Massage therapy · Kitchener–WaterlooSacroiliac Joint Osteoarthritis

The sacroiliac joint (SIJ) lies low in the back where the spine meets the pelvis (Kiapour et al., 2020). Discomfort in this area can come from a number of conditions, one being osteoarthritis. Cartilage is a firm, rubbery material that cushions and covers the bone ends in normal joints, and helps the joint move smoothly. In osteoarthritis, this protective cartilage breaks down, causing pain, swelling and problems moving the joint, and bony growths (osteophytes) can develop (NHS, 2023).

People often feel pain at the top of the buttock. Quite often the pain is associated with lower back pain, and this can be related to degenerative (wear-related) problems in the spine.

Possible Causes of SIJ Osteoarthritis

How to Treat Sacroiliac Joint Osteoarthritis

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

Tips

• If you are overweight, losing weight can reduce the strain on your joints (NHS, 2023).
• If you have had an injury from sports, work or an accident, you are more likely to develop osteoarthritis in that joint (NHS, 2023).
• Osteoarthritis may run in families, although no single gene has been found to be responsible (NHS, 2023).
• Even though the risk increases with age, osteoarthritis does not necessarily get worse over time, and it can sometimes gradually improve (NHS, 2023).
• Try not to overuse a joint when it has not had enough time to heal after an injury, as this can increase the risk of osteoarthritis (NHS, 2023).

Osteoarthritis is a long-term condition, so I treat it as ongoing care rather than a quick fix. My aim is to ease pain and stiffness in your low back and pelvis, keep things moving, and build strength in the muscles around the joint so it's better supported day to day.

I start by assessing how your low back, pelvis and hips move, testing the strength of your hip, buttock and trunk muscles, and watching how you walk, sit and stand. Pain at the top of the buttock is often linked with the lower back, so I look at both.

Hands-On Treatment

• Warmth first to loosen things, then massage, trigger point and myofascial work for the low back, buttock and hip muscles
• Gentle, low-velocity mobilisation of the low back and pelvis within a comfortable range, never quick thrusts
• Gentle stretching, including contract-relax stretches for tight hips and hamstrings
• Cool applications in the clinic if it has flared
• Work on areas that have been compensating
• Buttock and hip work is only with your informed consent and a written consent form

Exercise

• Gentle holds in positions that don't hurt, building into fuller movement and strength work for your hips and trunk
• Low-impact fitness like swimming, water exercise, walking or cycling
• Balance work, and gym-based strength work when you're ready
• A home programme between visits, with no pain during or after

At Home

1. 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
2. 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
3. NHS (2024) Sprains and strains. Available at: https://www.nhs.uk/conditions/sprains-and-strains/ (Accessed: 8 October 2026).
4. NHS (2023) Osteoarthritis. Available at: https://www.nhs.uk/conditions/osteoarthritis/ (Accessed: 7 October 2026).
5. NHS (2026) Back pain. Available at: https://www.nhs.uk/conditions/back-pain/ (Accessed: 8 October 2026).
6. 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).