Could Your Hip Pain Actually Be Sacroiliitis?
Hip pain does not always come from the hip joint itself. In some patients, pain around the hip, buttock, groin, or lower back may actually be coming from the sacroiliac joint, also called the SI joint. When this joint becomes inflamed or irritated, it can cause a condition called sacroiliitis, which may feel very similar to hip arthritis, sciatica, or a lumbar spine problem. Sacroiliitis can be difficult to recognize because the pain often overlaps with other common causes of hip and low back pain.
Dr. Gandhi, the
spine surgeon at Pinnacle Spine & Neurosurgery, treats patients experiencing sacroiliitis throughout Central Arkansas, including Conway, Hot Springs, and Little Rock, AR.
What Is Sacroiliitis?
Sacroiliitis is inflammation of one or both sacroiliac joints. The sacroiliac joints are located where the lower spine meets the pelvis. These joints help transfer weight and force between the upper body and the legs.
When the SI joint becomes irritated, inflamed, or painful, patients may feel discomfort in the lower back, buttock, hip, groin, or upper leg. Sacroiliitis may occur on one side or both sides, although many patients feel it more on one side.
Sacroiliitis may be related to arthritis, injury, pregnancy-related changes, repetitive stress, abnormal movement of the SI joint, inflammatory conditions, or degeneration over time. In some cases, the exact cause is not obvious.
Common Symptoms of Sacroiliitis
Sacroiliitis can feel different from patient to patient. Some people describe it as a deep ache in the lower back or buttock. Others feel sharp pain near the hip or pelvis, especially with certain movements.
Common symptoms of sacroiliitis may include:
- Pain in the lower back
- Pain in the buttock
- Pain around the hip or pelvis
- Pain that may travel into the groin or upper thigh
- Pain that is worse on one side
- Pain with standing, walking, or climbing stairs
- Pain when getting up from a chair
- Pain when rolling over in bed
- Pain after sitting or standing for a long time
- Stiffness in the lower back, hips, or pelvis
Sacroiliitis can sometimes feel like hip pain because the SI joint sits close to the back of the pelvis and can refer pain toward the hip, buttock, groin, or thigh. This overlap is one reason sacroiliitis is sometimes mistaken for hip arthritis, sciatica, or lumbar disc problems.
How Do You Know If Your Hip Pain Is Actually From Sacroiliitis?
It can be difficult to know on your own whether pain is coming from the hip joint, the lower back, or the SI joint. However, there are certain clues that may suggest sacroiliitis.
Your hip pain may actually be related to sacroiliitis if:
- The pain is located more in the buttock or back of the hip than in the front of the hip
- The pain is worse when standing or walking
- The pain increases when climbing stairs
- The pain is worse when getting up from a seated position
- The pain is mostly on one side
- The pain is near the “dimple” area of the lower back or upper buttock
- The pain does not clearly match classic hip arthritis symptoms
- Hip imaging does not fully explain the severity or location of the pain
True hip joint problems often cause pain in the groin or front of the hip, especially with hip rotation. Sacroiliitis more commonly causes pain in the lower back, buttock, back of the hip, pelvis, or upper thigh. However, there can be overlap, which is why a careful evaluation is important.
How Is Sacroiliitis Diagnosed?
Sacroiliitis is diagnosed using a combination of medical history, physical examination, imaging, and sometimes diagnostic injections.
During the evaluation, your provider may ask:
- Where is the pain located?
- Does the pain travel into the buttock, groin, hip, or leg?
- What activities make it worse?
- Is the pain worse with walking, stairs, standing, or sitting?
- Have you had prior spine, hip, or pelvic problems?
- Have you tried therapy, injections, medications, or other treatments?
A physical exam may include specific maneuvers that place stress on the SI joint. If these tests reproduce your usual pain, the SI joint may be involved.
Imaging may also be used. X-rays, CT scans, or MRI may help evaluate the pelvis, SI joints, lumbar spine, or hips. However, imaging alone does not always prove that the SI joint is the source of pain.
In some cases, an image-guided SI joint injection may be used for both diagnosis and treatment. If numbing medication placed into the SI joint significantly reduces the patient’s typical pain, this can help confirm that the SI joint is a major pain generator.
Sacroiliitis Treatment
Treatment depends on the cause of the pain, severity of symptoms, and how long the problem has been present. Many patients improve with nonsurgical treatment.
Treatment options may include:
- Activity modification
- Anti-inflammatory medications, when appropriate
- Physical therapy
- Stretching and strengthening exercises
- Core and pelvic stabilization
- Heat or ice
- SI belt or pelvic support in selected patients
- Image-guided SI joint injections
- Treatment of underlying inflammatory arthritis, when present
Physical therapy often focuses on improving strength, flexibility, and stability around the pelvis, hips, and lower back. The goal is to reduce stress across the SI joint and improve function.
If inflammation is a major contributor, injections may help reduce pain and improve mobility. In some chronic cases where pain persists despite conservative treatment, additional procedures may be considered depending on the patient’s condition and diagnostic findings.
When Should I See a Spine Specialist for Sacroiliitis?
You should consider seeing a spine specialist, such as Dr. Gandhi at Pinnacle Spine & Neurosurgery, if your hip, buttock, or lower back pain is persistent, worsening, or interfering with your daily life.
Evaluation may be especially important if:
- Pain has lasted more than several weeks
- Pain keeps returning despite rest or conservative care
- You have pain in the buttock, hip, groin, or upper thigh without a clear cause
- You have difficulty walking, standing, or climbing stairs
- Symptoms are affecting sleep, work, or activity
- You have been told your hip imaging is normal, but pain continues
- You have already tried therapy, medications, or injections without lasting relief
- You are unsure whether the pain is coming from your hip, spine, or SI joint
A spine specialist can help determine whether the SI joint, lumbar spine, hip joint, or another condition is responsible for the pain.
Schedule a Consultation
Hip pain is not always caused by the hip. If you are experiencing pain in the lower back, buttock, hip, groin, or upper leg, sacroiliitis may be part of the problem.
At Pinnacle Spine & Neurosurgery, we evaluate and treat patients with lower back, hip, buttock, and SI joint pain throughout Little Rock, Conway, Hot Springs, and Central Arkansas. Our team can help determine whether your pain is coming from the sacroiliac joint, lumbar spine, hip joint, or another source. View patient testimonials to learn more about the patient experiences at Pinnacle Spine & Neurosurgery.
To learn more, you can also read our related blog: Sacroiliitis: An Overlooked Cause of Lower Back and Buttock Pain.
Contact
Pinnacle Spine & Neurosurgery today to schedule a consultation.
Frequently Asked Questions
Where is sacroiliitis pain located?
Sacroiliitis pain is usually located in the lower back, buttock, pelvis, or back of the hip. It may occur on one side or both sides. Some patients also feel pain that travels into the groin or upper thigh.
Can sacroiliitis cause groin pain?
Yes. Although sacroiliitis most commonly causes lower back or buttock pain, it can sometimes refer pain into the groin. This can make it feel similar to a hip joint problem.
Can sacroiliitis cause pain in the buttocks?
Yes. Buttock pain is one of the most common symptoms of sacroiliitis. Patients may feel a deep ache, sharp pain, or pressure-like discomfort near the lower back and upper buttock.
Can sacroiliitis cause pain down the leg?
Yes, sacroiliitis can sometimes cause pain that travels into the thigh or down the leg. However, this is not the same as classic sciatica from a compressed lumbar nerve. Because the symptoms can overlap, a careful exam is important.
What are other common causes of hip pain?
Other common causes of hip pain include hip arthritis, bursitis, tendon problems, muscle strain, labral tears, lumbar disc herniation, spinal stenosis, sciatica, and referred pain from the lower back or pelvis.
Is sacroiliitis permanent?
Not always. Some cases improve with conservative treatment, therapy, medication, injections, or treatment of the underlying cause. However, sacroiliitis can become chronic in some patients, especially if the underlying source of inflammation or joint dysfunction is not addressed.
Is walking good or bad for sacroiliitis?
It depends. Gentle walking may help some patients stay mobile and reduce stiffness. However, prolonged walking, uneven ground, long strides, or hills may worsen SI joint pain in others. If walking consistently increases pain, it may be time to seek evaluation.
Can sacroiliitis be mistaken for hip arthritis?
Yes. Sacroiliitis can be mistaken for hip arthritis because both conditions may cause pain around the hip, pelvis, groin, or thigh. A careful exam and appropriate imaging can help determine whether the pain is coming from the hip joint, SI joint, or spine.
Is sacroiliitis the same as sciatica?
No. Sacroiliitis and sciatica are different conditions. Sacroiliitis involves inflammation or irritation of the sacroiliac joint. Sciatica usually refers to pain caused by irritation or compression of a nerve in the lower back. However, both conditions can cause pain that travels into the buttock or leg, which can make them feel similar.
Can sacroiliitis come and go?
Yes. Sacroiliitis symptoms can flare up and calm down over time. Pain may worsen with certain activities, prolonged positions, inflammation, or mechanical stress across the SI joint.
