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SI Joint Blockage: Causes, Symptoms & Treatment

An SI joint blockage is a functional restriction of the sacroiliac joint causing lower back pain. It is common and responds well to treatment.

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Things worth knowing about "SI Joint Blockage"

An SI joint blockage is a functional restriction of the sacroiliac joint causing lower back pain. It is common and responds well to treatment.

What Is an SI Joint Blockage?

An SI joint blockage refers to a functional movement restriction of the sacroiliac joint (SI joint). This joint connects the sacrum (the triangular bone at the base of the spine) with the ilium (the large pelvic bone) on each side of the body. It acts as a key link between the spinal column and the pelvis. When this joint becomes blocked or restricted, it can cause significant pain and limited mobility.

Causes

An SI joint blockage can be triggered by a variety of factors:

Poor posture or overloading, such as carrying heavy loads on one side, prolonged sitting or standing
Unaccustomed physical activity, such as intense sport or heavy manual labor
Falls or trauma with direct impact on the pelvis
Pregnancy, where hormonal changes loosen ligaments and reduce joint stability
Muscle imbalances or tension in the back and pelvic muscles
Leg length discrepancies, which can tilt the pelvis over time

Symptoms

The symptoms of an SI joint blockage can vary and are often mistaken for other back conditions:

Sudden, sharp pain in the lower back, usually on one side
Pain radiating into the buttocks, hip, or thigh
Restricted movement when getting up, bending, or climbing stairs
Pain during prolonged sitting or standing
A feeling of instability in the pelvic area
Occasional tingling or numbness in the leg (pseudo-radicular symptoms)

Diagnosis

Diagnosis is primarily clinical and is performed by a physician or physiotherapist using the following approaches:

Medical history: Assessment of symptoms, onset, and aggravating factors
Manual functional testing: Specific provocation tests such as the FABER test, the standing flexion test, and compression or distraction tests of the SI joint
Imaging (X-ray, MRI): To exclude structural pathologies such as osteoarthritis, inflammation, or fracture

Because the SI joint can also be involved in inflammatory conditions such as ankylosing spondylitis (Morbus Bechterew), careful differential diagnosis is essential.

Treatment

Conservative Treatment

Most SI joint blockages respond well to conservative management:

Manual therapy or chiropractic treatment: Targeted manipulation techniques to restore normal joint mobility
Physiotherapy: Strengthening and stretching of pelvic, hip, and back muscles to improve stability
Heat or cold therapy for local pain relief
Pain medication (e.g., ibuprofen, diclofenac) for short-term relief of acute symptoms
Muscle relaxants when accompanied by significant muscle tension

Interventional Treatment

For persistent or severe pain, additional treatment options are available:

SI joint injection: Injection of a local anesthetic and/or corticosteroid directly into the joint under imaging guidance
Radiofrequency ablation: Used for long-term pain reduction in chronic cases

Prevention

To prevent recurrence of an SI joint blockage, the following measures are recommended:

Regular strengthening exercises for the pelvis and lower back
Ergonomic sitting habits and back-friendly lifting techniques
Correction of leg length discrepancies with appropriate shoe insoles
Avoiding prolonged one-sided physical strain

References

Schwarzer AC et al. - The sacroiliac joint in chronic low back pain. Spine. 1995;20(1):31-37. PubMed.
Airaksinen O et al. - European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15(Suppl 2):S192-S300.
Vleeming A et al. - The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat. 2012;221(6):537-567.

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