SI Joint Pain – Understanding the Causes, Relieving the Pain

SI joint complaints are common, often one-sided, and can noticeably affect daily life – women in particular are frequently affected across different stages of life. They typically arise from an interplay of the joint, ligaments, muscles, and posture, rather than from a single cause.

x-ray image of the SI-Joints.

What Is the SI Joint and Why Does It Hurt?

The sacroiliac joint (SI joint) connects the sacrum to the ilium and is a stable but only minimally mobile joint. It transfers forces from the upper body to the legs and provides stability during walking, standing, and lifting.

Typical symptoms:

• One- or two-sided pain in the lower back, buttocks, or groin area

• Radiation into the upper thigh (usually the upper portion), rarely extending down the leg

• Worsening when rising from sitting, climbing stairs, turning in bed, or bearing weight on one leg

• A feeling of "blockage" or instability

Common causes in women:

• Pregnancy and the postnatal period: loosened ligaments due to relaxin, asymmetry caused by the baby

• Hormonal fluctuations (menstrual cycle, menopause): connective tissue loses tension

• One-sided loading: always carrying children on the same side, office work with crossed legs

• Weakness of the pelvic floor or abdominal muscles: less "natural support" for the joint

• Postural patterns: forward-leaning posture, hollow back, or asymmetrical sporting activity

Everyday Triggers and Risk Factors

SI joint complaints rarely require a sudden injury – they often creep in gradually:

• Unfavourable sleeping positions (e.g. always on the same side)

• Heavy coughing or straining (e.g. with constipation)

• High-heeled shoes or uneven soles

• Stress: automatically increased tension in the gluteal and back muscles

Many women seek help in the postnatal period because the pelvis is still "settling" – understanding this is important before starting any exercises.

What You Can Do Yourself – First Steps

1. Relieving load and posture

• Sit symmetrically, legs hip-width apart, feet flat on the floor

• When standing up: first lift the buttocks, then follow with your legs

• Place a pillow between your knees when sleeping on your side

2. Heat and gentle movement

• A heat pad on the SI joint for 15–20 minutes: promotes circulation and eases tension

• Light walks on even ground: keeps you mobile without one-sided strain

3. Breathing and pelvic floor

• Breathe deeply into the sides of your ribcage; on the exhale, gently activate the pelvic floor and lower abdominal muscles

• Avoid straining: instead, focus on sensing a "soft lift"

How Osteopathy Helps with SI Joint Complaints

Osteopathic treatment specifically looks for imbalances:

• Releasing tension in the gluteal muscles (e.g. piriformis), lower back, or pelvic floor

• Mobilising the SI joint itself and supporting the ligaments

• Assessing the whole body: other areas often play an important role too – for example, the feet, jaw, or neck

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After the treatment, you will receive practical tips and exercises you can do independently – for example:

• Four-point kneeling: Alternately extend one leg while keeping the core stable

• Lying down: Draw knees to the chest and gently circle them

• Standing: Distribute weight evenly across both feet, gently tilt the pelvis

When to Seek Help

See an osteopath or doctor if:

• Pain persists for more than 2 weeks or wakes you at night

• Numbness, tingling, or loss of strength in the leg develops

• Fever, severe stiffness, or pain following a fall occurs

• You feel uncertain after childbirth or surgery

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Tip: Note down for 1–2 days when the pain occurs (e.g. "after sitting for more than 30 minutes") – this is enormously helpful in the initial assessment.

With understanding, targeted treatment, and small adjustments to daily life, SI joint complaints can often be significantly improved – so you can move freely and confidently again. Feel free to book an appointment at our osteopathy practice in Sendling, Munich.