Sacroiliac Joint Pain: The Overlooked Cause of “Sciatica” — And Why the Right Technique Matters

Sacroiliac (SI) joint pain is one of the most underdiagnosed yet highly disabling causes of lower back and leg pain. Many patients walk into clinics describing classic symptoms of Sciatica—numbness radiating down the leg, deep aching in the lower back, and difficulty standing or walking.

Yet their scans often come back “normal.”

So what’s being missed?

What Is Sacroiliac Joint Dysfunction?

The sacroiliac joints connect your spine to your pelvis. While traditionally believed to have minimal movement, clinical experience shows that even small dysfunctions can create significant pain and instability.

This condition is frequently mistaken for:

Disc injuries
Muscle strain (often blamed on piriformis)
Ankylosing Spondylitis

In reality, many of these patients are dealing with mechanical SI joint dysfunction that doesn’t show clearly on imaging.

Why MRI Often Looks Normal

Unlike disc injuries, SI joint problems are:

Subtle
Movement-based
Ligament-driven

MRI scans are excellent for detecting structural damage—but they don’t capture instability or minor positional faults well.

This is why patients are often told:

“There’s nothing wrong.”

But their pain is very real.

The Fortin’s Finger Test: A Key Diagnostic Clue

One of the most reliable indicators of SI joint pain is the Fortin’s Finger Test.

Patients instinctively point to:

👉 A very specific spot beside the lower spine (near the “dimples” of the back)

When this matches their pain consistently, it strongly suggests SI joint involvement.

Many patients are surprised:

“That’s exactly where it hurts.”

Why It’s More Common in Women (Especially Pregnancy)

SI joint dysfunction is more prevalent in women due to:

Hormonal changes (relaxin increasing ligament laxity)
Pelvic anatomy
Pregnancy-related load changes

In some cases, this progresses into conditions like:

Hypermobile Ehlers-Danlos Syndrome

Where joint instability becomes a long-term challenge.

Symptoms That Are Often Misdiagnosed

Common complaints include:

Numbness or tingling down the leg
Pain when standing for more than a few minutes
Limited walking tolerance
Relief when leaning or shifting weight
Lower back spasms if untreated

These are frequently mislabelled as:

Muscle injuries
Disc problems
Or even inflammatory diseases

Sacroiliitis vs Ankylosing Spondylitis

In some cases, inflammation of the SI joints occurs:

Sacroiliitis

This can sometimes be diagnosed as:

Ankylosing Spondylitis

However, not all sacroiliitis is AS. Misdiagnosis can lead to unnecessary long-term treatment without addressing the true mechanical issue.

The Treatment Gap: Why Painkillers Aren’t Enough

Many patients are prescribed:

Painkillers
Epidural injections

While these may reduce symptoms temporarily, they do not fix the root cause—joint dysfunction and instability.

This is where many patients get stuck in a cycle of temporary relief and recurring pain.

As a Chiropractor: What I See Every Day

From years of clinical experience, I can confidently say:

SI joint dysfunction is something I encounter all the time.

Patients often come in after:

3–4 weeks of physiotherapy with little improvement
Being told it’s a piriformis issue
Having “normal” scans but persistent pain

Some are already severely limited:

Can only stand for a few minutes
Can only walk short distances
Living with daily discomfort

Others have developed additional complexity, especially with hypermobility conditions.

Not Every Joint Needs a “Crack”

Here’s where things get misunderstood.

Many people think chiropractic care = cracking joints.

But the truth is:

A “crack” is not always the solution.

Spinal Manipulative Therapy (SMT)

Works well for stiff, restricted joints
Can provide fast relief when used appropriately

But in SI Joint Cases…

Some patients improve
Some relapse quickly
Some become more unstable after adjustments

Especially in:

Hypermobility
Chronic instability
Ligament laxity

A Better Approach: Stability Before Force

In unstable SI joints, the goal is not force—it’s control and positioning.

This is where:

Sacro Occipital Technique (SOT)

comes in.

Using wedge-shaped blocks:

The pelvis is gently repositioned
No forceful adjustment is needed
The body resets through gravity and positioning

This blocking technique:

Reduces strain
Improves alignment
Provides immediate diagnostic feedback

Real Clinical Insight

I’ve treated patients diagnosed with Ankylosing Spondylitis where:

Manual adjustments worsened their SI joint pain
Instability increased after “cracking”

But when switching to SOT blocking:

Pain reduced
Joint stability improved
Function returned

This reinforces a critical point:

Technique matters more than force.

When Left Untreated

Ignoring SI joint dysfunction can lead to:

Chronic lower back spasms
Severe mobility limitations
Reduced quality of life

What starts as a “minor” issue can become debilitating over time.

Why Second Opinions Matter

Not all healthcare providers approach the body the same way.

And that’s okay.

But if you’re not improving:

👉 Don’t stop at one answer

Whether it’s:

GP
Orthopaedic specialist
Neurologist
Physiotherapist
Chiropractor

Find someone who understands your condition—and adapts their approach.

Be Your Own Health Advocate

If your pain is being dismissed or oversimplified:

Ask better questions
Seek another opinion
Send inquiries before committing to treatment

You deserve clarity—not confusion.

Use Tools to Communicate Your Pain

Many patients struggle to describe their symptoms accurately.

Using AI tools can help you:

Organize your symptoms
Track patterns
Prepare for consultations

It won’t treat your condition—but it will help you communicate effectively.

Final Thoughts

Sacroiliac joint pain is real, common, and often overlooked.

If you:

Have “sciatica” but normal MRI
Can pinpoint your pain with one finger
Are not improving despite treatment

…it’s time to consider your SI joint.

And remember:

Not every problem needs force.

Not every solution makes a sound.

But the right diagnosis—and the right technique—changes everything.

Medical Disclaimer

This article is for educational purposes only and does not constitute medical advice.

Scoliosis varies significantly between individuals. Always consult a qualified healthcare professional before starting any new sport or exercise program, especially if you have scoliosis, spinal conditions, pain, or previous injuries. Participation in sports should be guided by individual assessment and professional recommendation.

The image is shared for educational purposes with patient consent. Individual outcomes vary. Structural correction does not automatically restore full respiratory function. Clinical assessment is required.

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Sacroiliac Joint Pain: Fortin’s Finger Test, SI Joint Treatment & Chiropractic Approach