SI Joint Pain

When imaging looks “normal” but sitting, walking, or training keeps triggering the same sharp ache near the back of the pelvis.

The Clinical Reality

“SI joint pain” is often less about a single joint being damaged and more about how the pelvis transfers load between the spine and hip. When regional stability is delayed or asymmetrical, the tissues around the SI region can become sensitized. Commonly involved structures include the posterior pelvic ligaments, gluteal and deep hip rotators, thoracolumbar fascia, and sometimes pelvic floor tone and coordination. The result can be a pain pattern that feels localized to one “spot,” but is driven by movement strategy, gait mechanics, and myofascial trigger points that repeatedly overload the same region.

Why Standard Care Fails

Standard care often treats SI pain as either a structural joint problem (imaging, injections, bracing) or a generic strengthening problem (“do more core”). Imaging frequently does not correlate well with symptoms because the driver may be tissue sensitivity, poor load-sharing, or nerve irritation rather than visible damage. Medications can reduce symptoms temporarily but do not change movement coordination or myofascial tone. Injections may calm inflammation, but if gait and hip mechanics continue to overload the region, symptoms often return. The gap is functional assessment and targeted tissue work that links the pain pattern to a specific movement and load-transfer fault.

Signs & Symptoms

Do any of these sound familiar?

One-sided pain near the “dimple” area

Often points to a specific spot just medial to the back of the hip, worse after prolonged sitting or after a long walk when stride mechanics fatigue.

Pain with transitions

Getting out of the car, standing from a chair, rolling in bed, or turning to step can reproduce a sharp catch or stab that settles after a few steps.

Stair, hill, or single-leg intolerance

Symptoms increase when the pelvis must control rotation on one leg, such as stairs, hills, running, or split-stance lifting.

Gluteal tightness that never releases

A persistent sense of deep glute or piriformis tightness with trigger points that refer into the low back, hip, or upper hamstring.

Lower back and hip symptoms that alternate

Some days it feels like lumbar pain, other days like hip pain, with the same trigger being load transfer through the pelvis rather than one isolated structure.

Root Cause Contributors

The mechanical drivers behind your symptoms

Gluteal and deep hip rotator trigger points

Myofascial sensitivity in gluteus medius/minimus, piriformis, and obturator muscles can mimic joint pain and reduce the hip’s ability to absorb load, shifting stress to the SI region.

Thoracolumbar fascia and posterior chain guarding

Protective tone through the lumbar extensors, QL, and fascial system can bias extension and rotation patterns that repeatedly irritate the posterior pelvis.

Hip internal rotation restriction and femoral control deficits

Limited hip rotation or poor control during stance can create pelvic compensation, especially during gait, stairs, and split-stance training.

Pelvic floor overactivity and poor pressure management

Elevated pelvic floor tone and suboptimal breath-pressure strategy can increase pelvic ring compression and contribute to pain with sitting, lifting, and high-intensity exercise.

What to Expect

Your roadmap to recovery
Weeks 1 to 2
Clearer identification of provoking movements and tissue drivers. Many patients notice improved comfort with sitting or transitions and a more specific sense of what helps versus what aggravates.
Weeks 3 to 6
More consistent gait and single-leg tolerance with fewer sharp catches. Improved capacity for stairs, longer walks, and controlled strength work with reduced next-day rebound.
Weeks 6 to 10
Return to higher demand activities with better load-transfer endurance. Symptoms, if they occur, tend to be more predictable and easier to settle with a defined plan.

Frequently Asked Questions

Get answers to common questions

Not always. Many people feel pain “at the SI” because nearby tissues refer pain there or because the pelvis is absorbing load inefficiently. We treat it as a regional load-transfer problem and confirm drivers through palpation and movement testing.

A normal scan is common and can be reassuring. Imaging can miss functional contributors like myofascial trigger points, coordination deficits, or nerve irritation patterns. We use imaging as context while focusing on exam findings you can reproduce in real movements.

They can reduce myofascial sensitivity, downshift protective guarding, and improve muscle recruitment around the hip and pelvis. That creates a window to retrain load transfer with gait and movement work so the region is not repeatedly irritated.

Most plans start with 1 to 2 visits per week for a short period to change tissue reactivity and movement tolerance. Frequency then typically decreases as capacity and predictability improve. Your schedule is matched to symptoms, training demands, and how quickly your pattern changes.

Yes. SI-region pain frequently overlaps with hip mechanics and pelvic floor tone or coordination. We assess the full region and prioritize the driver that best matches your symptom triggers and movement tests. For pelvic floor concerns, care is discreet and clinically structured.

Seek medical evaluation if you have significant trauma, fever, unexplained weight loss, night pain that is not position-related, progressive weakness/numbness, bowel or bladder changes, or concern for fracture or systemic illness. Our care is complementary and works best when serious pathology has been ruled out when indicated.

Ready to Find Real Answers?

Schedule a free 15-minute discovery call to discuss your case and determine if our approach is right for you.

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118 W. 72nd, Rear Lobby, Upper West Side, NY 10023 Evidence-based acupuncture and dry needling on the Upper West Side, NYC. From chronic pain, headaches, and pelvic floor dysfunction, Dr. Jordan Barber integrates the highest level of training with compassionate care to help you thrive. Disclaimer: This site does not provide medical advice. Always consult a qualified healthcare professional before making changes to your health. Read our full disclaimer

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