Common Triggers of SI Joint Pain and How to Prevent a Flare-up

The sacroiliac (SI) joint is crucial to lower back, pelvic, and leg function. This pivotal joint is responsible for supporting the upper body's weight and transferring it to the lower body as well as acting as a shock absorber to control forces transmitted from the legs to the spine. ¹ Baronio M, Sadia H, Paolacci S, et al. Etiopathogenesis of sacroiliitis: implication for assessment and management. Korean J Pain. 2022;33(4):294-304. http://doi.org/10.3344/kjp.2020.33.4.294 ^{, 2} Wong M, Sinkler MA, Kiel J. Anatomy, Abdomen and Pelvis, Sacroiliac Joint. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507801/ ^{, 3} Cramer, Gregory D., and Chae-Song Ro. “The Sacrum, Sacroiliac Joint, and Coccyx.” Clinical Anatomy of the Spine, Spinal Cord, and Ans, Elsevier, 2014, pp. 312–39. http://doi.org/10.1016/B978-0-323-07954-9.00008-6 Acute trauma and repetitive microtrauma contribute to 88% of SI joint pain cases. ⁴ Dydyk AM, Forro SD, Hanna A. Sacroiliac Joint Injury. [Updated 2022 Jul 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557881/

Most commonly, SI joint pain is triggered by activities that involve the lower back, pelvis, and legs moving together, such as sitting, walking, climbing stairs, and standing. Incorporating lifestyle modifications and therapeutic activities that protect and strengthen the lower back and pelvis can help prevent future flare-ups.

See 2 Little-Known Treatments to Relieve Sacroiliac Joint Pain

This blog outlines the common triggers of SI joint pain and useful tips on how to modulate daily activities to prevent this pain from worsening.

Certain physical activities can stress the SI joint through overuse or repetitive microtrauma, causing the inflammation within the joint to flare-up. These triggers are discussed below.

• Certain occupations. Jobs that require frequent standing, sitting, and walking, such as teachers, store clerks, and restaurant jobs, may cause SI joint pain. Heavy manual labor that involves frequent lifting of heavy objects can also increase stress on the SI joint, leading to pain and discomfort.
• High-impact exercises. High-impact exercises, such as running, jumping, and plyometric exercises (such as lateral jumps and burpees) can stress the back and pelvis, leading to an increased risk of triggering SI joint pain. ⁵ Peebkes R, Jonas C. Sacroiliac Joint Dysfunction in the Athlete: Diagnosis and Management. Current Sports Medicine Reports. 2017;16(5):336-342. http://doi.org/10.1249/JSR.0000000000000410
• Cycling. Sitting in a forward-leaning position on a bike for long periods can cause the pelvis to tilt forward, leading to increased stress on the SI joint.
• Sports. Sports involving repetitive twisting motions, such as golf and gymnastics, and sports with repeated lateral movements such as tennis, soccer, ice skating, and basketball, can place significant stress on the lower back and pelvis, triggering SI joint pain. ⁴ Dydyk AM, Forro SD, Hanna A. Sacroiliac Joint Injury. [Updated 2022 Jul 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557881/

Frequently engaging in these activities can cause repetitive microtrauma to the joint and the surrounding structures, making the joint weak and painful over time.

Poor posture can trigger SI joint pain by placing stress on the lower back and pelvis, leading to SI joint misalignment or irritation. When we sit or stand with poor posture, the spine's natural curves can become exaggerated, causing the pelvis to tilt forward or backward, affecting the orientation of the SI joint, and leading to discomfort or pain in the lower back and buttock. ⁶ Rashbaum RF, Ohnmeiss DD, Lindley EM, Kitchel SH, Patel VV. Sacroiliac Joint Pain and Its Treatment. Journal of Spinal Disorders and Techniques. 2016;29(2):42-48. https://doi.org/10.1097/BSD.0000000000000359

Being inactive can weaken the muscles that support the spine and pelvis, leading to decreased spinal stability and increased stress on the SI joint. When we are inactive, the muscles that support the lower back and pelvis may become weak and stiff, making it harder for the body to maintain a supported posture. ³ Cramer, Gregory D., and Chae-Song Ro. “The Sacrum, Sacroiliac Joint, and Coccyx.” Clinical Anatomy of the Spine, Spinal Cord, and Ans, Elsevier, 2014, pp. 312–39. http://doi.org/10.1016/B978-0-323-07954-9.00008-6

Certain types of footwear can trigger SI joint pain by affecting the body's orientation and how we walk or stand. Wearing shoes that do not provide proper support can cause the feet to roll inward or outward when walking, leading to misalignment of the pelvis. ⁷ O’Leary CB, Cahill CR, Robinson AW, Barnes MJ, Hong J. A systematic review: The effects of podiatrical deviations on nonspecific chronic low back pain. Journal of Back and Musculoskeletal Rehabilitation. 2013;26(2):117-123. http://doi.org/10.3233/BMR-130367

Some common types of footwear that can contribute to SI joint pain include:

• High heels. High heels can cause the pelvis to tilt forward, increasing stress on the lower back and SI joint.
• Flats with little arch support. Wearing flat-soled shoes that do not provide adequate arch support can cause the feet to roll inward or outward, increasing the stress on the SI joint.
• Flip-flops or sandals with no arch support. Similar to flats, sandals that provide little-to-no arch support can increase the stress on the SI joint.

Over time, the stress caused by wearing these types of footwear also contributes to repetitive microtrauma to the SI joint—leading to pain and dysfunction.

Specific foods that trigger arthritis-related pain include:

• Sugar. Consuming too much sugar can trigger inflammation throughout the body, including the SI joint. Sugar can be found in many processed foods, such as candy, sweet beverages, and baked goods. ⁸ Jamar G, Ribeiro DA, Pisani LP. High-fat or high-sugar diets trigger inflammation in the microbiota-gut-brain axis. Critical Reviews in Food Science and Nutrition. 2021;61(5):836-854. http://doi.org/10.1080/10408398.2020.1747046 ^{, 9} Ma X, Nan F, Liang H, et al. Excessive intake of sugar: An accomplice of inflammation. Front Immunol. 2022;13:988481. http://doi.org/10.3389/fimmu.2022.988481
• Processed food. Processed food is often high in sugar, salt, and unhealthy trans fats, all of which can trigger inflammation. ¹⁰ Remig V, Franklin B, Margolis S, Kostas G, Nece T, Street JC. Trans Fats in America: A Review of Their Use, Consumption, Health Implications, and Regulation. Journal of the American Dietetic Association. 2010;110(4):585-592. http://doi.org/10.1016/j.jada.2009.12.024 Examples of processed food include fast food, frozen meals, and packaged snacks.
• Fried food. High-heat cooking methods, such as frying, use cooking oils high in trans fats that increase the production of inflammatory compounds. ¹¹ Song J, Park J, Jung J, et al. Analysis of Trans Fat in Edible Oils with Cooking Process. Toxicol Res. 2015;31(3):307-312. http://doi.org/10.5487/TR.2015.31.3.307
• Red meat. Red meat such as beef, veal, pork, and lamb are high in saturated fat, triggering inflammation. ¹² Wang X, Lin X, Ouyang YY, et al. Red and processed meat consumption and mortality: dose-response meta-analysis of prospective cohort studies. Public Health Nutr. 2016;19(5):893-905. http://doi.org/10.1017/S1368980015002062

Frequently consuming inflammatory foods, especially for individuals with arthritis-related conditions, can increase overall inflammation in the body, flaring up arthritis-related SI joint pain. ¹³ Khanna S, Jaiswal KS, Gupta B. Managing Rheumatoid Arthritis with Dietary Interventions. Front. Nutr. 2017;4. https://doi.org/10.3389/fnut.2017.00052

Physical changes in the body that may trigger SI joint pain include:

• Pregnancy. The hormonal and physical changes caused by pregnancy can trigger SI joint pain. As the body prepares for childbirth, the ligaments and joints in the pelvic region become more relaxed and flexible, increasing the risk of SI joint pain. ¹ Baronio M, Sadia H, Paolacci S, et al. Etiopathogenesis of sacroiliitis: implication for assessment and management. Korean J Pain. 2022;33(4):294-304. http://doi.org/10.3344/kjp.2020.33.4.294
• Obesity. Excess body weight can place extra stress on the SI joint, leading to inflammation and pain. Obesity can also lead to poor posture and weakened muscles, which can place additional stress on the SI joint. ¹ Baronio M, Sadia H, Paolacci S, et al. Etiopathogenesis of sacroiliitis: implication for assessment and management. Korean J Pain. 2022;33(4):294-304. http://doi.org/10.3344/kjp.2020.33.4.294
• Age. Although the SI joint is relatively mobile in young persons, it can stiffen with age. ³ Cramer, Gregory D., and Chae-Song Ro. “The Sacrum, Sacroiliac Joint, and Coccyx.” Clinical Anatomy of the Spine, Spinal Cord, and Ans, Elsevier, 2014, pp. 312–39. http://doi.org/10.1016/B978-0-323-07954-9.00008-6 Decreased mobility in the joint leads to inflammation and pain, and changes in the pelvic musculature and stability. ¹ Baronio M, Sadia H, Paolacci S, et al. Etiopathogenesis of sacroiliitis: implication for assessment and management. Korean J Pain. 2022;33(4):294-304. http://doi.org/10.3344/kjp.2020.33.4.294

Certain medical conditions can also contribute to SI joint pathology. Ankylosing spondylitis is the most common rheumatic arthritis that causes inflammation and stiffness in the SI joint and spinal ligaments. ¹ Baronio M, Sadia H, Paolacci S, et al. Etiopathogenesis of sacroiliitis: implication for assessment and management. Korean J Pain. 2022;33(4):294-304. http://doi.org/10.3344/kjp.2020.33.4.294 Over time, this inflammation and stiffness can lead to the fusion of the SI joint and other spinal joints. ¹⁴ Ebrahimiadib N, Berijani S, Ghahari M, Pahlaviani FG. Ankylosing Spondylitis. J Ophthalmic Vis Res. 2021;16(3):462-469. http://doi.org/10.18502/jovr.v16i3.9440

Additionally, after certain spine surgeries, such as a lumbar spinal fusion, increased mechanical loads are transferred to the SI joint, which may trigger pain within the joint. ¹⁵ Yoshihara H. Sacroiliac joint pain after lumbar/lumbosacral fusion: current knowledge. Eur Spine J. 2012;21(9):1788-1796. http://doi.org/doi:10.1007/s00586-012-2350-8

Several strategies can help prevent SI joint pain. Here are some useful self-care tips to keep in mind:

• Practice good posture. Good posture can help reduce the strain on the SI joint. Make sure you sit and stand up straight, with your shoulders back and your hips aligned.
• Exercise regularly. Regular exercise can help improve the strength and flexibility of the muscles surrounding the SI joint. Aim for at least 30 minutes of exercise daily, such as walking, swimming, or using an elliptical trainer.
• Practice proper lifting techniques. When lifting heavy objects, bend at the hips and point both knees straight ahead, keep the weight close to the body, and straighten the knees to stand up.
• Maintain a healthy weight. Excess weight can put extra strain on the SI joint. Aim to maintain a healthy weight through regular exercise and a balanced diet.
• Using supporting pillows. Using a lumbar support pillow while sitting and a wedge pillow while reclining on the bed can help support the lower back and maintain its natural curve.
• Wear supporting footwear. To prevent SI joint pain caused by footwear, wearing shoes that provide proper support and alignment for the feet and body is important. Orthotic inserts may also help provide additional support and reduce stress on the SI joint, especially when there is a difference in leg length. ¹ Baronio M, Sadia H, Paolacci S, et al. Etiopathogenesis of sacroiliitis: implication for assessment and management. Korean J Pain. 2022;33(4):294-304. http://doi.org/10.3344/kjp.2020.33.4.294
• Eat a healthy, anti-inflammatory diet. To prevent SI joint pain caused by dietary inflammation, avoiding inflammatory foods, such as saturated fats, trans-fats, and refined sugar, is beneficial. ¹⁶ Pahwa R, Goyal A, Jialal I. Chronic Inflammation. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493173/

By implementing these strategies, individuals can reduce the strain on the SI joint and prevent or manage ongoing SI joint pain.

Therapeutic activities to improve the health of the SI joint and reduce future pain flare-ups include:

• Low-impact aerobic exercise. Low-impact aerobic exercises, like walking, jogging, and using an elliptical trainer or stationary bike, can help improve cardiovascular health and effectively distribute essential nutrients throughout the body to help recover from injuries. Aerobic exercise is generally considered most beneficial when done for a minimum of 20-30 minutes a day but depending on the severity of the SI joint pain, it’s recommended to start slow. ¹⁷ American Heart Association Recommendations for Physical Activity in Adults. American Heart Association. July 27, 2016. Accessed January 13, 2023
• Swimming and water aerobics. Swimming and water aerobics are low-impact exercises that can help improve cardiovascular health, reduce pressure on the SI joint, and strengthen the surrounding muscles. ¹⁸ Barker AL, BHeallth Sci JT, Morello RT, et al. Effectiveness of Aquatic Exercise for Musculoskeletal Conditions: A Meta-Analysis. Archives of Physical Medicine and Rehabilitation. 2014;95(9):1776-1786. https://doi.org/10.1016/j.apmr.2014.04.005
• Stretching. Stretching exercises targeting the lower back, hips, and thighs can help improve lower back and pelvic flexibility and reduce stress on the SI joint.
• Physical therapy. Physical therapy can help alleviate SI joint pain by improving muscle strength and flexibility, reducing inflammation, and promoting healing.
• Yoga. Yoga is a low-impact exercise that can help strengthen and tone the muscles around the SI joint, reducing pressure on the joint and relieving pain. Yoga can also be easily performed at home.
• Ice and heat therapy. Applying ice or heat to the low back and pelvis can help reduce inflammation and may alleviate pain and discomfort associated with the SI joint.

SI joint pain can be debilitating and significantly affect the quality of life. Understanding the common triggers and avoiding activities that can aggravate the symptoms can help prevent future flare-ups and keep the pain under control. Any concerning symptoms or signs in the lower back or pelvis must be evaluated by a physician.

Learn more:

Treatment Options for Sacroiliac Joint Dysfunction

Surgical Treatment for Sacroiliac Joint Pain