Sacroiliac Joint (SIJ) Dysfunction in Women: Why It Happens and How Physiotherapy Can Help?

Aug 19

4 min read

If you've been experiencing pain around your lower back, buttock, or pelvis that just won't go away, your sacroiliac joint (SIJ) may be contributing to your symptoms. SIJ dysfunction is particularly common in women and can significantly affect daily activities such as walking, climbing stairs, exercising, or even rolling over in bed.

The good news? Physiotherapy is one of the most effective conservative treatments to help reduce pain, improve movement, and restore confidence in your body.

What is the Sacroiliac Joint?

The sacroiliac joints are two small joints that connect the base of your spine (the sacrum) to your pelvis (the ilium). Although these joints only move a few millimetres, they play a crucial role in transferring forces between your upper body and your legs during everyday movements like walking, running, bending, and lifting.

Rather than providing movement, the SI joints are designed primarily for stability.

Why Are Women More Likely to Experience SIJ Pain?

Women are more susceptible to SIJ dysfunction for several reasons:

Pregnancy and Postpartum Changes

During pregnancy, hormones such as relaxin soften the ligaments around the pelvis to prepare for childbirth. While this is completely normal, it can reduce the stability of the SI joints and contribute to pelvic pain. These hormonal effects may continue for several months after delivery.

Anatomical Differences

Women generally have a wider pelvis than men, which changes how forces are distributed through the pelvis and SI joints. This may increase stress on these joints during daily activities.

Hypermobility

Some women naturally have greater flexibility or joint laxity, making the pelvis less stable and increasing the likelihood of irritation around the SI joints.

Previous Injury or Repetitive Loading

Falls onto the buttocks, sporting injuries, prolonged standing, repetitive lifting, or asymmetrical movements can overload the SI joints and surrounding tissues.

What Does SIJ Dysfunction Feel Like?

SIJ pain often presents as:

Pain on one side of the lower back or buttock
Pain around the dimples of the lower back
Pain that may spread into the groin or upper thigh
Difficulty standing on one leg
Pain when rolling over in bed
Discomfort climbing stairs
Pain after prolonged sitting or standing
Pain during walking or running

Although SIJ pain can sometimes resemble sciatica, true nerve symptoms such as numbness, tingling, or significant leg weakness are usually caused by other conditions and should be assessed by a healthcare professional.

How is SIJ Dysfunction Diagnosed?

There is no single test that can accurately diagnose SIJ dysfunction.

Instead, physiotherapists combine:

A detailed history of your symptoms
Assessment of movement and function
A series of pain provocation tests
Examination of the hips, lumbar spine, and surrounding muscles

This comprehensive assessment helps determine whether the SI joint is the primary source of pain or whether another structure is contributing to your symptoms.

How Can Physiotherapy Help?

Exercise is the cornerstone of treatment and may include:

Deep core muscle activation
Glute strengthening
Hip stability exercises
Functional strengthening
Balance and single-leg control
Gradual return to walking, running, or sport

Research consistently shows that exercise improves pain and function for people with SIJ dysfunction.Modern physiotherapy focuses on restoring movement, improving stability, and reducing pain—not simply "putting the pelvis back into place."

A physiotherapy treatment plan may include:

Education

Understanding what is causing your pain can reduce fear and improve recovery. Your physiotherapist will explain which activities to modify temporarily and how to continue moving safely.

Manual Therapy

Hands-on treatment, including joint mobilisation or soft tissue techniques, may provide short-term pain relief and help restore comfortable movement. However, manual therapy is generally most effective when combined with an exercise program rather than used on its own.

Movement Retraining

Your physiotherapist may help improve how you move during everyday tasks such as lifting, squatting, climbing stairs, or caring for your children to reduce unnecessary stress on the pelvis.

Pregnancy and Postpartum Support

For women experiencing pregnancy-related pelvic girdle pain, physiotherapists can provide safe exercises, activity modification strategies, and, where appropriate, recommend pelvic support belts to improve comfort during daily activities.

Can SIJ Dysfunction Be Prevented?

While not every case can be prevented, maintaining good strength around the hips, core, and pelvis can reduce stress on the SI joints.

Helpful habits include:

Regular strengthening exercise
Gradually increasing activity levels
Avoiding sudden increases in training load
Taking regular movement breaks from prolonged sitting
Building good lifting mechanics
Maintaining hip flexibility

When Should You See a Physiotherapist?

Consider booking an assessment if your pain:

Persists for more than a few weeks
Limits your walking or exercise
Interferes with work or sleep
Developed during or after pregnancy
Keeps returning despite rest

Early assessment often leads to quicker recovery and helps prevent persistent pain.

The Bottom Line

Although SIJ dysfunction can be frustrating, it is highly manageable with the right treatment. An accurate assessment, education, and a tailored strengthening program are key to reducing pain and restoring confidence in movement.

At our clinic, we take an evidence-based approach to assessing and treating SIJ dysfunction. Every treatment plan is personalised to your goals, whether that's returning to exercise, caring for your family, or simply moving comfortably again.

If you're experiencing persistent pelvic or buttock pain, we'd be happy to help you get back to doing what you love.

About the Author

Aditi Dand, Physiotherapist

Aditi Dand is a Physiotherapist and Clinical Pilates Instructor with a Masters of Physiotherapy from the University of Sydney. She specialises in musculoskeletal physiotherapy, Clinical Pilates and chronic pain management, with a particular passion for helping people build strength, confidence and independence in their recovery. Aditi is also a certified PINC Cancer Rehabilitation Specialist