Low Back & Pelvis

What It Is

The sacroiliac joint (sometimes written sacro-iliac joint, or SIJ) sits towards the bottom of the spine, where the pelvis meets the sacrum. The joint is most easily felt by pressing around the top of the buttock.

The SIJ normally moves only a tiny amount, on average less than a millimetre and seldom more than 2mm (Kiapour et al., 2020). However, in some cases the SIJ can become hypermobile (move too much). This is most commonly seen in women, and often after childbirth: instability of the joint after childbirth or injury is one possible cause of SIJ pain (Laslett, 2008). During pregnancy, the ligaments around the pelvis soften to allow the pelvis to expand, and this can allow the SIJs to move more than normal. After birth, the ligaments can remain stretched and softened, making the joint move more than normal.

Surrounding muscles and ligaments work to stabilize the sacroiliac joints, especially in vulnerable or stressful positions. The buttock muscles (particularly gluteus maximus) and the deep abdominal core muscles are important for stabilizing this joint (Kiapour et al., 2020). If the SIJ is hypermobile, the ligaments are not stabilizing the joint as well as they should, and the joint surfaces can become strained and inflamed (Kiapour et al., 2020).

The deep core muscles help to press the joint surfaces together, improving the stability and control of the sacroiliac joints. Contraction of the transversus abdominis muscle (a deep stomach muscle) helps to support and stiffen the sacroiliac joints (Kiapour et al., 2020).

Causes of SIJ Hypermobility

Previous injury to the SIJ or the ligaments around the SIJ can cause instability (Laslett, 2008).
Childbirth can cause hypermobility, instability, and joint strain (Laslett, 2008).
General hypermobility – some people naturally have loose ligaments, which creates hypermobility in many joints in the body, including the SIJ.

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat Sacroiliac Joint Hypermobility

Hands-on therapy and exercise can help with a hypermobile SIJ. I can work on the muscles around your buttock and pelvis, check your lower back and the front of your pelvis, and guide you through exercises to stabilise the joint. See the My Approach tab for how I work.

1. Ice

The NHS suggests an ice pack (or a bag of frozen peas) wrapped in a tea towel to reduce pain and swelling, or a heat pack or hot water bottle wrapped in a tea towel to relieve stiffness or muscle spasms (NHS, 2026). Use ice for up to 20 minutes at a time, every 2 to 3 hours (NHS, 2024), and never put ice directly on the skin.

2. Anti-Inflammatory Medication

For lower back pain, the NHS suggests anti-inflammatory medicine such as ibuprofen, although it may not be suitable for everyone; paracetamol on its own is not recommended for back pain (NHS, 2026). (This medicine information comes from the NHS website, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

3. Crutches and Pelvic Support Belts

For pregnancy-related pelvic pain, a physiotherapist may recommend crutches to help you get around, or a pelvic support belt to help ease your pain (NHS, 2022). Ask me or your family doctor or nurse practitioner before using either. I can help you work out whether you need one and how to get it, and set up crutches and show you how to use them.

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Manipulation: some osteopaths and chiropractors use quick "thrust" techniques (manipulation) on the sacroiliac area. Research has not shown that manipulation actually moves the sacroiliac joint or changes the position of the pelvis (Laslett, 2008), and UK guidance recommends hands-on (manual) therapy for lower back pain only as part of a treatment package that includes exercise (NICE, 2016).
Prolotherapy: injections intended to tighten the ligaments around the joint. The quality of evidence for this treatment is poor (Laslett, 2008).

How I can help (see the My Approach tab)

Exercises to stabilise the joint
Hands-on work for the muscles around your pelvis
Gentle mobilisation for stiff areas above and below the joint

Tips

Keep up your rehabilitation: specific stabilizing exercises have been shown to reduce pelvic pain after childbirth (Laslett, 2008).
Make sure you stick to the deep abdominal and hip muscle exercises I give you, and do them a few times every week.
Your physiotherapist can help you to identify the best exercises for your specific situation. During pregnancy, these may include exercises to strengthen your pelvic floor, stomach, back and hip muscles (NHS, 2022). I can help with these too, including pelvic floor exercises.
Beyond addressing muscle control, I may also look at your spine, hips and legs.
Pilates may help ease lower back pain (NHS, 2026).

Treatment

My Approach

When your sacroiliac joint moves too much, the answer isn't more stretching. My aim is to ease the strained muscles around your pelvis and build the strength and control that hold the joint steady, so everyday movements stop provoking it.

I start by assessing how your low back, pelvis and hips move, how flexible your joints are in general, and the strength of your buttock and deep stomach muscles. I also check your lower back, which can refer pain to this area, and, if needed, the joint at the front of your pelvis (the pubic symphysis).

Easing the Pain

Hands-on work for the muscles around your buttock, pelvis and lower back, which often work overtime to hold the joint steady
Sustained pressure on tight, tender spots, followed by warmth
No stretching or mobilising of the loose joint itself; gentle, low-velocity mobilisation goes to stiff areas above or below, such as the back and hips
Warm or cool applications in the clinic, and I'll show you how to use ice and heat safely at home

Building Stability

Gentle holds for the deep stomach and buttock muscles in a well-supported position
Then bridges, clams and side-lying leg lifts, building to single-leg balance, step-ups, lunges and gym-based strength work
Pelvic floor exercises, especially during pregnancy and after childbirth
A home programme you can keep up a few times a week

Day to Day

Avoiding stretches that push the joint to the end of its range, such as the hurdler's stretch
Setting up crutches if you need them, and helping you work out whether a pregnancy support belt would help

Work around the buttock, hip and groin is only with your informed consent and a written consent form. I can treat you at any stage of pregnancy; if your pregnancy is high-risk, I'll need your midwife or OB's okay first.

What to Expect

Typical Course

Typical course: Most people come once or twice a week at first, then weekly, then less often as you take over your home programme, with a reassessment at about 4 to 6 weeks. Building stability takes time: most people notice a difference within about 6 to 12 weeks of regular exercise.

What I Focus On

Joint Assessment

Glute & Core Stability

Stiff-Neighbour Mobilisation

No Overstretching

Home Programme

Please read

When to See a Doctor First

When to Get Urgent Help

Call 911 or go to the emergency room at your nearest hospital if you have back pain and any of the following: pain, tingling, weakness or numbness in both legs; loss of feeling around your genitals or bottom (anus); changes in your bladder or bowels, such as difficulty peeing or not being able to control when you pee or poo; or the pain started after a serious accident, such as a car accident (NHS, 2026).

Sources

References

Kiapour, A., Joukar, A., Elgafy, H., Erbulut, D.U., Agarwal, A.K. and Goel, V.K. (2020) 'Biomechanics of the sacroiliac joint: anatomy, function, biomechanics, sexual dimorphism, and causes of pain', International Journal of Spine Surgery, 14(Suppl 1), pp. S3–S13. doi: 10.14444/6077
Laslett, M. (2008) 'Evidence-based diagnosis and treatment of the painful sacroiliac joint', Journal of Manual & Manipulative Therapy, 16(3), pp. 142–152. doi: 10.1179/jmt.2008.16.3.142
NHS (2022) Pelvic pain in pregnancy. Available at: https://www.nhs.uk/pregnancy/related-conditions/common-symptoms/pelvic-pain/ (Accessed: 7 October 2026).
NHS (2024) Sprains and strains. Available at: https://www.nhs.uk/conditions/sprains-and-strains/ (Accessed: 8 October 2026).
NHS (2026) Back pain. Available at: https://www.nhs.uk/conditions/back-pain/ (Accessed: 8 October 2026).
National Institute for Health and Care Excellence (2016, updated 2026) Low back pain and sciatica in over 16s: assessment and management (NICE guideline NG59). Available at: https://www.nice.org.uk/guidance/ng59/chapter/Recommendations (Accessed: 7 October 2026).

Massage therapy · Kitchener–WaterlooSacroiliac Joint Hypermobility

What It Is

Causes of SIJ Hypermobility

Self-Care & Treatment

How to Treat Sacroiliac Joint Hypermobility

1. Ice

2. Anti-Inflammatory Medication

3. Crutches and Pelvic Support Belts

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

Easing the Pain

Building Stability

Day to Day

Typical Course

When to See a Doctor First

When to Get Urgent Help

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooSacroiliac Joint Hypermobility

What It Is

Causes of SIJ Hypermobility

Self-Care & Treatment

How to Treat Sacroiliac Joint Hypermobility

1. Ice

2. Anti-Inflammatory Medication

3. Crutches and Pelvic Support Belts

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

Easing the Pain

Building Stability

Day to Day

Typical Course

When to See a Doctor First

When to Get Urgent Help

References

Related Conditions

Sacroiliac Joint Pain

Sacroiliac Joint Osteoarthritis

Cervical Spondylosis

Degenerative Disc Disease (DDD)

Book a session