Sacroiliac joint (SIJ) pain is a common yet often misunderstood condition that affects many individuals, particularly those with a history of lower back pain, pregnancy, or trauma. The sacroiliac joints connect the sacrum (the triangular bone at the base of the spine) to the pelvis, providing stability and shock absorption for the upper body. When these joints become dysfunctional or inflamed, they can cause significant discomfort and limit mobility.

In this article, we’ll explore the causes and symptoms of SIJ pain, the diagnostic tests used to identify it, and the most effective physiotherapy treatments to alleviate pain and restore function.

Causes of SIJ Joint Pain

SIJ pain can arise from various factors, including mechanical stress, injury, or systemic conditions. Some of the most common causes include:

1. Trauma or Injury

• A sudden impact, such as a fall or car accident, can strain or damage the ligaments around the SI joint.
• Repetitive stress from activities like heavy lifting, running, or prolonged standing can also contribute to joint dysfunction.

2. Pregnancy

• Hormonal changes (particularly relaxin) during pregnancy loosen the ligaments around the pelvis to prepare for childbirth, increasing SI joint instability.
• The added weight and altered posture in late pregnancy can further stress the joints.

3. Arthritis

• Over time, osteoarthritis can cause the cartilage in the sacroiliac joint to deteriorate.
• Inflammatory conditions like ankylosing spondylitis or psoriatic arthritis may also target the sacroiliac joints.

4. Leg Length Discrepancy

• A significant difference in leg length can create uneven pelvic loading, leading to SI joint strain.

5. Poor Posture and Movement Patterns

• Prolonged sitting, slouching, or improper lifting techniques can place excessive stress on the SI joints.

Symptoms of SIJ Dysfunction

SIJ pain can mimic other conditions like sciatica or lumbar disc issues, making an accurate diagnosis essential. Common symptoms include:

• Localized Pain: A dull or sharp ache in the lower back, buttock, or hip, often on one side.
• Radiating Pain: Discomfort may travel down the thigh but rarely extends below the knee (unlike sciatica).
• Stiffness: Difficulty moving after prolonged sitting or standing.
• Instability: A feeling of the joint “giving way” or being unstable during movement.
• Aggravating Factors: Pain worsens with activities like climbing stairs, standing on one leg, or transitioning from sitting to standing.

Diagnostic Tests for Sacroiliac Joint (SIJ) Pain

Diagnosing sacroiliac joint (SIJ) pain can be challenging because its symptoms often mimic other conditions like lumbar disc herniation or hip arthritis. To accurately identify SIJ dysfunction, healthcare professionals use a series of provocative tests that stress the joint and reproduce the patient’s pain. Below is a detailed breakdown of the most common SIJ tests and how they are performed.

1. Fortin Finger Test (Point Tenderness Test)

Purpose: To identify localized tenderness over the SI joint.

How to Perform:

1. The patient stands or lies prone (face down).
2. The examiner asks the patient to point with one finger to the area of greatest pain.
3. The examiner palpates the posterior superior iliac spine (PSIS) and the surrounding sacroiliac ligament area.
4. A positive test is indicated if the patient reports sharp tenderness within 2 cm of the PSIS (the typical location of SIJ pain).

Interpretation:

• Positive Test: Suggests SIJ involvement if pain is localized near the PSIS.
• Limitation: Non-specific—other conditions (e.g., lumbar facet issues) may also cause tenderness.

2. FABER Test (Patrick’s Test or Figure-4 Test)

Purpose: To assess SIJ dysfunction or hip pathology by stressing the joint.

How to Perform:

1. The patient lies supine (on their back).
2. The examiner flexes the patient’s hip and knee, placing the foot of the tested leg on the opposite knee (forming a “figure-4” position).
3. The examiner gently presses down on the flexed knee and the opposite anterior superior iliac spine (ASIS) to increase stress on the SI joint.
4. The test is repeated on both sides for comparison.

Interpretation:

• Positive Test: Pain in the gluteal or sacroiliac region (not the hip or groin) suggests SIJ dysfunction.
• Note: Groin pain may indicate hip pathology instead.

3. Gaenslen’s Test

Purpose: To stress the SI joint by twisting the pelvis.

How to Perform:

1. The patient lies supine at the edge of the bed with one leg hanging off.
2. The examiner flexes and brings the opposite hip and knee toward the chest to stabilize the lumbar spine.
3. The examiner applies downward pressure on the dangling leg, extending the hip and stressing the SI joint.
4. The test is repeated on the other side.

Interpretation:

• Positive Test: Pain in the sacroiliac region indicates SIJ dysfunction.
• Mechanism: The test creates a shear force across the SI joint.

4. Compression and Distraction Tests

Purpose: To assess SIJ stability and pain response.

A. Compression Test

1. The patient lies on their side with the affected side up.
2. The examiner applies downward pressure on the iliac crest, compressing the SI joint.
3. A positive result occurs when the patient’s usual pain is replicated.

B. Distraction Test

1. The patient lies supine.
2. The examiner places hands on both ASIS and applies outward (lateral) pressure to separate the SI joints.
3. A positive test is pain in the SI region.

Interpretation:

• Compression increases SIJ load, while distraction stretches the ligaments.
• Pain in either test suggests SIJ involvement.

5. Thigh Thrust Test (Posterior Shear Test)

Purpose: To assess SIJ pain by applying a posterior shear force.

How to Perform:

1. The patient lies supine with the hip flexed to 90° and the knee bent.
2. The examiner stabilizes the opposite ASIS with one hand.
3. The examiner applies a quick, downward thrust along the axis of femur.
4. The test is repeated on the other side.

Interpretation:

• Positive Test: Sharp pain in the SI joint area (not the hip or lumbar spine).
• Useful for: Detecting ligamentous laxity or inflammation in the SIJ.

6. Sacral Thrust Test

Purpose: To assess SIJ pain by applying anterior pressure on the sacrum.

How to Perform:

1. The patient lies prone (face down).
2. The examiner places the heel of their hand over the sacrum.
3. A firm, anterior pressure is applied.
4. A positive test is the reproduction of the patient’s SIJ pain.

Interpretation:

• Pain localized to the SI joint suggests dysfunction.
• Differentiates from lumbar spine issues.

7. Gillet Test (Stork Test or Ipsilateral Posterior Rotation Test)

Purpose: To assess SIJ mobility and dysfunction.

How to Perform:

1. The patient stands, and the examiner palpates the PSIS and sacrum with their thumbs.
2. The patient lifts one knee toward the chest (hip flexion).
3. Normally, the PSIS on the lifted side should move inferiorly and slightly laterally.
4. A positive test occurs if the PSIS does not move or moves asymmetrically compared to the other side.

Interpretation:

• Restricted motion suggests SIJ hypomobility.
• Excessive motion may indicate hypermobility.

8. Yeoman’s Test

Purpose: To stress the SI joint by extending the hip.

How to Perform:

1. The patient lies prone.
2. The examiner extends the patient’s hip while stabilizing the sacrum.
3. Pain in the SI joint area indicates a positive test.

Interpretation:

• Differentiates SIJ pain from lumbar or hip issues.

Which Tests Are Most Reliable?

Research suggests that no single test is 100% accurate, so clinicians often use a combination of at least 3 positive tests to confirm SIJ dysfunction. The most commonly used cluster includes:
✅ Thigh Thrust Test
✅ Compression Test
✅ FABER Test

Physiotherapy Treatment for SIJ Pain

Physiotherapy is a highly effective, non-invasive approach to managing SIJ pain. Treatment focuses on reducing pain, improving stability, and correcting movement patterns.

Key Exercises for sacroiliac joint pain:

Mobility and Flexibility Work

Piriformis Stretch: 

Relieves tension in the buttock muscles that may compress the SI joint.

Knee-to-Chest Stretch:

Gently mobilizes the sacroiliac region.

Cat-Cow Stretch:

Promotes spinal and pelvic mobility.

Stabilization Exercises

Pelvic Tilts:

Gentle movements to engage deep abdominal muscles.

Glute Bridges:

Strengthens the glutes and stabilizes the pelvis.

Clamshells:

Targets the hip abductors to improve pelvic control.

Prone double leg raises:

Postural and Movement Re-education:

• Ergonomic Adjustments: Proper sitting, standing, and lifting techniques to reduce strain.
• Gait Analysis: Correcting walking patterns to prevent excessive SI joint stress.

Progressive Loading and Functional Training

• Gradual reintroduction of weight-bearing activities (e.g., squats, lunges) to rebuild strength.
• Balance and proprioception exercises to enhance joint stability.

Preventing SIJ Pain Recurrence

• Maintain a strong core and hip musculature.
• Avoid prolonged sitting or standing in one position.
• Use proper body mechanics when lifting heavy objects.
• Stay active with low-impact activities like swimming or cycling.

Conclusion:

SIJ pain can be debilitating, but with the right diagnosis and physiotherapy approach, most individuals experience significant relief. A combination of manual therapy, targeted exercises, and postural corrections helps restore joint function and prevent future issues.

If you’re experiencing persistent lower back or pelvic pain, consult a physiotherapist for a personalized treatment plan. Early intervention can speed up recovery and improve long-term outcomes.

Would you like a tailored exercise plan for SIJ pain? Contact us today to schedule an appointment.