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Sacroiliac Joint (SIJ) Pain in Athletes: What Causes It, Why It Lingers, and How Rehab Helps

By Emma Glynn - The Hip & Knee Physio - Camberwell


Sacroiliac joint pain in athletes is often misunderstood. It’s not just a pregnancy issue or something that needs cracking back into place. For runners, lifters, and field-sport athletes, SIJ-related pain can limit performance, affect training consistency, and be incredibly frustrating to pin down. This blog unpacks what SIJ pain is, the common patterns in active populations, and how rehab usually helps.


What is the SIJ and why can it become painful?

The sacroiliac joint connects the sacrum (tailbone) to the ilium (pelvis). It’s a strong, relatively immobile joint designed for force transfer, not big movement (Vleeming et al., 2012). In athletes, the SIJ plays a key role during load transmission between the trunk and legs, especially during single-leg tasks like running, cutting, or lifting.

Contrary to popular belief, the SIJ doesn’t “slip out” or dislocate under normal conditions. Pain is more often driven by local overload (ligamentous, capsular, or adjacent soft tissue strain), altered motor control, or referred patterns from nearby structures (Murakami et al., 2007; Laslett et al., 2005).


Common symptom patterns in athletic SIJ pain

Unlike pregnancy-related SIJ issues, athlete presentations usually don’t involve ligament laxity. Instead, symptoms tend to follow load-driven or irritability-based patterns. Some of the most common include:

1. Localised pain near the PSIS (posterior superior iliac spine)

This pain often feels deep, dull, or occasionally sharp during provocative tasks like single-leg stance, uphill running, lunges, or barbell squats (Palsson et al., 2021).

2. Unilateral, sometimes alternating

One side is usually worse, but not always consistently. SIJ-related symptoms may "swap sides" depending on asymmetries in loading (Mooney et al., 2001).

3. Reproduction with load transfer or asymmetrical tasks

Pain may be triggered with:

  • Single-leg standing or hopping

  • Deep squats or lunges

  • Sprint starts or deceleration drills

  • Prolonged sitting or standing

4. Referred pain but usually not below the knee

Referred discomfort can radiate into the buttock, groin, or upper posterior thigh, but rarely goes past the knee unless another structure (like the lumbar spine) is also involved (Laslett et al., 2005).


How is SIJ pain diagnosed?

There’s no single scan or movement that confirms SIJ pain.

Diagnosis is usually clinical, based on a combination of pain provocation tests (e.g., thigh thrust, Gaenslen’s, FABER, compression) that reproduce familiar symptoms (Laslett et al., 2005). If at least three provocation tests are positive, and lumbar spine tests are negative, SIJ involvement is more likely.

Imaging (like MRI) may be used to rule out other causes, but it’s often inconclusive for SIJ pain itself (Zheng et al., 2021).


Key contributors in athletes

In athletic populations, SIJ pain is rarely due to structural failure. It’s often a product of:

1. Asymmetrical loading

Runners, kickers, and rotational athletes often develop side-to-side differences in strength, control, or flexibility that shift load through the SIJ asymmetrically (Palsson et al., 2021).

2. Poor force transfer or gluteal control

If the glutes aren’t stabilising well (especially gluteus maximus and medius), load gets transferred through passive structures, like the SIJ, rather than through active muscular control (Van Wingerden et al., 2004).

3. Previous lumbar or hip pathology

SIJ pain often co-exists with or follows lumbar disc injuries, hip labral issues, or altered pelvic mechanics (Vleeming et al., 2012). The joint itself may not be the origin, but becomes sensitised from compensatory overload.


Where rehab starts

Hands-on techniques (e.g., joint mobilisation or muscle energy techniques) may help reduce symptoms short-term, but they’re not enough on their own. Long-term management centres on restoring load-sharing capacity across the pelvis, spine, and hips (Palsson et al., 2021).


Rehab usually includes:

  • Targeted gluteal strengthening (glute max and medius especially)

  • Trunk stability and motor control work

  • Load desensitisation (volume and intensity management)

  • Pelvic symmetry retraining, especially in high-load lifts or runs


Rehab may also involve gait retraining, movement pattern work, and (in some cases) referral for pain-modulating injections when symptoms are highly irritable (Murakami et al., 2007).


When to consider a review

You don’t need to live with SIJ pain indefinitely. Consider booking an assessment if:

  • Symptoms limit performance or daily function

  • Pain recurs with training progression

  • There's persistent night pain or sharp pain with simple tasks

  • You’ve had prior hip/spine injuries and now feel deep buttock/groin discomfort



FAQs about SIJ pain in athletes

  1. Is SIJ pain common in athletes?

    Yes - particularly in runners, rotational athletes, and lifters with prior low back or hip issues (Palsson et al., 2021).

  2. Can SIJ pain cause sciatica?

    True sciatica is more often from lumbar disc issues, but SIJ pain can refer to similar areas (Laslett et al., 2005).

  3. Do I need a scan for SIJ pain?

    Not always. Diagnosis is usually clinical. Imaging may help rule out other causes (Zheng et al., 2021).

  4. Does cracking the SIJ fix it?

    Manipulation can help short-term, but long-term rehab focuses on control, strength, and load sharing (Van Wingerden et al., 2004).

  5. Can SIJ pain go away with rehab?

    Often yes, especially with a structured, load-based rehab program tailored to your sport and asymmetries (Palsson et al., 2021).




Next steps in Camberwell

If your SIJ is still problematic and symptoms have lasted beyond the expected timeframe, or if pain keeps returning with normal activity, an individual assessment can clarify what’s driving it and how to adjust your rehab plan.


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The content provided on this website is for general information and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.

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Reference List

  1. Laslett, M., Aprill, C. N., McDonald, B., & Young, S. B. (2005). Diagnosis of sacroiliac joint pain: Validity of individual provocation tests and composites of tests. Manual Therapy, 10(3), 207–218. https://doi.org/10.1016/j.math.2005.01.003

  2. Mooney, V., Pozos, R., Vleeming, A., Gulick, J., & Swenski, D. (2001). Exercise treatment for sacroiliac pain. Orthopedics, 24(1), 29–32.

  3. Murakami, E., Tanaka, Y., Aizawa, T., Ishizuka, M., Ozawa, H., & Kokubun, S. (2007). Effect of periarticular and intraarticular lidocaine injections for sacroiliac joint pain: Prospective comparative study. Journal of Orthopaedic Science, 12(3), 274–280. https://doi.org/10.1007/s00776-007-1115-8

  4. Palsson, T. S., Hirata, R. P., Graven-Nielsen, T., & Fernández-de-Las-Peñas, C. (2021). Sacroiliac joint pain and dysfunction in athletes: A systematic review. Journal of Bodywork and Movement Therapies, 25, 215–224. https://doi.org/10.1016/j.jbmt.2020.12.002

  5. Van Wingerden, J. P., Vleeming, A., & Snijders, C. J. (2004). Load transfer through the pelvic girdle: The function of the lateral abdominal muscles. Clinical Biomechanics, 19(6), 555–563. https://doi.org/10.1016/j.clinbiomech.2004.02.004

  6. Vleeming, A., Schuenke, M. D., Masi, A. T., Carreiro, J. E., & Danneels, L. (2012). The sacroiliac joint: An overview of its anatomy, function and potential clinical implications. Journal of Anatomy, 221(6), 537–567. https://doi.org/10.1111/j.1469-7580.2012.01564.x

  7. Zheng, C. J., Kang, Y. M., Kim, S. Y., & Sohn, M. H. (2021). Diagnostic accuracy of imaging for sacroiliac joint-related pain: A systematic review and meta-analysis. Pain Physician, 24(1), 1–14.

 
 
 

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