SIJ and pelvic girdle pain treatment in Adelaide
The sacroiliac joint is one of the most commonly missed diagnoses in spinal physiotherapy. It sits at the junction of the pelvis and the base of the spine, and when it becomes irritated, stiff or unstable it produces pain patterns that are easily and frequently attributed to lumbar disc or facet joint pathology. This is why a targeted SIJ assessment is so important and something we include as a routine part of our spinal evaluation.
At The MSK Studio, our practitioners are trained in evidence-based SIJ assessment protocols that allow us to reliably identify when the sacroiliac joint is the primary pain driver. Research suggests the SIJ accounts for approximately 20% of all lower back pain presentations, a significant proportion that deserves specific clinical attention.
SIJ pain can arise from dysfunction, instability, inflammation or degeneration of the joint and each presentation requires a different management approach. Conditions we assess and treat include:
Sacroiliac joint dysfunction
Post-partum pelvic pain
SIJ hypermobility / instability
Degenerative SIJ changes
Post-traumatic SIJ dysfunction
Deep buttock pain
SIJ pain most commonly presents as deep, one-sided buttock pain that can refer into the hip, groin or upper thigh. Because it can mimic lumbar disc and facet pain so closely, and does not always show on standard imaging, it can be easy to miss without a targeted assessment. Symptoms that may indicate SIJ involvement include:
The SIJ can become dysfunctional through a single loading event or through gradual accumulation of stress over time. It is particularly susceptible to hormonal and mechanical changes during and after pregnancy. Common causes include:
SIJ pain most commonly presents as deep, one-sided buttock pain that can refer into the hip, groin or upper thigh. Because it can mimic lumbar disc and facet pain so closely, and does not always show on standard imaging, it can be easy to miss without a targeted assessment. Symptoms that may indicate SIJ involvement include:
The SIJ can become dysfunctional through a single loading event or through gradual accumulation of stress over time. It is particularly susceptible to hormonal and mechanical changes during and after pregnancy. Common causes include:
Yes, and this is one of the main reasons SIJ dysfunction is so commonly confused with sciatica. The SIJ can refer pain into the buttock, hip, groin and upper thigh, and in some cases further down the leg. Unlike true lumbar radiculopathy, where nerve root compression produces a defined pattern of tingling or numbness that follows a dermatomal path, SIJ referral tends to be more diffuse and does not typically extend below the knee. However, the two conditions can co-exist, and in some presentations the SIJ is irritating nearby neural structures directly. Accurately distinguishing between SIJ referral and lumbar nerve root involvement is an important part of the assessment process at our Adelaide clinic, because the treatment approach for each is quite different.
This is one of the most common clinical questions we encounter with low back and buttock pain presentations in Adelaide, and it is not always straightforward to answer without a targeted assessment. SIJ pain most commonly presents as deep, one-sided buttock pain that can refer into the hip, groin or upper thigh, and is often aggravated by transitional movements such as sitting to standing, rolling in bed, or climbing stairs. Lumbar disc and facet pain can produce a very similar pattern, which is why the two are so easily confused. The key differentiators lie in the specific provocation tests that stress each structure independently, a positive cluster of SIJ tests alongside a negative lumbar assessment points clearly toward the SIJ as the primary driver. In some cases both structures are involved simultaneously, which is why a comprehensive assessment of the lumbar spine and pelvis together is more informative than assessing either in isolation.
SIJ pain that has come on acutely, following a specific incident such as a fall, a heavy lift or a sudden awkward movement, will sometimes settle with relative rest and gradual return to activity. However, SIJ pain that persists beyond a few weeks, recurs regularly, or has developed in the context of post-partum hormonal changes or degeneration rarely resolves fully without addressing the underlying mechanical and muscular contributors. Without targeted rehabilitation, the muscles that control and stabilise the SIJ, particularly the deep gluteals, the deep lumbar stabilisers and the pelvic floor, remain underactive, leaving the joint vulnerable to ongoing irritation and repeated flare-ups. For Adelaide residents experiencing persistent or recurrent SIJ pain, physiotherapy assessment and treatment is the most clinically appropriate next step.
Treatment at our Adelaide clinic begins with a thorough assessment using a cluster of evidence-based SIJ provocation tests to confirm the diagnosis and understand whether the joint is presenting as stiff and restricted or hypermobile and unstable, because these two presentations require quite different approaches. For restricted SIJ dysfunction, hands-on mobilisation and manipulation of the joint and surrounding pelvis is often effective in restoring normal movement, alongside a targeted exercise program such as clinical Pilates. For hypermobility or instability, which is more common in post-partum presentations, the focus shifts to strengthening the deep gluteal muscles, pelvic floor and lumbar stabilisers that control and protect the joint rather than mobilising a structure that already has too much movement. In both cases, education about load management and activity modification in the early stages is an important part of treatment. Where appropriate, we may also recommend a sacroiliac support belt as a short-term adjunct during the acute phase.
