Sports Injury Treatment - Spokane, WA
Reviewed By: Stephen Byers, DC CSCS
SI JOINT PAIN--AND WHAT ACTUALLY FIXES IT
Sacroiliac (SI) joint pain is one of the most commonly misdiagnosed lower-body complaints we treat at the Movement Clinic. Most of the time it isn't from the low back itself — it's from the pelvis being driven into a compressed position under load. Once we figure out what's actually happening, the pain usually responds quickly.
First--Is It Actually SI Joint Pain?
Many patients come in thinking they have sciatica when they actually have SI joint pain. The two get confused constantly, but they're distinct conditions with different causes and different treatments. Here's the quick way to tell:
SCIATICA
Sciatica is pain that travels down the back of the thigh and into the leg, sometimes into the foot. It's often accompanied by numbness, tingling, or weakness somewhere along the path of the nerve.
SI JOINT PAIN
SI joint pain stays in the gluteal region itself. Usually one side, often described as a deep ache or a sharp catch in one cheek, without the down-the-leg traveling pain.
If your pain stays at or above the gluteal fold, what you have is much more likely to be SI joint pain. Our Movement Assessment can quickly distinguish between the two and identify the right treatment plan for either.
Does This Sound Familiar?
Pain that follows you in and out of the gym
"I get a sharp catch in one buttock that won't let go."
"My low back hurts every time I squat heavy."
"It hurts to get out of the car or roll over in bed."
"I feel a deep ache in my glute when I sit too long."
"It started after a hard lifting session."
"I've stretched my hip flexors and rolled my glutes — nothing sticks"
Why It Happens
Two patterns we see in almost every patient with SI joint pain
SPINE HYPEREXTENSION
Most acute SI joint flare-ups come from the same setup: the pelvis tips forward (anterior pelvic tilt), the lumbar spine sways backward into extension, and then you add load. The pelvis gets driven forward into the sacrum, and the joint surfaces compress against each other. The result is an immediate, sharp catch in one side of the gluteal region.
This pattern shows up in predictable places — most often at the gym and on the field. Lifters who set up to squat with excessive sway in their lower back are doing it. Football linemen who fire out of their stance to block from the same position are doing it. Gymnasts who initiate a back walkover from the same setup are doing it. In each case, the athlete is loading a hyperextended pelvis, and the SI joint and other joints of the lower spine are what breaks down.
ANTERIOR TILTED PELVIS
The second pattern is the same problem, just sustained instead of acute. When the pelvis is chronically tilted forward — common in anyone who sits all day, has tight hip flexors, or has weak glutes — the SI joint sits in a compressed, loaded position 24/7. The joint surfaces don't compress as forcefully as they do under a heavy squat, but the load is constant. Add any activity on top of that (walking, lifting, standing, even prolonged sitting) and the joint stays irritated.
Both patterns share an end state: the pelvis tipped forward, the spine swayed backward, and the SI joint compressed in a position it wasn't built to tolerate for long. That's why most "stretch your low back" or "rest it out" advice doesn't fix it — you have to address the pelvic position and the muscles driving it.
The two patterns can also occur together, which is why our Movement Assessment looks at both the spine and the pelvis before we build a treatment plan.
What's Driving It
The physical reasons these patterns develop
SI joint pain doesn't happen in isolation. It's usually the body's way of working around a limitation. When we evaluate patients with SI joint pain, we commonly find one or more of these:
ANTERIOR PELVIC TILT
The upstream cause of most chronic SI joint pain. When the pelvis is tilted forward, the joint is preloaded into compression before you do anything. Every step, lift, or position adds to it.
TIGHT HIP FLEXORS
The psoas and rectus femoris attach to the front of the pelvis. When they're chronically short — usually from prolonged sitting — they pull the pelvis forward and down, locking it into anterior tilt.
WEAK GLUTES
​Strong glutes hold the pelvis in a neutral position. When they're underactive, the pelvis is free to tip forward and the SI joint never gets a chance to unload.
POOR CORE CONTROL
The core's job isn't just to crunch — it's to control extension under load. When the deep core (transverse abdominis, internal obliques) isn't doing that job, the lumbar spine sways under any load and the SI joint takes the hit.
POOR LIFTING AND ATHLETIC SETUP
Specifically, allowing the lower back to arch and the pelvis to tip forward at the bottom of a squat, deadlift, or any athletic stance. Most lifters and athletes were never taught what neutral pelvis looks like or how to maintain it under load.
POOR RECOVERY BETWEEN SESSIONS
Small irritations accumulate. Without consistent recovery work between training, work, or daily life, stiff joints and tight muscles compound — turning a manageable issue into one that won't resolve on its own.
Our Approach
How we evaluate SI joint pain at the Movement Clinic
Most SI joint treatment starts with the symptom — ice, rest, anti-inflammatories, sometimes a steroid injection. We start with the movement, because that's where the answer usually is.
01
FULL MOVEMENT ASSESSMENT
We assess basic mobility, stability, and movement patterns across your whole body — not just your pelvis. This reveals any physical limitations contributing to the problem, and it's where we distinguish SI joint pain from sciatica, hip pain, and other potential drivers.
02
ACTIVITY-SPECIFIC BIOMECHANICAL TESTING
We test pelvic position, hip flexor length, glute activation, core control, and how your body handles loaded extension. SI joint pain rarely lives in the joint alone — we look up and down the chain to find the real driver.
03
SPORTS CHIROPRACTIC CARE
Targeted adjustments restore motion to stiff joints in the pelvis, lumbar spine, and hips. Soft-tissue treatments release the tight hip flexors and lumbar musculature that are pulling the pelvis into anterior tilt.
04
ACTIVITY-SPECIFIC REHABILITATION
We use exercises to lengthen the hip flexors, wake up the glutes, retrain a neutral pelvic position, and build the anti-extension core control needed to keep the SI joint protected under load. The goal isn't just to feel better — it's to fix the pattern that caused the problem.
05
RETURN TO ACTIVITY PLANNING
We work with you on lifting technique, athletic setup, desk ergonomics, and warm-up routines so you can train, work, and live without ending up in the same compromised position. The goal is to keep you moving — not just rehab you out of the pain.
Every plan starts with a Movement Assessment.
Common Question
Should you stop training or working if you have SI joint pain?
Some initial rest can be helpful during an acute flare-up, but long-term avoidance is rarely the solution. Pain is a signal that something needs to change — usually how you're setting up under load — not necessarily that training needs to stop. With the right plan, most patients are able to keep training while they recover.
What we want to understand is why it's happening. Once that's clear, we can usually modify your lifting setup, your exercise selection (swap heavy back squats for front squats or split-stance work, modify deadlifts), your volume, and your training program — and the pain starts to improve without giving up the gym entirely.
Pain lasting more than 1–2 weeks, recurring flare-ups, sharp catches that interrupt daily life, or pain that wakes you up at night are all signs that it's worth getting assessed sooner rather than later. SI joint pain responds well when it's caught early and gets harder to resolve the longer you push through it.
What to Expect
Realistic recovery timelines
Every athlete is different, but here's what we typically see based on the nature of the issue.
6-8 VISITS
Acute Flare-up
Recent onset, first-time issue. Fast response with the right treatment and activity modification
4-8 WEEKS
Persistent or Recurring Pain
Pain that has been present for weeks or months, or keeps coming back. Requires addressing the underlying movement dysfunctions.
8-16 WEEKS
Performance Rebuild
Full recovery requires building the necessary mobility, strength and movement mechanics needed to stay pain-free for the long term.
Frequently Asked Questions
Questions patients ask us about SI joint pain
Q: Can a chiropractor actually help with SI joint pain?
A: Yes — particularly when the care is movement-based rather than just adjustment-focused. Chiropractic care that combines adjustments with targeted mobility and strength work addresses both the pain and the underlying pattern driving it. Most patients see meaningful improvement within a few weeks.
Q: Do I need imaging before coming in?
A: No. In most cases of SI joint pain, imaging isn't the first step. Our movement assessment gives us the information we need to get started. If imaging becomes relevant, we'll let you know and we can help refer you for it.
Q: How do I know if it's sciatica or SI joint pain?
A: The quickest tell is where the pain goes. Sciatica travels — down the back of the thigh, into the leg, sometimes into the foot. It often comes with numbness or tingling. SI joint pain stays in the buttock and doesn't travel below the gluteal fold. Our Movement Assessment will confirm which one is driving your symptoms (and many patients have some of both).
Q: Will an SI joint belt fix it?
A: An SI joint belt can provide short-term relief during an acute flare-up by compressing the joint and reducing irritation. It's useful as a bridge during recovery — especially for patients who have to keep working or training through pain. But a belt doesn't change the underlying pattern that caused the problem. We use belts tactically while we address the real driver: the anterior pelvic tilt and the muscle imbalances behind it.
Q: Should I keep stretching my low back?
A: Usually not the way most people are doing it. When the SI joint is irritated by anterior pelvic tilt, stretching the low back into more extension can actually aggravate the problem rather than help. We typically have patients pause low-back stretching during recovery and focus on hip flexor lengthening, glute activation, and core control instead.
Q: How is this different from seeing a regular chiropractor or physical therapist?
A: Our team specializes in working with athletes and active individuals. We assess movement patterns, understand the demands of lifting, rotation, and sustained postures, and build treatment plans that include targeted exercise and adjustments. We're focused on solving the underlying problem and getting you back to doing what you love.