Pelvic & Joint Pain
SI Joint Pain Doesn’t Have to Be a Mystery
Deep ache low in your back. Pain on one side that gets worse when you stand on one leg. SI joint dysfunction is one of the most under-recognized sources of chronic back pain — especially in postpartum and athletic women.
Understanding the SI Joint
What the SI Joint Is and How It Causes Pain
Most people don’t know they have an SI joint until it hurts. There are actually two — one on each side of your pelvis — where the sacrum (the triangular bone at the base of your spine) connects to your iliac bones (the bowl-shaped pelvis bones).
The SI joint isn’t designed to move much. It transmits force between your spine and legs, especially during walking, lifting, and any single-leg activity. It’s stabilized by some of the strongest ligaments in the body, plus the deep coordination of your pelvic floor, glutes, deep core, and inner thigh muscles.
When that stabilization system breaks down — from pregnancy, an injury, postural patterns, or asymmetric muscle activation — the joint moves more than it should on one side, less than it should on the other, or both. The result: deep, often one-sided low back pain that doesn’t respond to standard back treatment.
Signs & Symptoms
What SI Joint Dysfunction Feels Like
One-Sided Low Back Pain
Deep, aching pain on one side of the lower back, often described as “right where the dimple is” — the dimple of Venus, just above the buttock.
Pain with Single-Leg Activities
Worse when standing on one leg, getting in or out of a car, climbing stairs, or putting on pants while standing. The pelvis needs symmetric stability to handle unilateral loading.
Buttock Pain
Pain that radiates into the buttock, sometimes the back of the thigh — but usually NOT below the knee. This is a key distinction from sciatica.
Pain Rolling Over in Bed
A sharp catch when rolling to the painful side. Often the first symptom many women notice and one of the most telling signs.
Pain After Sitting
Stiffness or sharp pain when getting up from a chair or car after prolonged sitting that takes a few steps to walk off.
Feeling “Out of Place”
A sensation that something in your pelvis isn’t aligned, or that one hip is higher than the other. The asymmetry is real — and it’s treatable.
Not sure where to start? Schedule a Free Consultation →
Quick Self-Test
Is My SI Joint Involved?
These two simple tests can suggest SI joint involvement, though only a hands-on assessment can confirm:
Two Tests You Can Do at Home
- Single-leg stance test: Stand on one leg for 30 seconds. Does pain reproduce or worsen on the side you’re standing on? If yes, that side’s SI joint is suspect.
- The dimple test: Find the dimples just above your buttocks (one on each side). Press firmly into them. Sharp pain or marked tenderness on one side — especially compared to the other — points to SI joint dysfunction on the painful side.
These are not diagnostic on their own. But if both are positive, see a pelvic floor PT before you see a back specialist or get imaging.
Why Standard Advice Often Fails
The Stretches and Rest That Don’t Help
Standard advice for back pain is some combination of: rest, stretch your hamstrings, ice, ibuprofen. For SI joint dysfunction, that advice often makes things worse.
Stretching the wrong things: A common pattern with SI joint pain is tight, overworking adductors (inner thighs) and glute medius (side of the hip) on one side. Stretching the back when the actual problem is asymmetric muscle activation in the hips can make the joint less stable, not more.
Rest creates dependency: The SI joint needs muscle activation to stay stable. Prolonged rest deconditions exactly the muscles that hold it together.
Imaging often misses it: SI joint dysfunction is largely a clinical diagnosis. MRIs and X-rays usually look normal. Patients told “your imaging is clean, it’s probably just muscular” are often correctly described — but their muscles are still the problem, and that’s what needs treatment.
How PT Helps
Treating the Joint AND the System That Controls It
Dr. Danaya is a board-certified pelvic floor specialist (PRPC, Cert-DN) trained to address both the joint mechanics and the muscular system that controls SI joint stability.
Treatment Includes:
- Comprehensive Assessment: Hands-on evaluation of joint motion, muscle activation patterns, hip mobility, core engagement, and gait — because SI joint pain is rarely just about the joint
- Stabilization Training: Targeted activation of the deep core, pelvic floor, glute medius, and inner thighs to restore symmetric muscle support
- Hands-On Mobilization: Specific techniques to restore normal joint motion when joint position itself is part of the problem
- Dry Needling: Targeting muscle trigger points contributing to asymmetric pull on the joint — particularly in the gluteus medius, piriformis, and quadratus lumborum. Learn more about dry needling →
- Movement Retraining: Identifying the daily patterns (getting out of a car, climbing stairs, sleeping position) that aggravate the joint, and changing them
- Progressive Return to Activity: For athletic patients, building back to running, lifting, or sport without pain — session by session
What to Expect
Most patients with SI joint dysfunction see meaningful improvement in 4-8 sessions. Long-standing or postpartum cases with multiple compensations may take longer. Treatment focuses on resolving the cause, not just managing the symptoms.
Differential Diagnosis
Is This SI Joint Pain or Something Else?
Several conditions cause similar symptoms. If your pain crosses categories, that’s not unusual — many patients have a primary issue and secondary compensations. A comprehensive assessment sorts it out.
| Condition | Pain Location | Pain Pattern | Made Worse By |
|---|---|---|---|
| SI joint dysfunction | Low back, one side, buttock | Deep ache, often sharp with movement | Single-leg activities, getting up from sitting, rolling in bed |
| Sciatica | Buttock to back of leg, often below the knee | Burning, shooting, numbness/tingling | Sitting, certain bending positions |
| Lumbar disc issue | Low back, often radiating to legs | Variable; often worse with bending forward | Bending forward, prolonged sitting |
| Piriformis syndrome | Deep buttock, sometimes radiating | Aching, sharp with specific movements | Sitting on hard surfaces, crossing legs |
| SPD | Pubic bone, groin, inner thighs | Sharp with single-leg movements | Stairs, getting out of car (similar to SI joint, but pain in front) |
Patient Stories
What Patients Say
“I worked with Danaya and Taylor and they were both amazing! They helped me with my hip pain and other issues while pregnant and postpartum. I have recommended them to many friends and will definitely be back.”
— Laurel M. — Pregnancy & Postpartum
*Reviews reflect Dr. Danaya’s work at her previous Utah Valley practice
When to Get Help
When to Seek Treatment
Get evaluated if:
- You have one-sided low back or buttock pain that’s been going on more than 4 weeks
- The pain interrupts walking, sleep, or daily activities
- You’re postpartum (any timeline) with new or persistent pain on one side
- You’ve been told your back imaging is normal but the pain hasn’t resolved
- You’re an athlete experiencing pain with single-leg work or asymmetric loading
Get medical evaluation FIRST (not pelvic floor PT first) if:
- The pain started after a fall, car accident, or other significant trauma
- You have numbness, tingling, or weakness in your leg
- You have changes in bowel or bladder function with the pain
- The pain is severe at night, unrelated to position, and not improving
You don’t need a referral for pelvic floor PT in Utah (Direct Access state). But for red-flag scenarios above, see your primary care doctor or an orthopedic specialist first.
Your Questions Answered
Common Questions About SI Joint Pain
How is SI joint pain different from sciatica?
Sciatica typically causes burning, shooting pain that travels DOWN the back of the leg, often below the knee, with numbness or tingling. SI joint pain is usually a deep ache concentrated in the low back and buttock on one side, and rarely radiates below the knee. Both can coexist, but the patterns are distinct enough that a hands-on assessment can usually tell them apart without imaging.
Does SI joint pain show up on MRI?
Often not. SI joint dysfunction is largely a clinical diagnosis based on movement patterns, palpation findings, and specific provocation tests. Most MRIs of patients with SI joint dysfunction look normal. This doesn’t mean the pain isn’t real — it means imaging is the wrong tool for this diagnosis.
Can SI joint pain happen during pregnancy?
Yes — pregnancy is one of the most common triggers. The hormone relaxin softens pelvic ligaments, and the changing weight distribution loads the SI joints differently. Pelvic floor PT during and after pregnancy is safe and effective.
Will I need an SI joint injection?
Most patients don’t. Injections can be useful for diagnostic purposes or for severe acute flares, but they don’t fix the underlying muscle and movement pattern that caused the dysfunction. Pelvic floor PT addresses the cause.
How is SI joint pain different from SPD?
SI joint pain is in the BACK of the pelvis. SPD is in the FRONT of the pelvis — at the pubic symphysis joint where the two halves of the pelvis meet. Both can occur during pregnancy and many patients have both, but the locations and specific treatments differ.
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