Sacroiliac joint dysfunction can cause lower back, buttock, hip, groin, thigh, or pelvic-region pain that may be mistaken for sciatica, herniated disc pain, hip pain, or pelvic pain. MPM provides diagnosis-first evaluation to determine whether the SI joint is the primary pain generator or part of a broader spine, pelvis, hip, inflammatory, or hypermobility-related pattern.
This video explains how sacroiliac joint dysfunction can mimic spine, hip, and pelvic pain, and how careful evaluation guides treatment planning.
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Hi, I’m Dr. Jason Siefferman, medical director at Manhattan Pain Medicine. When we think about sacroiliac joint dysfunction, we really want to understand the mechanics of what’s going on.
The sacroiliac joint is at the posterior pelvic ring on either side and our bodies will use the SI joint to balance out the pelvic ring for anything that happens in the lower extremities that needs to be corrected for. As a result, the sacroiliac joint is often overused and from that overuse, it may be a source of pain.
Secondarily, for those with hypermobility spectrum disorders or primary sprains of that joint, there may be other pains that are actually downstream from the sacroiliac joint being hypermobile. In either of these situations, there’s a mechanical process that’s leading to pain. There’s often a chicken or egg effect, some compensatory biomechanical activity one way or another, either directed towards it or reacting from it.
We have to tie together the cascade of events and we have to choose a point of intervention that will help bring stability and interrupt that pain-driving cycle. It’s not as easy as just putting a steroid in the joint.
When a patient comes to us with sacroiliac joint dysfunction, we want to know: is there a mechanical problem driving the SI joint to be overused? Is there a prior trauma or hypermobility that led to hypermobility of the sacroiliac joint? Is there a primary inflammatory process like ankylosing spondylitis affecting the sacroiliac joint that needs to be diagnosed and treated?
Know that if you come to us with low back pain in general, we’re aware of all of these possibilities.
We dive deep to understand it, because if we don’t really understand what’s happening and why it’s happening, we’re not going to be able to provide a treatment path that will actually result in durable relief. If you have any low back pain at all, know that we’re aware of all the complexities that surround the sacroiliac joint and all the mimickers of sacroiliac joint pain. So, we can help you figure out what’s going on and get to the root cause.
The sacroiliac joints connect the sacrum at the base of the spine to the pelvic bones. These joints help transfer force between the upper body, pelvis, and legs. When the sacroiliac joint becomes irritated, inflamed, unstable, or mechanically overloaded, it can cause pain in the lower back, buttock, hip, groin, thigh, or pelvic region.
Sacroiliac joint dysfunction is often missed because it can resemble sciatica, herniated disc pain, lumbar facet pain, hip impingement, pelvic floor pain, sacroiliitis, or general low back pain. Some patients have normal or mild spine imaging but continue to experience significant pain with sitting, standing, stairs, walking, rolling in bed, or changing positions.
For patients looking for sacroiliac joint dysfunction treatment in Manhattan or NYC, MPM focuses on identifying whether the SI joint is truly the pain source, whether hypermobility or instability is contributing, whether inflammatory sacroiliitis may be present, and whether other spine, hip, pelvic, or nerve-related conditions are involved.
At Manhattan Pain Medicine (MPM), evaluation begins with a detailed review of the pain location, movement triggers, injury history, pregnancy or postpartum history when relevant, hypermobility features, inflammatory symptoms, imaging, prior treatments, and functional limitations.
MPM evaluates whether symptoms may be driven by mechanical SI joint dysfunction, SI joint instability, inflammatory sacroiliitis, lumbar radiculopathy, herniated disc pain, spinal stenosis, hip pathology, pelvic floor dysfunction, anterior pelvic tilt, hypermobility spectrum disorder, Ehlers-Danlos syndrome, autoimmune-related pain, or another pain generator. Treatment may include conservative care coordination, diagnostic ultrasound when appropriate, ultrasound-guided injections, sacroiliac joint injection, steroid injections, prolotherapy, PRP, regenerative options, medication management, Feldenkrais, acupuncture, or referral for rheumatology, spine, orthopedic, pelvic, or surgical evaluation when needed.
SI joint pain can appear in areas that overlap with many other conditions. Some patients feel pain on one side of the lower back near the pelvis. Others feel pain in the buttock, outer hip, groin, thigh, or pelvic region. In some cases, symptoms can feel similar to sciatica, even when the lumbar spine is not the main source.
The SI joint can be painful because of mechanical irritation, ligament laxity, altered pelvic mechanics, pregnancy-related changes, trauma, repetitive load, inflammatory arthritis, sacroiliitis, or hypermobility-related instability. It can also coexist with hip pain, spine pain, pelvic floor dysfunction, anterior pelvic tilt, or chronic pain sensitization.
MPM’s diagnosis-first approach is designed to avoid treating SI joint dysfunction as a catch-all explanation. The goal is to determine whether the SI joint is the main pain generator, a secondary contributor, or one part of a more complex pain pattern.
Sacroiliac joint dysfunction fits within MPM’s Musculoskeletal issues Zone of Expertise, with important overlap in Hypermobility and Pelvic Pain. The SI joint sits at the intersection of the spine, pelvis, hips, and lower extremities, which means instability or irritation in this region can affect movement, sitting tolerance, walking, and pelvic-region symptoms.
In patients with EDS or hypermobility spectrum disorder, ligament laxity and altered muscle control may increase load through the SI joint. Muscles around the pelvis, hips, and lower back may guard or tighten to create stability, which can contribute to secondary muscle pain or trigger points.
In patients with pelvic pain, SI joint dysfunction may overlap with pelvic floor dysfunction, hip mechanics, pudendal nerve symptoms, anterior pelvic tilt, or chronic pelvic pain. MPM evaluates these relationships carefully so treatment can target the right pain generator.
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
The best care I've received as a chronic pain patient. I traveled from out of state to visit Manhattan Pain Medicine because I could not find knowledgeable doctors in my hometown for my hypermobility, and Ehlers-Danlos syndrome symptoms and comorbidities. Let me tell you, it was worth every travel e...
I was injured in a bicycle accident over 8 years ago. I’ve suffered throughout the years since my accident with nothing seeming to work. PT, Yoga, lifestyle changes, NOTHNG! I finally made an appointment with Dr Kane and I’m feeling an improvement in my life. I no longer stay up all night in pain, a...
One of the best experiences, if not the best, I have ever had at the doctor’s office. From the front desk to the nurses to the PA assisting the doctor this was a great experience. Dr.Nino actually listened to me and came up with a game plan. Would recommend this practice to as many people as I could...
I have very unique & severe nerve pain from CRPS which has no known specific cure. Dr. Siefferman has a huge tool box, far greater than the other 23 Drs. I have seen. He saved me from jumping off a bridge and continues to help me with both treatments and advice. Dr. S. is in a different league!
After two years of searching and feeling lost and let down, I finally found real help at Manhattan Pain Medicine. With Dr. Siefferman, Adam Rosenberg, Dr. Mikaberidze, and the whole team, I feel heard, supported and understood. Every symptom is being considered and I’m finally getting answers with m...
Why is Dr Dr. Tayyaba Ahmed one of the top pevic Floor specialists - 1- She wants to know a full history of what led the patient to get to this point. 2 - She listens intensley to the patient 3- She does not rush you 4- Extremely skilled at giving pelvic floor injections 5- I thank my luck stars she...
The staff was friendly and helpful. Dr. Siefferman was thoughtful, listened, asked questions and proposed simple safe ways to come to further conclusions regarding my pain and discomfort. The office staff including Dr. Siefferman is responsive even after the initial in-person visit. Very pleased.
Dr. Siefferman is a brilliant provider. While my pain is still a work in progress, Dr Siefferman always gives me options and explains his reasoning behind things. He listens to my feedback and concerns. I never feel rushed; and am grateful he works to meet me where I am. I highly recommend him.
What a great find! They listen to me, I listen to them and the diagnosis is made and a plan developed to develop an approach to treat all of my chronic pain. I wish I could have discovered this type of treatment sooner. This doctor and group give me hope.
Sacroiliac joint dysfunction occurs when one or both SI joints become painful because of irritation, inflammation, instability, altered mechanics, or abnormal loading. The SI joints connect the sacrum at the base of the spine to the pelvic bones. When the joint is not moving or loading well, it may cause lower back, buttock, hip, groin, thigh, or pelvic-region pain.
SI joint pain often feels like aching, sharp, or deep pain near one side of the lower back or pelvis. It may spread into the buttock, outer hip, groin, thigh, or pelvic region. Pain may worsen with prolonged sitting, standing, walking, stairs, rolling in bed, getting in and out of a car, or standing on one leg.
The sacroiliac joint is located where the sacrum, the triangular bone at the base of the spine, meets the iliac bones of the pelvis. There is one SI joint on each side. Pain is often felt low in the back, near the dimples of the pelvis, but it can refer into the buttock, hip, groin, thigh, or pelvic area.
Yes. SI joint pain can sometimes feel like sciatica because it may radiate into the buttock, hip, or thigh. However, true sciatica often involves irritation of a spinal nerve root, commonly from a herniated disc, spinal stenosis, or another spine condition. MPM evaluates the spine, SI joint, hip, pelvis, and neurologic findings to determine the most likely source.
Yes. The SI joint is closely connected to the pelvis and hip region, so SI joint dysfunction may refer pain into the hip, groin, thigh, or pelvic area. Similar symptoms can also come from hip impingement, labral tears, pelvic floor dysfunction, pudendal neuralgia, abdominal wall pain, or lumbar spine conditions, so careful evaluation is important.
SI joint dysfunction can be caused by trauma, repetitive load, pregnancy-related pelvic changes, altered gait, leg length differences, hip or spine mechanics, ligament laxity, hypermobility, EDS, inflammatory arthritis, sacroiliitis, or muscle guarding around the pelvis. Sometimes it develops after another pain condition changes the way a patient moves or loads the pelvis.
Hypermobility and EDS can contribute to SI joint instability in some patients because connective tissue laxity may reduce passive joint support. When the SI joint feels unstable, surrounding muscles may tighten or guard to compensate. This can create pain in the lower back, pelvis, hips, buttocks, or thighs. MPM evaluates hypermobility as one possible contributor, not as an automatic explanation for every SI joint symptom.
SI joint dysfunction often refers to mechanical pain from abnormal loading, irritation, or instability of the sacroiliac joint. Sacroiliitis refers to inflammation of the SI joint, which may occur with inflammatory conditions such as axial spondyloarthritis or other autoimmune-related patterns. The distinction matters because inflammatory SI joint pain may require rheumatology coordination and different treatment planning.
Diagnosis usually involves a detailed history, physical exam, pain location review, movement testing, SI joint provocation tests, spine and hip evaluation, imaging review, and consideration of inflammatory or hypermobility-related contributors. In selected cases, an image-guided SI joint injection may help confirm whether the SI joint is the source of pain.
Yes, in selected patients. A diagnostic SI joint injection may help determine whether the SI joint is contributing to pain. If a patient experiences meaningful temporary improvement after anesthetic is placed in or around the suspected pain source, that response may support the diagnosis. The injection result must still be interpreted in the context of the full clinical picture.
Treatment depends on the cause. Options may include activity modification, pelvic stabilization, physical therapy coordination, Feldenkrais, acupuncture, medication management, image-guided SI joint injections, steroid injections, prolotherapy, PRP, regenerative options, or referral for inflammatory, orthopedic, spine, pelvic, or surgical evaluation when appropriate. Treatment should be individualized based on the pain generator and patient goals.
SI joint-like pain should be evaluated urgently when it is associated with fever, unexplained weight loss, history of cancer, major trauma, new weakness, progressive numbness, bowel or bladder dysfunction, saddle anesthesia, inability to bear weight, severe night pain, a hot swollen joint, eye pain or vision changes, chest pain, shortness of breath, or rapidly worsening symptoms.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
If lower back, buttock, hip, groin, thigh, or pelvic-region pain is interfering with sitting, standing, walking, stairs, sleep, or daily activity, MPM can help evaluate what may be contributing. Our diagnosis-first approach considers sacroiliac joint dysfunction, SI joint instability, sacroiliitis, sciatica, herniated disc pain, hip pathology, anterior pelvic tilt, pelvic pain, hypermobility, EDS, and inflammatory spine conditions. Request an appointment to discuss your symptoms and care options.
The sacroiliac joints are located at the back of the pelvis, where the sacrum meets the iliac bones. These joints are small, but they play an important role in transferring force between the spine, pelvis, and legs. Because the SI joints sit at the intersection of the lower back, hips, and pelvis, pain from this area can be difficult to identify.
Sacroiliac joint dysfunction can occur when the joint becomes irritated, inflamed, unstable, stiff, or overloaded. Some patients feel pain directly over one side of the lower back near the pelvis. Others feel pain in the buttock, hip, groin, thigh, or pelvic region. Symptoms may worsen with sitting, standing, walking, stairs, bending, rolling in bed, or transitioning from sitting to standing.
SI joint pain is often confused with lumbar spine pain, sciatica, herniated disc pain, hip pain, muscle strain, or pelvic pain. This is because the pain patterns overlap. A patient may feel lower back and buttock pain and assume the problem is a disc. Another patient may feel hip or groin pain and assume the problem is inside the hip joint. Others may experience pelvic-region pain and be evaluated through gynecology, urology, GI, or pelvic floor therapy before the SI joint is considered.
MPM evaluates the full pain pattern instead of relying on one symptom or one imaging finding. The goal is to determine whether the SI joint is the main pain generator, whether another condition is responsible, or whether multiple sources are interacting.
Sciatica usually refers to radiating leg pain caused by irritation of a nerve pathway, often from the lumbar spine. A herniated disc, spinal stenosis, or nerve root irritation may cause burning pain, numbness, tingling, weakness, or pain that travels below the knee.
SI joint pain can sometimes mimic sciatica, but it more commonly refers pain into the buttock, hip, groin, or thigh. It may not follow a classic nerve root pattern. However, the distinction is not always clear from symptoms alone. MPM evaluates neurologic findings, spine imaging, hip mechanics, SI joint provocation tests, and the patient’s functional pattern before selecting treatment.
Hip and SI joint pain can overlap. Hip impingement, labral tears, arthritis, tendon pain, and pelvic mechanics can all create pain near the groin, outer hip, buttock, or thigh. SI joint dysfunction can also refer pain into these areas.
This overlap is one reason diagnosis-first care matters. Treating the hip when the SI joint is the primary driver may not help. Treating the SI joint when hip pathology is the main issue may also miss the source. MPM evaluates both regions when symptoms suggest a hip and pelvis connection.
The SI joint is part of the pelvic ring. When it is irritated or unstable, it can contribute to pelvic-region pain, buttock pain, groin discomfort, or pain that worsens with sitting, standing, walking, or load transfer. In some patients, SI joint dysfunction may coexist with pelvic floor dysfunction, pudendal neuralgia, anterior pelvic tilt, hip impingement, abdominal wall pain, or chronic pelvic pain.
For patients with complex pelvic symptoms, MPM considers whether the SI joint is a primary driver, a secondary contributor, or part of a broader pelvic pain pattern. This helps guide coordinated care with pelvic floor therapy, gynecology, urology, GI, orthopedics, rheumatology, or other specialists when needed.
In patients with hypermobility spectrum disorder or Ehlers-Danlos syndrome, ligament laxity can affect joint stability. The SI joint may become painful when passive support is reduced and surrounding muscles must work harder to stabilize the pelvis. This may create pain, muscle guarding, tightness, recurrent flares, or a feeling that the pelvis is unstable.
Hypermobility-related SI joint pain requires careful treatment selection. Aggressive stretching or manipulation may not be appropriate for every patient. Stabilization, joint protection, movement retraining, and selective procedures may be considered depending on the patient’s pattern and goals.
Not all SI joint pain is mechanical. Inflammatory sacroiliitis can occur with autoimmune or inflammatory conditions, including seronegative spondyloarthropathy and related inflammatory spine disorders. Patients may report morning stiffness, pain that improves with movement, pain that worsens with rest, alternating buttock pain, fatigue, tendon pain, heel pain, psoriasis, bowel symptoms, or eye inflammation.
These features do not diagnose inflammatory disease by themselves, but they are important clues. MPM evaluates inflammatory pain patterns and coordinates with rheumatology when DMARDs, biologics, infusions, or other immune-directed treatments may be appropriate.
MPM begins with a detailed history of pain location, triggers, duration, injury history, pregnancy or postpartum factors when relevant, hypermobility, inflammatory symptoms, prior imaging, prior injections, and response to physical therapy or medication.
The physical exam may include SI joint provocation tests, lumbar spine evaluation, hip assessment, neurologic screening, gait or movement review, and assessment of pelvic mechanics. Imaging may be reviewed to evaluate the spine, hips, SI joints, and inflammatory or structural findings. In selected cases, an image-guided SI joint injection may help confirm whether the SI joint is a meaningful pain source.
Treatment depends on the underlying driver. Mechanical SI joint dysfunction may respond to stabilization-focused rehabilitation, activity modification, medication management when appropriate, pelvic mechanics work, bracing in selected cases, acupuncture, or Feldenkrais.
When pain persists or the diagnosis remains unclear, image-guided SI joint injections may be considered. Steroid injections may be used when inflammation is suspected and clinically appropriate. Prolotherapy, PRP, or other regenerative options may be considered for selected patients with instability or soft tissue-related pain patterns, but they are not automatic treatments and should not be presented as guaranteed solutions.
For patients with inflammatory sacroiliitis, care may require rheumatology coordination and disease-directed treatment. For patients with severe instability or persistent symptoms despite appropriate care, SI joint fixation or fusion may be considered only after careful specialist evaluation.
SI joint fixation or fusion is not first-line treatment for most patients. It may be considered when a patient has persistent, function-limiting SI joint pain, a confirmed SI joint pain generator, failure of appropriate conservative and interventional care, and structural findings that support surgical evaluation.
MPM does not treat SI joint fusion as a routine solution. When advanced structural intervention may be appropriate, care should be coordinated with the right orthopedic, spine, or surgical specialist.
SI joint-like symptoms can overlap with herniated disc, sciatica, spinal stenosis, hip disease, pelvic floor dysfunction, inflammatory arthritis, sacroiliitis, infection, fracture, malignancy, vascular disease, pregnancy-related pelvic pain, and central pain syndromes.
This is why MPM avoids assuming that all lower back, buttock, groin, hip, pelvic, or leg pain comes from the SI joint. A diagnosis-first evaluation helps protect patients from unnecessary procedures and helps direct care toward the most likely source.
Patients should seek urgent evaluation for lower back, pelvic, hip, or SI joint-like pain associated with fever, unexplained weight loss, history of cancer, major trauma, new weakness, progressive numbness, bowel or bladder dysfunction, saddle anesthesia, inability to bear weight, severe night pain, hot swollen joint, eye pain or vision changes, chest pain, shortness of breath, or rapidly worsening symptoms.
These signs may point to a more serious spine, neurologic, infectious, inflammatory, vascular, or systemic condition that should not be treated as routine SI joint dysfunction.
MPM approaches sacroiliac joint dysfunction through a diagnosis-first model. The goal is to identify whether pain is coming from the SI joint, lumbar spine, hip, pelvis, inflammatory disease, hypermobility-related instability, or another overlapping contributor.
For patients looking for sacroiliac joint dysfunction treatment in Manhattan or NYC, MPM provides coordinated evaluation for SI joint pain, lower back pain, pelvic pain, hip-region pain, sciatica-like symptoms, hypermobility-related instability, and inflammatory SI joint pain. The goal is to clarify the source of symptoms and guide a treatment plan that is precise, safe, and function-focused.
