CONDITIONS • WESTMINSTER, ARVADA, BROOMFIELD, THORTON & DENVER METRO
Sacroilliac Joint Pain Treatment in Westminster, CO
The sacroiliac joint is one of the most common sources of low back and buttock pain — and one of the most commonly blamed on something else entirely.
Studies estimate that up to 25 percent of all low back pain originates from the sacroiliac joint. Yet it is one of the least commonly diagnosed and least specifically treated structures in the spine. Most patients with SI joint pain are told their disc is the problem, or that it is muscle tightness, and spend months or years in treatment that addresses the wrong structure. Understanding what the SI joint is, why it hurts, and what it actually takes to treat it effectively changes the entire picture.
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WE UNDERSTAND WHAT YOU'RE GOING THROUGH
The pain at the base of your spine that seems to be everywhere and nowhere at once. You have tried to describe it and found it almost impossible.
SI joint pain is notoriously difficult to describe to a doctor, a partner, or anyone who has not experienced it. It is in the back, but lower than typical back pain. It is in the buttock, but not quite like a piriformis or sciatica. It may travel into the groin, the hip, or even partway down the thigh. It is sharp when you roll over in bed, when you step off a curb onto the painful side, or when you hold your weight on one leg. It makes getting in and out of a car feel like a negotiation with your own body. Sitting too long makes it worse. So does standing too long. There is no position that fully relieves it. You have probably been told it is a disc, or a muscle problem, or just general back pain — and you have spent time and money treating those things while the real source remained unaddressed. We recognize this pattern, and we see it regularly.
WHAT YOU MAY BE EXPERIENCING
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Pain at the very base of the spine, just above or beside the tailbone, usually on one side
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Deep buttock pain that does not feel like a muscle — more fixed and localized
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Pain that may radiate into the groin, hip, or front or back of the thigh
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Significant pain with rolling over in bed, stepping off a curb, or single-leg standing
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Stiffness and aching after prolonged sitting that requires a moment to "get going" when standing
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A feeling of instability in the pelvis — as though it might give way — with certain activities
IF THIS SOUNDS FAMILIAR
You have probably been told it is a disc problem, a muscle strain, or general low back pain. You may have been sent for an MRI that showed disc changes, been given anti-inflammatories, and sent to physical therapy for general low back exercises. Some things helped, temporarily. The specific pain at the base of your spine persisted.
What you almost certainly have not been told is that the sacroiliac joint was almost certainly never specifically examined or treated — and that this single joint is responsible for a quarter of all low back pain cases according to current research.
WHAT YOU PROBABLY HAVEN'T BEEN TOLD
The sacroiliac joint is not supposed to move much. But when it stops moving correctly — even by a fraction of a millimeter — it produces an extraordinarily large amount of pain.
Most people have never heard of the sacroiliac joint, let alone thought about it as a potential source of their pain. Yet it is one of the most force-transmitting joints in the entire body. It connects your sacrum — the triangular bone at the base of your spine — to your ilium, the large bone of your pelvis on each side. Every step you take, every time you lift something, every time you sit or stand, this joint is transferring force between your spine and your legs. Understanding what happens when it is not working correctly is the key to understanding why your pain is where it is.
WHY THE SI JOINT IS SO HARD TO DIAGNOSE — AND WHY THAT MEANS SO MANY PATIENTS GO WITHOUT THE RIGHT TREATMENT
The sacroiliac joint is designed to move only a few millimeters in any direction. This tiny movement is essential for absorbing the shock of each footfall and transferring load smoothly between the spine and the legs. When the joint becomes restricted — losing even this tiny range of motion — or when it becomes unstable — moving more than it should — the surrounding muscles respond immediately by going into protective spasm. This produces the deep, fixed pain at the base of the spine that SI joint patients describe. The problem is that the SI joint does not show up clearly on a standard MRI. Its dysfunction is a movement problem, not a structural damage problem. A normal MRI cannot detect a restricted or hypermobile sacroiliac joint, which is exactly why so many patients are diagnosed with a disc problem when the actual source of the pain is the joint sitting right next to the disc on the other side of the pelvis.
The correct diagnosis of SI joint dysfunction requires a specific physical examination using a set of clinical tests that assess the joint's movement, position, and pain response. A skilled examiner can identify SI joint dysfunction in minutes. Without that examination, it is routinely missed — and the patient continues to be treated for the wrong structure indefinitely.
Two very different SI joint problems
SI joint problems come in two opposite forms, and they require opposite treatment approaches. A hypomobile SI joint — one that is restricted and stuck — needs to be mobilized and freed. A hypermobile SI joint — one that is too loose and unstable — needs to be stabilized and supported. Treating a hypermobile joint with mobilization makes it worse. Treating a hypomobile joint with stabilization exercises while leaving the restriction in place also fails. Identifying which pattern you have before selecting treatment is not optional. It is the most important step in the entire treatment process.
This is a significant reason why generic physical therapy for SI joint pain often does not work — the exercises prescribed may be appropriate for the opposite problem from the one the patient actually has.
Why it is so easily confused with other conditions
The SI joint's pain referral pattern overlaps almost exactly with other very common diagnoses. It refers pain to the buttock in a pattern that looks exactly like sciatica or piriformis syndrome. It refers pain into the groin and inner thigh in a pattern that looks like hip joint pathology. It refers pain into the lower back in a pattern that looks like lumbar disc pain. This is why the same patient can receive three different diagnoses from three different practitioners and have all three be wrong — because none of them specifically assessed the SI joint.
The hallmark that points toward the SI joint: pain that is clearly worse on one specific side, localized to the region just below the iliac crest, and provoked by compressive or distraction forces on the pelvis specifically.
Why it happens in the first place
The SI joint becomes dysfunctional from asymmetric loading. Anything that creates an imbalance in how force is transferred through the pelvis over time can trigger SI joint problems: leg length inequality, one-sided sports, prolonged sitting with the weight shifted to one side, pregnancy and the hormonal loosening of pelvic ligaments, a previous lumbar spinal fusion that transfers more stress to the joint below, or simply years of walking patterns that load the pelvis slightly more on one side. The trigger is usually cumulative rather than a single event — which is part of why patients often cannot identify what started it.
Post-fusion SI joint pain affects a meaningful proportion of patients who have had lumbar spinal surgery — a pattern that is well documented in the literature but rarely discussed with patients before surgery.
Why this condition responds so well once it is correctly identified
Sacroiliac joint dysfunction is one of the most satisfying conditions to treat because it responds so reliably to the right intervention. A hypomobile SI joint that is specifically mobilized often produces immediate, dramatic pain relief — the kind that makes patients say they cannot believe how quickly they felt better after months of ineffective treatment elsewhere. The challenge is not the treatment itself. It is arriving at the correct diagnosis and identifying whether the joint needs to be mobilized or stabilized, alongside addressing the biomechanical, neurological, and biochemical contributors that allowed it to become dysfunctional in the first place.
UNDERSTANDING YOUR PAIN
Why SI joint pain looks different depending on what is happening in the joint and how long it has been present
The specific character of your pain, what provokes it, and whether it involves one side or both, all point toward the underlying pattern — which directly determines the treatment approach that will be effective.
Hypomobile SI joint — restricted and locked
WHAT HAPPENING
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The joint has lost its normal tiny range of motion and is stuck in a specific position
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Intense protective muscle spasm around the joint is holding it in place
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Often triggered by a single awkward movement, a heavy lift, or following a period of extreme asymmetric loading
WHAT IT FEELS LIKE
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Sharp, localized pain at the base of the spine on one side — often with a very specific tender spot
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Significant pain with rolling in bed or stepping forward onto the affected leg
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Brief, dramatic relief when the joint spontaneously "pops" — only to tighten back up within hours
Hypermobile SI joint — unstable and loose
WHAT'S HAPPENING
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The ligaments that stabilize the SI joint have been stretched or loosened — most commonly by pregnancy, but also by repetitive loading or generalized hypermobility
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The joint moves more than it should, producing microinstability with each loading cycle
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The surrounding muscles strain to provide the stability the ligaments no longer fully supply
WHAT IT FEELS LIKE
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A feeling of looseness or giving way in the pelvis during movement
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Pain that is worse with prolonged walking or standing and better with rest and compression support
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A sacroiliac belt or support providing noticeable relief — a key clinical indicator of instability
Chronic and inflammatory SI joint pain
WHAT'S HAPPENING
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Long-standing restriction or instability has produced inflammatory and sometimes arthritic changes within the joint
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In some cases, inflammatory arthritis (such as ankylosing spondylitis) is the primary driver — a systemic autoimmune condition that often begins at the SI joints
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The nervous system has sensitized to the chronic joint input, amplifying pain beyond what the structural findings would produce
WHAT IT FEELS LIKE
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Severe morning stiffness that takes more than 30 minutes to ease — a hallmark of inflammatory joint disease
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Pain that improves with activity rather than worsening with it
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Bilateral symptoms — both SI joints affected simultaneously
An important note on inflammatory SI joint disease
If you experience profound morning stiffness lasting more than 45 minutes, bilateral SI joint pain, pain that improves with movement rather than worsening, and onset before age 40 — these are warning signs for ankylosing spondylitis or other inflammatory spondyloarthropathies. These conditions require specific rheumatological assessment and treatment beyond standard manual therapy. We will identify this pattern in our initial evaluation and ensure you are appropriately referred. However, even in these cases, our naturopathic approach to systemic inflammation management plays a highly supportive role alongside rheumatological care, and most manual therapy is still beneficial at appropriate stages.
THE BIGGER PICTURE
What you've probably already tried
The frustrating reality for most SI joint pain patients is that the treatments they received were not wrong. They simply were not directed at the SI joint specifically — because the SI joint was never identified as the source. The disc was treated. The lumbar muscles were worked on. The piriformis was stretched. And the joint at the base of the spine that was producing the symptoms remained unaddressed throughout.
TREATMENTS PEOPLE TYPICALLY TRY
✓ General low back physical therapy and core exercises
✓ Massage to the lumbar muscles and piriformis
✓ Chiropractic adjustments to the lumbar spine (but not specifically the SI joint)
✓ Anti-inflammatory medication
✓ Cortisone injection into the SI joint itself
✓ Wearing a sacroiliac belt for temporary support
Each of these addresses one part of the problem. None of them simultaneously correct the joint dysfunction, identify and correct the biomechanical loading pattern, address the nerve sensitization, and support the body's internal ability to stabilize and heal the joint.
THE CONVERSATION THAT NEEDS TO HAPPEN DIFFERENTLY
You have described the pain in exactly the right place. You have pointed to the dimple at the base of your spine, pressed on the spot that is always tender, and explained that it is worse on one side. And you have still been sent home with a diagnosis of lumbar strain, disc disease, or hip bursitis — and a treatment plan for those other structures.
"I know exactly where it hurts. It is right here, at the very base of my spine on this side. But nobody seems to have treated that specific spot. They keep treating my back in general and it keeps coming back."
That specific spot is almost certainly the sacroiliac joint. It is a millimeter from where you are pointing. It requires specific clinical testing to confirm and specific treatment to address. Once those two things happen, most patients who have been struggling for months or years find they begin to improve within a few sessions.
OUR FRAMEWORK
What's actually driving your sacroiliac joint pain
Sacroiliac joint pain almost never involves just the joint in isolation. The muscles that are failing to stabilize it, the nervous system amplifying its pain signal, and the internal environment determining whether its ligaments and cartilage can recover all need to be addressed alongside the joint itself for recovery to be complete and lasting.
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The Physical System
The joint's movement pattern, the muscles responsible for stabilizing it, and the biomechanical loading asymmetry that created the dysfunction
What goes wrong
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The SI joint becomes restricted — losing its normal tiny movement — or hypermobile — moving more than its ligaments can comfortably allow
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The muscles that support and stabilize the joint — the gluteus maximus, the deep hip rotators, the multifidus, and the biceps femoris — either stop activating correctly or go into protective spasm
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A biomechanical asymmetry — leg length difference, one-sided muscle tightness, post-surgical load transfer, or habitual posture — creates ongoing uneven load on the joint with every step
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The lumbar spine and hip joint above and below begin to compensate for the SI joint dysfunction, developing their own secondary restrictions and pain contributions
Why that matters
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A restricted SI joint sends a distress signal to the surrounding muscles, which tighten and compress the already-restricted joint further — the same self-sustaining cycle seen in facet joint syndrome, but at a lower and more disabling level
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An unstable SI joint creates micromovement with every step that the surrounding muscles cannot fully control — eventually exhausting them and producing the characteristic aching after walking
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Neither pattern resolves without treating the joint itself alongside the muscles and the loading pattern — treating any one in isolation leaves the others to perpetuate the cycle
The correct first step is always identifying whether the SI joint is restricted or unstable — because the treatment for each is the direct opposite of the other.
What this means
A specific clinical examination identifies the pattern. If the joint is restricted, chiropractic mobilization of the SI joint specifically — not the lumbar spine generally — produces immediate relief. If the joint is hypermobile, stabilization exercises targeting the gluteus maximus, deep hip rotators, and multifidus are the primary intervention, alongside correction of the loading asymmetry that is producing the instability. In either case, the lumbar spine and hip joint need to be assessed and treated as secondary contributors. This specific, pattern-directed approach is what standard care consistently fails to deliver for SI joint patients.
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The Nervous System
Why SI joint pain can spread, become constant, and outlast the structural dysfunction — and why the referred pain pattern so reliably confuses the diagnosis
What goes wrong
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The SI joint has an extensive nerve supply from the lower lumbar and sacral nerve roots. When it becomes dysfunctional, it refers pain along the paths of those nerves — into the buttock, groin, hip, and thigh — in patterns that are specific enough to be mapped clinically but are routinely mistaken for sciatica, hip pathology, or lumbar disc pain
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The lumbar and sacral nerve roots that supply the SI joint also supply the leg. This creates genuine overlap between SI joint dysfunction and nerve root pain — a dual-source problem that requires both to be addressed
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After months of chronic SI joint irritation, central sensitization develops and the pain becomes amplified and more widespread than the joint dysfunction alone would produce
Referred pain from the SI joint does not follow the sharp, electric quality of nerve root pain. It is typically a deep, diffuse aching in the buttock and thigh — but that distinction is subtle enough to be easily missed.
What this feels like
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Deep aching in the buttock and posterior thigh that follows activity
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Groin or inner thigh pain alongside the buttock pain that confounds every diagnosis attempted
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Pain that has gradually spread from its original single point to a broader region over time — central sensitization expanding the pain territory
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Symptoms that are clearly worse during periods of high stress or poor sleep — the sensitized nervous system component
What this means
Understanding the SI joint's referral pattern eliminates the diagnostic confusion that has kept patients misdiagnosed for months or years. Treating the SI joint specifically eliminates the referred pain from the buttock and thigh — providing confirmation of the diagnosis in real time. For patients with concurrent lumbar nerve root involvement, both need to be addressed. And for patients with sensitization, nervous system regulation through chiropractic care, hydrotherapy, and autonomic regulation reduces the chronic pain amplification that has made the condition more severe and more disabling than the underlying joint dysfunction alone would justify.
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The Biochemical System
The internal environment that determines whether the ligaments and joint cartilage can recover — and whether systemic inflammation is adding a chemical irritation to the mechanical problem
What Goes Wrong
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Systemic inflammation directly irritates the SI joint's synovial lining and ligamentous attachments — in some people this is the primary driver, especially in those with inflammatory arthropathy, gut dysfunction, or high dietary inflammation
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Hormonal changes — particularly the elevated relaxin of pregnancy and the ligamentous laxity of perimenopause — directly affect the stability of the SI joint, producing a biochemical contributor to instability that no amount of exercise will fully resolve without hormonal support
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Nutritional deficiencies in collagen co-factors reduce the body's ability to repair and maintain the ligaments that give the SI joint its stability
What this feels like
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SI joint pain that began or significantly worsened during pregnancy, postpartum, or around menopause
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Pain that varies clearly with dietary changes or periods of systemic illness
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SI joint instability that does not improve as expected with appropriate stabilization exercises, suggesting the ligamentous laxity has a hormonal or nutritional component
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Inflammatory morning stiffness accompanying the SI pain, suggesting a systemic inflammatory driver
What this means
For patients whose SI joint pain has a hormonal component — particularly those whose symptoms began or intensified during pregnancy, postpartum, or perimenopause — naturopathic medicine's approach to hormonal regulation is a critical and often overlooked intervention. For patients with systemic inflammation as a contributor, identifying and treating the gut health, dietary, and environmental drivers of that inflammation directly improves the joint's chemical environment. These are not optional additions to care. For many SI joint patients, they are the deciding factor in whether recovery is complete or indefinite.
OUR APPROACH
How we treat sacroiliac joint pain differently
We begin with specific clinical testing to identify the exact dysfunction pattern — restricted or unstable — and direct treatment precisely at that pattern. We address the biomechanical contributors that produced the dysfunction, the nervous system's sensitization and referral patterns, and the internal biochemical environment that determines whether the joint can stabilize and recover. All simultaneously.
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Correct the specific SI joint dysfunction and address its biomechanical contributors
The pattern must be identified before the treatment is selected — and the treatment must be directed at the SI joint specifically, not the lumbar spine generally.
Specific SI joint mobilization using techniques directed at the sacroiliac joint itself — different from lumbar adjustments and highly effective for hypomobile SI dysfunction — often producing immediate and dramatic pain relief
Release the gluteal, piriformis, deep hip rotator, and lumbar multifidus trigger points caught in the protective spasm cycle around the restricted joint
Custom Orthotics
Correct leg length inequality or foot pronation asymmetry that is loading the SI joint unevenly with every step — permanently reducing the biomechanical trigger for recurrence
Pattern-specific rehabilitation: mobilization exercise for restriction, or specific gluteus maximus, deep hip rotator, and multifidus activation for instability, plus correction of the gait and loading asymmetry that produced the dysfunction
WHAT THIS CORRECTS
SI joint restriction or instability · Protective muscle spasm cycle · Loading asymmetry · Adjacent compensation patterns
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Resolve the referred pain and reduce nervous system sensitization
Correctly treating the SI joint directly eliminates the referred pain to the buttock, groin, and thigh — and for chronic cases, sensitization needs additional direct treatment.
Restoring SI joint mobility provides immediate confirmation of the diagnosis as the referred buttock and thigh pain resolves — and consistent treatment progressively reduces the sensitization driving the broader pain territory
Dry Needling
Directly release the referred pain trigger points in the gluteal and posterior thigh muscles that have formed secondary to the chronic SI joint irritation and are now generating their own pain contribution
Constitutional Hydrotherapy
Regulate the autonomic nervous system and reduce the chronic sympathetic activation that amplifies the SI joint's pain output and drives the referred pain territory to expand
Release the chronic pelvic and hip muscle tension that is adding compressive load to the SI joint and maintaining the secondary muscle pain contributors alongside the joint dysfunction itself
WHAT THIS CORRECTS
Referred buttock and thigh pain · Secondary muscle trigger points · Central sensitization · Autonomic reactivity
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Address the hormonal, inflammatory, and nutritional contributors to joint instability and cartilage health
Critical for patients whose SI joint pain has a hormonal component, a clear systemic inflammatory pattern, or whose stabilization exercises are progressing more slowly than expected.
Identify and treat hormonal contributors to ligamentous laxity, systemic inflammatory drivers, gut health, and nutritional deficiencies affecting the SI joint's ligament quality and the body's capacity for stabilization
Assess hormonal status, inflammatory markers, gut function, HLA-B27 and autoimmune markers if inflammatory arthropathy is suspected, and nutritional status for connective tissue support
Reduce systemic inflammation, support deep muscle relaxation around the pelvis, and improve the circulation to the SI joint and its surrounding ligamentous structures
Anti-inflammatory protocols, collagen co-factors for ligament repair, hormonal support where appropriate, and specific nutritional protocols for joint cartilage maintenance
WHAT THIS CORRECTS
Hormonal ligamentous laxity · Systemic joint inflammation · Ligament nutritional support · Stabilization plateau
WHY THIS APPROACH WORKS
We diagnose the specific dysfunction, then treat the joint, the system, and the body that supports it
Most SI joint patients have never had their SI joint specifically tested. They have had their lumbar spine tested, their hip tested, their piriformis stretched. The joint that is producing their symptoms has been adjacent to every treatment they received and never directly addressed. Identifying it, confirming it through clinical testing, treating the specific dysfunction pattern it presents, and then addressing everything that produced and maintains that dysfunction is what produces the outcomes these patients have been waiting months or years for.
✓ The specific movement dysfunction — restriction or instability — of the joint itself
✓ The biomechanical asymmetry, muscle dysfunction, and loading pattern producing the dysfunction
✓ The hormonal, inflammatory, and nutritional internal environment determining whether ligaments and cartilage can stabilize and recover
Sacroiliac joint pain is one of the most gratifying conditions to treat because the response to correct, specific treatment is so often rapid and dramatic. The right diagnosis, finally — and the treatment that follows from it.
WHO THIS IS FOR
This approach is for people whose pain...
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Is located at the base of the spine on one side, just above or beside the tailbone — the classic SI joint location that they can point to with one finger
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Has been attributed to disc disease, hip pathology, or sciatica without specific SI joint testing — and the treatment for those diagnoses has not resolved it
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Began or worsened during pregnancy, postpartum, or around perimenopause
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Developed or worsened after lumbar spinal fusion surgery — the documented post-fusion SI joint stress pattern
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They have been struggling for months or years and have never had their sacroiliac joint specifically examined — and they are ready for an answer that finally fits
TAKE THE NEXT STEP
You know exactly where it hurts. We know exactly what it is, and exactly what to do about it.
We specifically test, diagnose, and treat the sacroiliac joint — then address the system, the loading, and the body around it.
Not sure where to begin? Give us a call and we'll help you choose the best first step.