Sacroiliac joint (SIJ) dysfunction is controversial territory. Chiropractors frequently diagnose it; orthopaedic surgeons often don't.
The truth is somewhere between: genuine SIJ dysfunction exists, accounts for perhaps 15–25% of chronic low back and buttock pain, but is over-diagnosed by clinicians using it as a catch-all and under-diagnosed by clinicians who dismiss it.
Getting the diagnosis correct matters because the treatment is distinct from lumbar spine treatment.
Here's how we actually identify it and treat it in Johor.
How SIJ pain presents
Typical pattern:
- Pain located below the level of L5 - the classic zone is a band across the lower back into the buttock and sometimes into the back of the upper thigh.
- One-sided, not both sides together.
- Worse with certain movements - sit-to-stand, getting out of a car, turning in bed, going up or down stairs.
- Often triggered by a specific event - a fall on one buttock, pregnancy, a twisting lift.
- Frequently co-exists with lumbar or hip issues, so the diagnosis is rarely pure.
Distinguishing from lumbar and hip
This is the crucial piece.
Three joint systems can all produce buttock pain: the lumbar spine, the SIJ, and the hip joint.
Each requires specific tests.
Evidence-based SIJ provocation tests (Laslett's cluster): compression, distraction, thigh thrust, Gaenslen's, sacral thrust.
Three or more positive strongly suggests SIJ pain. Fewer than three, the SIJ is probably not the primary source.
Lumbar spine screening: pain provoked by spinal extension, lumbar movements reproducing symptoms, dermatomal pattern, straight-leg raise positive - points to lumbar source.
Hip joint screening: pain with FABER (flexion-abduction-external-rotation), FADIR (flexion-adduction-internal-rotation), or deep hip flexion - points to hip source.
A 15-minute systematic exam usually sorts this out.
A diagnosis made on "the SIJ felt tight when I pressed on it" alone isn't reliable.
The three SIJ subtypes
Hypomobile SIJ - the joint is stiff, typically in a specific direction (nutation or counter-nutation). Often responds to mobilisation and targeted exercise.
Hypermobile SIJ - the joint has too much motion, often in pregnancy-related SIJ dysfunction or in patients with generalised ligament laxity. Needs stabilisation, not stretching.
Arthritic SIJ - in older patients, degenerative changes; distinct from inflammatory SIJ disease (sacroiliitis) which is part of axial spondyloarthritis.
The treatment for each is different. Mixing hypermobile-suitable exercise into a hypomobile patient is ineffective and vice versa.
The 8-week programme
Weeks 1–2: pain control and specific re-education
- Sacroiliac belt (for hypermobile types) - an elastic belt worn at the level of the SIJ, reduces pain by 40–60% in carefully-selected cases.
- Manual therapy - specific SIJ mobilisation for hypomobile, muscle energy techniques, or positional release.
- Avoidance of provoking activities temporarily.
Weeks 3–5: stabilisation
- Deep abdominal (transversus abdominis) activation.
- Deep multifidus (back stabiliser) work.
- Pelvic floor coordination - specifically for SIJ stability.
- Glute medius strengthening - the big muscle that stabilises the pelvis laterally.
- Obliques and lateral chain work.
Weeks 6–8: integration
- Loaded patterns: squats, deadlifts, lunges, single-leg work.
- Return to running, sport, or activity with progressive loading.
- Gradual discontinuation of the belt if used.
When injections help
If conservative care fails or the diagnosis is uncertain, an image-guided SIJ injection (done by a pain specialist or interventional radiologist) serves two purposes: diagnostic (does the pain disappear when the joint is anaesthetised?) and therapeutic (steroid reduces inflammation).
Available at several Johor private hospitals.
When surgery is considered
SIJ fusion is a last-resort option for a small subset of patients who fail everything else.
Most patients don't need it.
Pregnancy-related SIJ pain
Pregnancy produces ligament laxity via relaxin, and weight gain + changing biomechanics load the SIJ more. SIJ pain in the second and third trimester is common.
Treatment focuses on stabilisation and support - a pregnancy-specific support belt, adapted strengthening, and postural education.
Most cases resolve in the months following delivery, though women with persistent postpartum pelvic girdle pain benefit from targeted rehab.
Typical Johor costs
- Physio course: 8–12 sessions at RM120-250.
- SIJ belt: RM 60–150 depending on quality.
- SIJ injection (private): RM 1,200–2,500 per injection.
How PhysioJohor matches SIJ patients
WhatsApp us with: where the pain is, triggers, any pregnancy history, any previous lumbar or hip problems, and your JB location.
We match to a physio who will do the full screening - SIJ, lumbar, and hip - not just treat what another clinician has named.
Related guide: Physiotherapy in Johor - complete guide