubmed 2013 Jan;13(1):99-116.

Medical disclaimer

This content is for general educational purposes only and should not be used as a substitute for professional medical advice, diagnosis or treatment. Exercises and advice may not be suitable for everyone, especially if you have pain, injury, medical conditions or worsening symptoms. Always seek advice from a suitably qualified healthcare professional if you are unsure. Please read our full Medical Disclaimer for more information.