Sacroiliac Joint Dysfunction: The Back Pain Culprit Nobody Talks About Enough
Low back pain is almost a rite of passage at this point. Around 85% of people will experience it at some point in their lives — which means if you haven't had it yet, statistically speaking, your time is probably coming. Life happens. Lifting happens. Sitting happens. Pregnancy happens. Falls happen. And a significant chunk of all that back pain? Comes from one small, easy-to-overlook joint that most people have never heard of.
The sacroiliac joint — or SIJ — sits where your pelvis meets the base of your spine, one on each side. It doesn't move much, but it doesn't need to. Its job is to transfer load between your upper body and your legs, absorb shock, and keep things stable. When it stops moving the way it should — either too much or, more commonly, getting stuck — you feel it. And you feel it in some very specific ways.
Does this sound familiar?
Struggling to get up from a chair. Rolling over in bed feeling like your pelvis has seized up. Reaching down to tie your shoelaces and getting a sharp, catching pain in your lower back or buttock. That one-sided, deep ache that sits just below the belt line and sometimes radiates into the hip or upper leg. These are classic SIJ presentations — and they're regularly mistaken for disc problems, hip issues, or just "general back pain."
Up to 25% of low back pain cases are thought to originate from the sacroiliac joint, making it one of the most common and most under-diagnosed sources of back pain going.
So who gets it?
Pretty much everyone, at some point. There are two peaks — younger adults following sporting injuries or pregnancy, and older adults from general degeneration. Pregnancy is a big one: the hormones that loosen the pelvis for delivery can leave the SIJ hypermobile and irritable long after the baby arrives. A rear-end car collision, an awkward landing, years of running on one side, or simply spending decades sitting unevenly — all of it can tip the joint into dysfunction. It's not dramatic. It's just life accumulating in one spot.
Why stretching only gets you so far
This is something I see constantly. People stretch, get temporary relief, and then the pain comes back within hours. They stretch again. It helps a bit. It comes back again. And the cycle goes on.
The reason stretching alone doesn't fix it is simple: if the joint is stuck, releasing the surrounding muscles gives you some slack in the system — but the underlying restriction is still there. The muscles tighten back up because they're responding to an unstable or restricted joint. Until the joint itself is addressed, you're just managing the symptom rather than the cause. This is exactly what manipulation and mobilisation do that stretching can't — they directly restore movement to the joint, which is what actually breaks the cycle.
The muscles that matter
That said, strengthening absolutely has a role once the joint is moving properly — and three muscles in particular deserve attention.
The gluteus medius and gluteus maximus are the key stabilisers of the pelvis. When they're weak or inhibited — which happens very easily after an injury, during pregnancy, or simply from too much sitting — the SIJ loses its muscular support and starts compensating. Research confirms that muscle imbalance, particularly involving the gluteus medius, is one of the most important contributors to sacroiliac joint dysfunction.
The quadratus lumborum — the QL — is the deep muscle that runs from your lower ribs to the top of your pelvis. It's the one that goes into spasm and makes you feel like you can't straighten up properly. A 2024 randomised controlled trial found that combining QL muscle release with gluteus medius strengthening produced significantly better outcomes for SIJ dysfunction patients than gluteus medius strengthening alone — which backs up what I do clinically every day. You need to release what's tight and strengthen what's weak. It's rarely just one or the other.
When it's more than just dysfunction
Most of the time, SIJ pain is mechanical — it has a clear trigger, it responds well to treatment, and with the right rehab it stays away. But if someone has been dealing with SIJ-area pain from a very young age, particularly if it started in their teens or early twenties, came on gradually rather than after an obvious event, and feels worse with rest and better with movement — that's a different pattern, and it warrants a closer look.
Axial spondyloarthritis is a chronic inflammatory condition affecting the sacroiliac joints and spine, and while it most commonly presents in the third or fourth decade of life, 10-20% of patients first experience symptoms in childhood or adolescence. Conditions like Axial SpA, Ankylosing Spondylitis, and Rheumatoid Arthritis can all present with SIJ-area pain — and they need a different management pathway to mechanical dysfunction. This is why history matters so much. Not just where it hurts and when it started, but how it behaves, what makes it better or worse, whether there's a family history of inflammatory conditions, and whether there are any other symptoms in the picture.
A good chiropractor isn't just treating the area that hurts. They're building a full picture of what's going on — and if something doesn't fit the mechanical pattern, the right call is to refer on rather than just keep treating.
The takeaway
SIJ dysfunction is incredibly common, very treatable, and massively underestimated as a source of back pain. If you recognise the symptoms — the sit-to-stand struggle, the rolling-over-in-bed grimace, the shoelace problem — come and get it looked at properly. A proper assessment, some targeted manipulation, and the right strengthening work can make a huge difference. Your pelvis will thank you.
