Sacroiliac Joint Pain During Pregnancy
What are the sacroiliac joints?
The sacroiliac joints are located at the back of the pelvis and they connect each ilium to the sacrum through large ligamentous and muscular attachments. The main function of these joints is to transfer load from the spine to the legs, and in women, the uterus is directly attached to the front of the sacrum itself. As the uterus grows and expands to make room for baby, that direct ligamentous attachment can place a lot of stress on the sacrum and the sacroiliac joints. Another factor during pregnancy is the hormone relaxin, which allows the ligaments and muscles surrounding the pelvis to soften and stretch. An amazing thing for childbirth but can be a huge factor in pregnancy-related aches and pains!
What are the symptoms of sacroiliac joint dysfunction?
- Sharp, stabbing pain near the tailbone or hips
- Radiating pain into the glutes, down the leg, or wrapping around to the groin
- Pain with movements such as climbing stairs or going from sitting to standing
- Pregnancy waddle and altered gait mechanics
- Unable to sleep on your sides due to increased pain
How do you manage sacroiliac joint pain?
The best option for mommas dealing with SI joint pain is to seek out care with a specialized prenatal chiropractor or physical therapist. There are so many different treatment options, but manual therapy and specialized rehab exercises are the most effective! Here are a few tips that you can implement right away.
- Strengthen, strengthen, strengthen! This is SO important to help stabilize the pelvis. Work on glute strengthening exercises such as banded lateral walks, glute bridges, clamshells, and deadlifts.
- Check your posture, keep that diaphragm stacked over the pelvic floor, and don’t let your pelvis tip forward.
- If you are a side sleeper, make sure to use a pillow between your knees at night to keep your pelvis level.
- Last resort comfort measure would be the purchase of a sacroiliac belt. I recommend the Serola Belt!
About the author
Dr. Eric Dickerson, DC, FRCms
Founder, Sports Chiropractor
As the Founder and Director of Clinical Development at Radius Physical + Sports Rehab, Dr. Eric Dickerson is a dedicated musculoskeletal provider who blends clinical experience with a patient-centered approach. He integrates functional rehabilitation, evidence-based physical rehabilitation modalities, joint manipulation, and advanced manual therapy techniques to craft a comprehensive approach to your health.
More from Dr. Eric Dickerson →Frequently Asked Questions
Common questions about sacroiliac joint pain.
What is sacroiliac joint pain?
Sacroiliac joint pain is pain arising from the sacroiliac joint, one of the potential causes of axial low back pain. The sacroiliac joints are the connection between the spine and the pelvis, where the sacrum (the large bone at the base of the spine) meets the ilium (the upper part of the pelvis). Between 15% and 30% of low back pain is attributable to sacroiliac joint problems, making it an often under-recognized source of lower-back pain.
What does sacroiliac joint pain feel like and where is it felt?
Sacroiliac joint pain is typically felt in the buttock region, in the area between the gluteal folds and the posterior iliac crests. It can be sharp and stabbing or a more constant dull ache, and it may radiate from the low back into the buttocks, hips, groin, or thigh. The posterior thigh is the most common site of referred pain, reported in about 50% of patients, and pain can extend down toward the knee.
What causes sacroiliac joint pain, and who is at risk?
Approximately 88% of sacroiliac joint problems arise from either repetitive microtrauma or acute trauma, such as falls or motor vehicle collisions. Pregnancy accounts for about 20% of cases, related to weight gain, increased lumbar curvature, and hormone-induced ligament laxity. Other reported risk factors include female sex, prior lumbar fusion, obesity, leg-length discrepancy, and occupational or athletic overuse. Arthritis and inflammatory conditions can also affect the joint.
How is sacroiliac joint pain diagnosed?
Sacroiliac joint pain is identified through a combination of physical examination and, in some cases, imaging or diagnostic injection. Clinicians use provocation tests such as the FABER (Patrick's) and Gaenslen's tests; when three or more provocation tests are positive, sensitivity and specificity reach 91% and 78%, respectively. An image-guided anesthetic injection into the joint that relieves pain is considered the reference standard for confirming the joint as the pain source.
How is sacroiliac joint pain treated without surgery?
Sacroiliac joint pain is usually managed conservatively, and more than 75% of cases respond to conservative measures and physical therapy. Care often includes an exercise-oriented spinal stabilization and stretching program, activity modification, and analgesics or NSAIDs. Hands-on manual therapy, including massage and manipulation, may help, and a sacroiliac belt to support the joints has shown benefit comparable to a home exercise program. A physical therapist may also address body mechanics such as how you sit, lift, or carry.
When should I see a clinician about sacroiliac joint pain?
It is reasonable to see a healthcare provider for new or worsening pain in your lower back, buttock, or hip that does not settle. Because sacroiliac joint pain can be difficult to distinguish from other sources of low-back pain, a clinician can perform an examination, use provocation tests, and confirm the diagnosis before guiding conservative treatment such as an exercise program, manual therapy, and activity modification.
Sources
- StatPearls "Sacroiliac Joint Injury" (NBK557881) — tier 2, peer-reviewed NCBI Bookshelf overview (15–30% of LBP; 88% microtrauma/trauma; pregnancy 20%; buttock location; posterior-thigh referral ~50%; 3+ provocation tests 91%/78%; >75% respond to conservative care/PT; risk factors)
- StatPearls "Sacroiliac Joint Pain" (NBK470299) — tier 2, peer-reviewed NCBI Bookshelf overview (definition "one of the potential causes of axial low back pain"; up to 25% of LBP; referral %; FABER/Patrick's, Gaenslen's, 3+ tests; image-guided injection reference standard; exercise/stabilization program, NSAIDs, SI belt "equal benefit as a home exercise program," manual therapy/manipulation/chiropractic; pregnancy causes)
- APTA ChoosePT "Physical Therapy Guide to Sacroiliac Joint Dysfunction" — tier 3, professional-body patient education (SIJ definition sacrum/ilium; 10–25% of LBP; pain one side of pelvis/low back/groin/tailbone radiating to knee; aggravated by standing from sitting, turning in bed, bending, twisting; childbearing-age/hormonal laxity; PT evaluation of gait/stairs/single-leg; manual therapy, strengthening/stretching, SI belt, body mechanics)
- Cleveland Clinic "Sacroiliitis" — tier 4, patient-facing general clinical reference (SI joints = spine-to-pelvis connection, sacrum meets ilium; sharp/stabbing or dull ache; radiation to buttock/hips/thighs; worse after prolonged sitting/standing and with hip rotation; pregnancy widens/rotates joints; PT most common treatment; NSAIDs; see a provider for new or worsening low-back pain)
The information on this website is general education about musculoskeletal and movement-related conditions. It is not medical advice or a diagnosis, and it cannot tell you what is causing your symptoms. Reading it is not a substitute for an in-person evaluation, and booking a visit does not confirm that your condition is right for our care until a provider has examined you. This information cannot identify every condition, and some urgent problems can feel like musculoskeletal pain. If your symptoms are severe or getting worse, or you are unsure how urgent they are, contact your physician, call 911, or go to the nearest emergency room. When in doubt, seek emergency care.
