Is pain on one side of your lower back making it uncomfortable to walk, stand up or roll over in bed?
Maybe you feel it near the top of your buttock, particularly after sitting for a while or when putting weight through one leg. It can be difficult to tell whether the discomfort is coming from your back, hip or somewhere around your pelvis.
One possible source is the sacroiliac (SI) joint. This article explains what the joint does, what may cause pain around it, and how an individualised assessment and rehabilitation plan can help.
At Adaptive Physiotherapy & Massage in Booragoon, we start by understanding your symptoms, your daily activities and what you want to get back to doing.
What is sacroiliac joint dysfunction?
The sacroiliac joints connect the sacrum, at the base of your spine, to the iliac bones of your pelvis. They are strong, weight-bearing joints that transfer forces between your trunk and legs. They normally move only a small amount.
SI joint dysfunction is a term often used for pain or difficulty around this region. However, it does not necessarily mean that your pelvis is misaligned or that a joint has moved out of place. It can be challenging to distinguish pain arising from the SI joint itself from pain referred from the lumbar spine, hip or surrounding tissues.
Important distinction: Feeling stiff, unstable or uneven does not prove that the SI joint is too tight, too loose or out of alignment. A physiotherapy assessment considers several possible sources of pain before recommending treatment.
What might contribute to pain around the SI joint?
Symptoms around the pelvis and lower back can arise in different circumstances. Potential factors include:
- Changes in activity or training load: more walking, running, lifting or other demands than you are accustomed to.
- Pregnancy and the postnatal period: some people develop pelvic girdle pain that can include the SI joint region.
- Previous injury or trauma: a fall or other injury involving the pelvis or lower back.
- Inflammatory conditions: for example, sacroiliitis associated with some forms of inflammatory arthritis.
- Other conditions: lumbar spine, hip or muscular problems that can produce similar symptoms.
The contributing factors are not the same for everyone. Posture or a particular movement pattern alone cannot reliably identify the source of pain.
Common symptoms
One-sided lower back pain
Discomfort near the back of the pelvis or upper buttock, sometimes extending towards the thigh.
Pain changing positions
Symptoms when standing after sitting, turning in bed or moving between positions.
Difficulty with weight-bearing
Discomfort with stairs, prolonged standing, walking or putting weight through one leg.
Activity-related flare-ups
Pain that varies with work, exercise, walking distance or other daily demands.
These symptoms are not unique to SI joint pain, so assessment matters.
How is SI joint pain assessed?
At Adaptive, a physiotherapy assessment begins with your history: where the pain is, how it started, what aggravates it, and what you need to be able to do. Your physiotherapist may then assess movement, hip and lumbar function, strength and relevant clinical signs.
Where appropriate, they may use a group of SI joint pain-provocation tests. No single test can confirm that your SI joint is the cause, and routine movement tests cannot reliably establish whether the joint is 'out of place'. Other causes, including inflammatory or nerve-related conditions, may require medical investigation or referral.
When to seek urgent medical attention: New bladder or bowel dysfunction, numbness around the groin or saddle area, progressive leg weakness, or severe pain following significant trauma need urgent assessment. Fever, feeling systemically unwell, or unexplained severe night pain also warrant prompt medical review.
Evidence-informed treatment for SI joint-related pain
The goal is not simply to 'put the pelvis back in place'. Treatment is guided by your symptoms, physical capacity and daily requirements. The following four areas reflect the approach that may be appropriate following assessment.
Initial pain management and activity modification
Early management often involves reducing activities that are particularly aggravating without stopping all movement.
- Temporarily adjust longer walks, heavy lifting, repeated twisting or high-impact training if they increase symptoms.
- Use comfortable movement and regular changes of position rather than extended rest.
- Heat or cold may help with comfort, depending on personal preference.
- In selected situations, an SI belt or other support may be considered, particularly for pelvic girdle pain.
Manual therapy — when appropriate
Hands-on treatment may help some people manage associated muscular discomfort or stiffness. This could include gentle work around the glutes, hip or lower back, and suitable mobilisation of neighbouring areas.
Manual therapy is optional support, not a method of correcting a proven pelvic misalignment, and it should not replace progressive activity and exercise. Where muscular care is relevant, remedial massage can be considered separately according to the person's needs.
Exercise rehabilitation: strength, movement and load tolerance
Rather than prescribing different exercises based solely on a presumed 'stiff' or 'loose' SI joint, we select and progress exercises according to symptoms and capacity.
- Starting movement and trunk control: pelvic tilts, dead bugs, bird-dogs and modified side planks when tolerated.
- Hip and leg strength: glute bridges, sit-to-stands, step-ups, split squats and controlled lunges.
- Balance and coordination: weight shifts, single-leg balance and pelvic control drills where useful.
- Progressive resistance: hip hinges, Romanian deadlifts and other functional lifting movements at a suitable level.
No single exercise is essential for everyone. Your physiotherapist adapts the range, resistance and frequency to how you respond.
Return to activity and longer-term management
As your tolerance improves, rehabilitation can move towards the tasks that matter to you—walking, lifting at work, gym training, running or sport.
- Gradually increase strength and activity volume.
- Reintroduce rotational movements, impact or plyometric drills when appropriate.
- Monitor symptoms and adapt loads rather than relying on a fixed timeline.
- Reassess progress and adjust the plan to support ongoing participation.
For people returning to higher-demand exercise or sport, our sports rehabilitation program may provide a suitable progression pathway after individual assessment.
Can SI joint pain keep coming back?
Symptoms can recur, especially when activity demands change. Building strength, maintaining regular physical activity and adjusting workloads can support function and confidence, although no program can guarantee that pain will never return.
The aim is to help you understand what you can do, how to respond to flare-ups, and how to progress back towards your usual activities.
When should you see a physiotherapist?
Consider an assessment if pain near your lower back or pelvis keeps returning, interferes with walking, sitting, work or training, or leaves you unsure how to exercise. An assessment can help clarify possible contributing factors and whether physiotherapy or further medical review is appropriate.
Book a Lower Back & Pelvic Pain Assessment
If you're experiencing persistent discomfort around your lower back, buttock or pelvis, an individualised physiotherapy assessment is a useful place to start.
Adaptive Physiotherapy & Massage
27 Shields Crescent, Booragoon WA 6154
References
- Laslett M. (2008). Evidence-based diagnosis and treatment of the painful sacroiliac joint. Journal of Manual & Manipulative Therapy, 16(3), 142–152.
- American Society of Pain and Neuroscience (2024). Best Practice Guideline for the Treatment of Sacroiliac Disorders. Journal of Pain Research.
- Multispecialty international working group (2025). Consensus practice guidelines on sacroiliac joint complex pain. Regional Anesthesia & Pain Medicine.