Conditions
Understanding pain where the lower back meets the pelvis
Sacroiliac joint pain can make walking, sitting, climbing stairs or turning over in bed uncomfortable. It is often felt low in the back or deep in the buttock and can be mistaken for pain coming from the lumbar spine or hip.
At Wye Sanctuary, we offer specialist assessment of persistent lower back and pelvic pain. The aim is to understand what is contributing to your symptoms and develop a plan that may combine rehabilitation, medication review and carefully selected injections.
What are the sacroiliac joints?
The sacroiliac joints connect the sacrum—the triangular bone at the base of the spine—to the pelvis. There is one on each side. These strong joints allow a small amount of movement and help transfer load between the upper body and legs. They are supported by substantial ligaments and surrounding muscles.
Pain may arise from the joint itself or from the tissues around it. This is sometimes described as sacroiliac joint complex pain, recognising that more than one structure may contribute.
What does sacroiliac joint pain feel like?
Common symptoms
Symptoms vary, but may include pain on one side of the lower back near the dimple at the back of the pelvis; a deep ache or sharper pain in the buttock; pain spreading towards the hip, groin or thigh; discomfort when sitting or standing for a prolonged period; pain when climbing stairs, standing on one leg or getting in and out of a car; and difficulty turning over in bed or moving from sitting to standing. One or both sides may be affected. These symptoms can suggest sacroiliac pain, but they do not confirm the diagnosis: several other conditions can produce a similar pattern.
Why does sacroiliac pain develop?
Symptoms may develop when the joint or surrounding ligaments become painful during loading and movement. This can follow an injury, a change in activity or repeated physical strain, although there is not always an obvious trigger. Pain does not necessarily mean that the joint is damaged, unstable or “out of place”. Examination focuses on how the area responds to movement and pressure, rather than assuming that the pelvis needs realigning.
Degenerative changes
Age-related changes can affect the sacroiliac joints, as they can other joints. However, changes seen on a scan do not always cause pain. The important question is whether the symptoms and examination findings fit with the joint being a significant source of discomfort.
Pregnancy-related pelvic girdle pain
Pain around the sacroiliac joints may develop during pregnancy or after childbirth as part of pelvic girdle pain. Changes in load, movement and the supporting tissues can contribute. Symptoms may be particularly noticeable during activities involving one leg at a time, such as climbing stairs or getting dressed. Some people have persistent symptoms after pregnancy and benefit from assessment and tailored rehabilitation.
Hypermobility
People with hypermobility may experience pain around the pelvis and sacroiliac region. Greater joint movement, muscle fatigue and the demands of maintaining control during activity may contribute. Treatment usually emphasises manageable strengthening, movement control and gradual improvements in activity tolerance. Hypermobility alone does not establish that the sacroiliac joint is the source of pain.
Pain following spinal surgery
The sacroiliac joints can sometimes contribute to persistent or new pain after lumbar spinal fusion. Changes in how load is transferred through the spine and pelvis may play a part. However, pain after spinal surgery needs a broad assessment. It should not automatically be attributed to the sacroiliac joints.
Inflammatory sacroiliitis
Sacroiliitis means inflammation of the sacroiliac joint. It can occur as part of an inflammatory condition such as axial spondyloarthritis. Features that may raise suspicion include back pain beginning before the age of 45, prolonged morning stiffness, waking with pain in the second half of the night, and symptoms that improve with movement rather than rest. Psoriasis, inflammatory bowel disease or previous episodes of eye inflammation may also be relevant. These features warrant consideration of rheumatology assessment. Inflammatory disease needs treatment of the underlying condition, rather than relying on pain injections alone.
Is it sacroiliac pain, sciatica or hip pain?
These conditions can overlap, and more than one may be present. Sacroiliac pain commonly centres around the lower back and buttock. Sciatica more typically involves pain travelling down the leg because of irritation of a spinal nerve, sometimes with tingling, numbness or weakness. Hip conditions may cause groin pain and difficulty with hip movement. The location of pain alone cannot reliably distinguish them. Assessment may therefore include the lumbar spine, hips, nerves and surrounding muscles as well as the sacroiliac region.
How is sacroiliac joint pain diagnosed?
There is no single symptom, examination manoeuvre or scan that reliably confirms every case. Your assessment brings together your pain history and its effect on everyday activities; examination of the back, pelvis and hips; a combination of tests that gently load the sacroiliac region to see whether they reproduce your familiar pain; relevant previous investigations; and consideration of other possible causes. Several examination tests giving a consistent response can support the diagnosis, but they are not conclusive on their own.
Will I need a scan?
Not everyone needs imaging. X-rays, MRI or CT may be useful when there is concern about inflammatory disease, injury or another underlying condition. However, scans are often less helpful for identifying the source of mechanical sacroiliac pain. A normal scan does not exclude all pain arising from this region, and degenerative changes on a scan do not prove that the joint is painful.
Can an injection help clarify the diagnosis?
In selected cases, an image-guided local anaesthetic injection into the joint can help assess whether it contributes to your pain. A clear temporary improvement during activities that usually hurt can provide useful information. However, the response is not a perfect diagnostic test: medicine may spread outside the joint, and pain may arise from surrounding ligaments or other structures. The result is interpreted alongside your history and examination.
Rehabilitation and movement
Treatment often begins with an individual programme to improve strength, movement confidence and tolerance of everyday activity. This may include exercises for the hip and trunk muscles, gradual increases in walking or other activity, and practical adjustments to movements that currently provoke pain. There is no single exercise programme that suits everyone. The approach should reflect your symptoms, physical capacity and goals, particularly if you have hypermobility or pregnancy-related pelvic pain.
Medication review and sacroiliac joint injections
Medicines may help some people manage symptoms while remaining active. We review what you are taking, whether it provides worthwhile benefit and whether side effects or other medical conditions limit its suitability. An injection may be considered when assessment suggests that the sacroiliac region is a significant source of pain and simpler measures have not provided enough relief. Local anaesthetic, sometimes with steroid, is used to target the joint or selected surrounding tissues. The intended target, guidance technique and purpose of the injection will be explained before treatment. The aim may be to obtain diagnostic information, reduce pain or make rehabilitation more manageable.
Risks and aftercare
Possible risks include soreness, bruising, a temporary increase in pain, bleeding, infection and reactions to the medicines. Local anaesthetic can occasionally spread to nearby nerves and cause temporary leg numbness or weakness. If steroid is used, it may temporarily raise blood glucose and can occasionally cause skin or tissue changes. Before treatment, we review relevant medical conditions and medicines, including blood thinners. You will receive instructions about activity, driving and symptoms that require medical advice. Do not stop prescribed medication without guidance.
When should I seek urgent help?
Seek urgent medical assessment for new difficulty passing urine, loss of bladder or bowel control, numbness around the genitals or bottom, or rapidly worsening leg weakness. Severe pain after a significant injury, or back or pelvic pain with fever and feeling very unwell, also needs urgent assessment. Tell your clinician about unexplained weight loss, a history of cancer or a substantial change in your usual pain pattern.
How Wye Sanctuary can help
Your consultation focuses on understanding your symptoms and identifying the important contributors to your pain. We explain the findings, discuss whether further investigation is needed and agree realistic treatment goals. With your permission, we can work alongside your GP, physiotherapist, rheumatologist or spinal specialist to coordinate your care.
What benefit can I expect?
The response varies. Some people experience worthwhile temporary relief; others have little or no improvement. Lasting benefit cannot be guaranteed. An injection does not correct every cause of pelvic pain or replace rehabilitation. Its value is assessed against your goals, such as walking further, sleeping more comfortably or managing exercises.
If persistent lower back, buttock or pelvic pain is affecting your daily life, arrange a consultation to explore its cause and your treatment options.
Discuss your sacroiliac pain