Condition
Sacroiliac pain and osteoarthritis of the sacroiliac joint
You feel a pulling pain low in your back or buttock when getting out of the car. A longer walk, a twisting movement or turning over in bed causes symptoms. When the sacroiliac joint, or SI joint (ISG in German), is mentioned as a possible cause, terms such as joint restriction or osteoarthritis soon arise.
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Symptoms that should not wait until a routine visit
New paralysis, numbness in the groin or new bladder or bowel problems require immediate medical assessment. Call 112 for these very rare emergency signs; do not wait until the practice or your GP can be reached. Fever with marked back or buttock pain, severe symptoms after an accident or sudden inability to bear weight also need urgent examination.
For a routine appointment, existing pelvic, hip or spine findings and your medication plan are helpful. Tell us whether symptoms are particularly noticeable in the morning, at night or with certain activities. You do not need to have decided yourself whether the sacroiliac joint is the cause.
Understanding
A closer look
We want to distinguish with you what these terms mean in your situation. Not every pain in this region comes from the sacroiliac joint, and not every change in the joint is osteoarthritis. Appropriate treatment begins with this assessment.
Where the sacroiliac joint is and what it connects
The two sacroiliac joints connect the sacrum to the iliac bones of the pelvis. Strong ligaments support them, and they transfer load between the trunk and legs. They move very little compared with many other joints.
Pain can arise in connection with the joint or its surrounding structures. The exact spot you point to is a useful clue, but not reliable proof on its own. Symptoms from the lumbar spine or hip can also radiate into the region.
Distinguishing osteoarthritis from inflammation
Sacroiliac joint osteoarthritis involves degenerative changes in the joint. Whether these explain the pain is assessed alongside the examination and the course of symptoms. An imaging indication of osteoarthritis is therefore not automatically a complete diagnosis of your symptoms.
This differs from an inflammatory condition of the sacroiliac joint called sacroiliitis. Possible signs include longstanding symptoms with pronounced morning stiffness or an unusual pattern at night. Accompanying conditions also matter. These observations do not prove a rheumatic disease but may prompt targeted further assessment. Pain should not be hastily explained by an assumed misalignment of the pelvis.
Further information
What we check during the examination
We ask when the symptoms started, how they relate to activity, about previous injuries and treatment so far. The examination includes the hip and lumbar spine as well as the pelvis. Certain combinations of provocation tests may give clues; a single tender point does not confirm the diagnosis.
Whether imaging is needed, and which type, depends on the outstanding question. Is there an injury, degenerative change or suspected inflammation? Existing images and reports help avoid unnecessary repetition. Further laboratory tests or specialist assessments are considered when there is a relevant clinical question, rather than arranged routinely for every case of buttock pain.
How treatment can make everyday life easier
If non-surgical treatment is appropriate, the main focus is movement you can tolerate and gradually building your capacity for activity. We want to know which activity you would like to manage better again. Long periods of sitting may need different adjustments from frequent lifting and carrying at work.
Exercises and, where appropriate, physiotherapy support are tailored to the findings. Manual medicine may complement treatment in a suitable situation. It should not be associated with the idea that the pelvis repeatedly needs to be permanently ‘put back into place’. A short-term change after treatment helps us assess progress, but does not prove a lasting displacement of the joint.
If accompanying muscle tension worsens the symptoms, additional treatment on the Evocell couch may be an option. It is used with the aim of relaxing muscles. It does not resolve inflammation, osteoarthritis or another cause affecting the sacroiliac joint; nor do we promise that it will reliably release the joint restriction for good.
When injections or further assessment may be considered
For persistent symptoms whose source has been narrowed down sufficiently, targeted diagnostic or treatment procedures may be considered. An injection should answer a specific question or support a justified treatment goal. It is not the standard response to every pain around the sacrum.
The discussion includes possible benefits, infection and bleeding risks, and what a temporary improvement can tell us. If the cause remains unclear or the current plan is not helping enough, a fresh diagnostic assessment is often more important than simply repeating the same measure. More involved procedures require specialist assessment and their own benefit–risk evaluation.
Frequently asked questions
Is sacroiliac joint restriction the same as osteoarthritis?
No. Joint restriction describes a functional problem; osteoarthritis describes degenerative joint changes. Neither term replaces assessment of what actually explains your symptoms.
Does sacroiliac joint pain always need an MRI?
No. It depends on the question that needs answering. An MRI can be important if inflammation is suspected or there are other particular findings; the decision follows medical assessment.
Could the pain also come from the hip?
Yes, symptoms from the hip, spine and pelvic region can overlap. That is why the examination is not limited to the spot where you feel pain.
Your next step
