Massage therapy · Kitchener–WaterlooSacroiliac Joint Pain

Sitting next to the SIJ are the buttock muscles – gluteus maximus, gluteus medius, gluteus minimus, and piriformis. There are also strong SI ligaments that support the joint (Kiapour et al., 2020).

Causes of SIJ pain:

1. Hypermobility – following childbirth, or in women with hypermobility syndromes, the SIJ can become hypermobile (too mobile) or even unstable (Laslett, 2008). This means the joint moves too much, and the ligaments are not supporting it as well as they should. This can create shearing forces at the joint and cause inflammation along the joint line (Kiapour et al., 2020).
2. Stiffness – the SIJ can also become stiff, with too little movement (Kiapour et al., 2020). Stiffness can occur in people who lack range of movement or who do not exercise much.
3. Osteoarthritis – degenerative wear and tear to the joint can cause bony growths (osteophytes) or joint inflammation.
4. SIJ Syndrome – this is simply another name for SIJ pain, and covers an umbrella of painful problems around the SIJ.
5. Referred Pain – pain from the lower back can spread into the SIJ area.
6. Buttock Muscle Tightness in the gluteal and piriformis muscles.
7. Strain or Inflammation of the SIJ ligaments (Kiapour et al., 2020).
8. Inflammatory Conditions, such as ankylosing spondylitis (a type of spondyloarthritis), causing inflammation of the SIJ (Kiapour et al., 2020; Laslett, 2008).

1. 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.)

2. Ice and Heat

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. I can help you work out whether ice or heat would suit you best.

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).

How I can help (see the My Approach tab)

• Hands-on work for the low back, buttock and hip muscles
• Gentle, low-velocity joint mobilisation, never quick thrusts
• Exercises for stability and strength around the lower back, pelvis and hips

Any work on the buttock and hip needs your informed consent and a signed consent form. If you're pregnant, I can treat you in any trimester, lying on your side; a high-risk pregnancy needs your midwife's or OB's okay first. With ankylosing spondylitis, I can still treat you during a flare, with gentler, shorter sessions that avoid the most inflamed areas.

If you get weakness or numbness in both legs, or changes in your bladder or bowels, call 911 (see When to Get Urgent Help).