Sacroiliac joint dysfunction

The sacroiliac joint (SI joint) connects the sacrum to the pelvis on the left and right. It moves only a few millimetres, but it transfers all force from the trunk to the legs. When that force transfer is disturbed, pain develops.

Causes include a fall on the buttock, pregnancy and childbirth, a leg length difference, a stiff hip or previous back surgery. After a total hip replacement the SI joint can also become temporarily overloaded, because the pelvis has to adapt to a normal position again.

SI joint dysfunction is one of the most frequently missed causes of pain around the hip and buttock.

• Pain just next to the lower back, at the dimple above the buttock, usually one sided
• Radiation into the buttock, groin or the back of the thigh, rarely below the knee
• Pain when turning over in bed, getting up from a chair and sitting for long periods
• Discomfort when loading one leg, for example when putting on trousers
• Patients often point to the pain with one finger on a small spot

Diagnosis is based on a series of specific provocation tests and, in case of doubt, on an image guided test injection into the joint.

• Physiotherapy focused on pelvic stability, gluteal muscles and hip mobility
• Correction of a leg length difference with an insole
• A pelvic belt in case of clear instability
• An image guided injection into the SI joint
• Referral for a nerve treatment or stabilisation for stubborn complaints

Because the pain closely resembles hip pain, we always assess both. Use the symptom explorer or make an appointment.