If you’ve ever felt a sharp, localized ache right in the dimple of your lower back—or a deep pain in your buttock when you stand up from a chair—you’ve likely suspected your sacroiliac joint (SIJ).
The SIJ sits at a critical load bearing part of your body, connecting the base of your spine (sacrum) to your hip bones (ilium). Because it takes the brunt of the weight transfer between your upper and lower body, it is a frequent source of load and can be a very frustrating pain to understand and fix.
Unfortunately, it is also a region plagued by bad advice and diagnostic myths. At Active Physiotherapy, we take a unique and highly skilled approach to fixing it. Here is how we look at SIJ pain at our Newtown and Darlinghurst clinics, and what it actually takes to fix it for good.
Myth Buster: Your Joint is Not “Out”
The most common phrase we hear from patients is, “My SI joint is out.” They’ve likely been told this by a practitioner who has then tried to crack their back to “make it go back in”.
Let’s clear this up right away: your SIJ is incredibly robust, bound together by some of the strongest ligaments in the human body. Short of a massive, high-impact traumatic force (like a severe car accident or a fall from a height), the joint does not dislocate or “slip out.” In fact most of the times the pelvis will fracture before this.
When people feel like it’s “out,” what they are actually experiencing is either a joint that has moved into a non-optimal, fixated (locked) position, or a brain that has gone into an intense “protective clench,” tightening the surrounding global muscles to guard the area. This strong clenching can rotate the pelvis and this is what people perceive to be “wrong”.
Step 1: Finding the Real Driver (Weeks 1–2)
If you’ve tried physio/chiro/osteo before and only received temporary relief from dry needling, massage or cracking it’s usually because the treatment was chasing symptoms.
When you come into our clinic, we don’t just poke where it hurts. We put you through a unique, robust battery of specific pelvis tests and also functional movement tests to look at the lumbo-pelvic-hip complex as a whole. We will also look above and below the pelvis/SIJ region to see what the relationship is like between the pelvis and other regions of the body.
Why? Because the hidden driver of your SIJ pain might not even be the SIJ itself. It could be:
- A locked SIJ that has lost its optimal mechanics.
- A hip issue (like a lack of deep rotation or an anterior femoral head overload).
- Stiffness all the way up in your thorax (mid-back) forcing your pelvis to over-rotate during movement.
The Fast-Track Fix: Once we locate the driver, we use specialized manual therapy techniques that are part of our clinical IP. By normalising the pelvis mechanics and using soothing soft tissue techniques to turn off the brain’s protective gripping, most patients experience a significant drop in pain within just 1 to 3 sessions.
Step 2: Rebuilding from the Inside Out (Weeks 3–6+)
Once the joint is moving optimally and the pain has quieted down, we have to teach your body how to keep it there. The SIJ relies heavily on “dynamic stability”—meaning your muscles have to create pelvis stability when you move.
We build this from the inside out, targeting the deep stabilizers:
- Transversus Abdominis (your deep lower abs)
- Multifidus (the deep muscles along your spine)
- Gluteus Medius (your side hip stabilizers)
- The Pelvic Floor
Once we have your deeper core muscles firing correctly, we will look to increase loads and use some of the other bigger muscles across your lumbo-pelvic-hip region. We will begin to include some functional tasks like squats into your program and begin increasing loads as we see you can tolerate things. Once the pain has nearly gone, we will aim to return you to the things you love. It might be a 5km run, a bike ride or a hike. We will work to target your goals and get you back to doing the things you love ASAP.
The Common “Core” Mistake
When trying to activate their core, many people make the mistake of “bearing down” with their diaphragm and external obliques—essentially sucking their stomach in aggressively or bracing so hard they stop breathing. This actually skyrockets pressure inside the abdomen and can increase your pain. We teach you how to precisely isolate the deep muscles without the unnecessary clenching. To do this, we use our real time ultrasound guided imaging in our clinic to ensure you’re using exactly the right muscles when you activate your core.
Navigating the Road to Recovery
How long does a full fix take? It heavily depends on how long your body has been compensating.
| Scenario | Estimated Timeline | What to Expect |
| Acute Overload (e.g., a recent gym or sporting injury) | ~4 Weeks | Quick restoration of mechanics, fast strength adaptation. |
| Chronic Issue (e.g., a 2-year history of undiagnosed pelvic rotation) | 8+ Weeks | Longer timeline to break old brain habits, re-train deep stabilizers, and rebuild lost muscle mass. |
Daily Habits to Pause
While you are in the middle of re-training your pelvis, your daily life can throw some roadblocks your way. To avoid irritating the joint while it’s settling, temporarily try to minimize:
- Long-haul flying or prolonged driving.
- Sitting in poor, unsupportive seating especially very soft or deep sofas.
- Standing with all your weight constantly shifted onto one hip.
Step 3: Graduation
We don’t believe in keeping you on a lifelong maintenance schedule. We want you fully discharged, happy, and back to the activities you love—whether that’s running, heavy lifting, or chasing the kids. Once you’ve returned to the things you love doing and your SIJ/pelvis region is moving normally, we’ll discharge you back to normal life! Yay!