SI Joint Dysfunction – What It Is and Why It’s Often Missed
Julkaistu tiistaina 17. kesäkuuta 2025
SI Joint dysfunction and problems are incredibly common. Based on over 20 years of clinical experience, I can confidently say that in the vast majority of lower back pain cases, the sacroiliac joint (SI joint) plays at least a partial role — especially when it comes to pain and stiffness.
The SI joint is a large joint located on both sides of the pelvis. Its name comes from Latin: articulatio sacroiliaca — with sacrum referring to the base of the spine and ilium referring to the pelvic bone. So the SI joint is where the sacrum and ilium meet.
Si Joint
Functionally, it plays an important role in load transfer and stability. And when it causes trouble, the problem is usually functional in nature — meaning the joint is structurally normal (no arthritis, no inflammation, nothing visibly “broken”), but it isn’t working properly.
Of course, it’s important to acknowledge that inflammatory conditions can also affect the SI joint.
The most well-known are ankylosing spondylitis (affecting about 1% of Finns), psoriatic arthritis, and Reiter’s syndrome. These are systemic diseases and — fortunately — quite rare. But they do exist, and they need to be recognized. Inflammatory joint disease typically falls under the expertise of a rheumatologist.
The SI Joint Is Prone to Dysfunction
Back to the functional side of the SI joint. Structurally speaking, the SI joint is a well-engineered part of the body: sturdy, reliable, and built for function.
But when it comes to how it moves and behaves, it’s surprisingly prone to dysfunction. These issues usually come down to either movement restrictions or positional misalignments.
The SI joint seems to be very particular about its state — it wants to be just right. Aligned exactly as it should be, moving precisely as it’s meant to. Not too much, not too little.
A movement restriction in the SI joint usually means that it isn’t moving enough — it’s stiff or stuck. That’s what we often refer to as a ”locked” joint. But yes, the SI joint can also move too much — it can be hypermobile. That, however, is its own topic and deserves an article of its own.
SI Joint Hypermobility
Still, hypermobility of the SI joint is an interesting concept — especially because when we talk about hypermobility, the focus of treatment shifts toward activating the muscles that support the joint.
And truthfully, all SI joints benefit from this — whether they’re too stiff, too loose, or somewhere in between.
When it comes to stabilizing muscles around the SI joint, the key player is gluteus medius — that glorious middle glute muscle. In Latin: musculus gluteus medius. Hands down, my favorite muscle in the entire body.
Gluteus medius, if anything, is pure gold — especially when it’s functioning. Not overly tight, and most importantly, activating properly, particularly during walking and running.
When gluteus medius slacks off, it creates more chaos for the back and hips than you’d believe.
I promise to return to this in a future post.
Joint Manipulation Helps
Now, back to SI joint hypomobility. The SI joint is meant to move. Period.
But it doesn’t need to move much — its physiological range of motion is minimal, estimated at only about two degrees.
When the SI joint locks up, it can be in a state of full restriction — completely stuck. But more often, in my experience, it’s not totally locked but rather in a kind of stiffness or sluggishness.
This type of stiffness means the joint still moves a little — there’s a slight give when you test it manually — but the motion is clearly limited. In my experience, this is the most common pattern of SI joint dysfunction. In these cases, it’s important to treat not only the joint’s movement issue itself, but also the surrounding muscular tension patterns.
Doctor of Chiropractic, D.C. Krista Ketelä.
As someone trained in manipulation, I find that joint manipulation tends to give the fastest and clearest result in SI joint dysfunction. That said, the muscles can’t be overlooked. Their role is always essential.
Whether the issue is muscle tightness, weakness, or something else, addressing the surrounding muscles is key to making sure the SI joint correction holds.
No one can give a lifelong guarantee for SI joint treatment — but by supporting it with well-targeted muscle activation, we can often make the results more durable.
One-Sided Low Back Pain Often Comes from the SI Joint
A stuck SI joint is usually painful. In fact, the SI joint has an unusually high number of pain-sensitive nerve endings. The pain may present as a dull, ongoing ache, but most typically, SI joint pain shows up as movement-related discomfort.
That means you feel sharp pain or jolts only during certain movements or in specific positions — like bending forward, getting up from a chair, or rising from bed.
It may hurt while walking. It might not ache while you’re sleeping, but it can make turning in bed difficult. And when the pain is intense, it can even feel like your leg might give out beneath you.
SI joint pain usually appears as one-sided low back pain. It often radiates into the buttock and sometimes down the back of the thigh. In some cases, the pain can also curve forward across the pelvis.
SI Joint Dysfunction and Problems Are Truly Common
Sometimes, SI joint pain can even radiate all the way down to the shin. Quite the list, I know — but SI joints seem to have a mind of their own. They don’t always follow the textbook when it comes to how they express symptoms.
As I mentioned earlier, misalignment of the SI joint is something I see often too. It usually goes hand-in-hand with that same movement dysfunction — the joint settles into a slightly unfavorable position and gets stuck there.
It’s probably also worth asking: where do these SI joint problems come from in the first place?
Well, seeing as I work with tricky SI joints daily, I’m tempted to just say: “life.”
Because honestly, they’re that common. I don’t spend too much time trying to pinpoint a specific cause — and in many cases, the exact reason remains unclear.
That said, here are some common triggers I’ve seen:
- Repeated forward bending with a rounded back
- Lifting something heavy in an awkward position
- Stepping into a hole or uneven ground while walking
- Disturbed gait (while walking or running)
- Falling on your backside (especially on ice, or while skating or skiing)
- Poor gluteal support — especially underactive glutes
Get Your SI Joint Checked by a Chiropractor
If your SI joint is acting up, it’s worth having it assessed and corrected by a professional who truly understands the joint.
And chiropractors — especially those with formal training — definitely do. During our five-year education, the SI joint is studied in depth, from both a theoretical and functional perspective.
There’s no need to panic if your SI joint is misbehaving. In fact, it’s often quite a rewarding joint to treat — in the right hands, its function can often be restored within just a few sessions.
When the SI joint is flaring up, self-care options are limited. In my opinion, it’s best to have it corrected. But when it comes to prevention — well, there’s a topic worth its own blog post. That just might be the next one I open on my laptop.
Speaking of other topics, feel free to check out my article on neck, shoulder, and headache issues as well.
And you’re warmly welcome to visit my clinic to have your pelvis assessed — whether your symptoms are coming from the SI joint or something else entirely.
You’ll find me at The Back Room in Tampere (Papinkatu 19), and at Fysio-Ketelä in Seinäjoki (Puskantie 23).
Book an appointment in Tampere or Seinäjoki
Krista Ketelä (formerly Krista Valli)
Doctor of Chiropractic, D.C.
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About the Author
Krista Ketelä D.C. is a Finnish chiropractor with over 20 years of clinical experience.
While she is especially known for her work with sacroiliac joint dysfunction, she treats a wide range of spinal issues — including problems in the neck, thoracic spine, and lower back — with equal depth and care.
Her patients include both local clients and those who seek her out from across the country after years of unresolved pain.
In addition to hands-on care and precise diagnostics, she brings a strong understanding of pelvic rehabilitation and is well-versed in using Pilates-based methods to support long-term recovery and stability.
Through her writing, she’s helping to raise awareness that chiropractors in Finland are the most highly trained professionals when it comes to manual diagnosis and treatment.