7 signs that your low back pain might be coming from your pelvis.

I’ve been a physiotherapist for more than 20 years, the majority of that working as a specialist musculo-skeletal (MSK) physio in both the NHS and private practice. So I have seen a lot of people with back pain. A lot. A recent large study showed that 15% of people in Western Europe had low back pain.

One of the major problems with low back pain is that it is very hard to diagnose accurately. You might say “but I’ve had an MRI or CT scan which shows a “slipped disc”” (I hate that term, discs don’t slip). The problem with this diagnosis is that the scan may show a worn, prolapsed or herniated disc, but that doesn’t prove that your pain is being caused by the disc. When scans have been done on the low back area for reasons other than back pain, up to 75% of people with no back pain are seen to have disc degeneration with some having disc bulges. It’s known as a false positive. If your scan shows compression of a nerve root, and you have pain, weakness and/or numbness in the area of your leg connected to that nerve root, then the diagnosis is more clear.

Much of what we classify as low back pain can come from 3 main structures, the lumbar spine, sacro-iliac joints (SIJ) and the hip. They are closely linked with each other and the known patterns of pain associated with each overlap. A problem in one structure can also lead to a secondary problem in another, perhaps due to an increase in spasm in the muscles which surround the joints.

Common symptoms of sacro-iliac joint dysfunction:

  1. Left or right low back pain
  2. Pain worsens in sustained positions (standing, lying, sitting)
  3. Walking is painful, especially up hills or stairs
  4. Groin and inner thigh pain
  5. Buttock and back of leg pain (sciatica)
  6. Sudden need to urinate (urinary urgency)

People sometimes complain that their leg feels unstable or weak

Simply put, the sacro-iliac joints (there are 2), are where the pelvis joins to the spine. They are large joints, supported by strong ligaments and a number of muscles. The joint surfaces have ridges and valleys lining up to help maintain stability. The joint moves a little, mainly rotating forward and backwards a few degrees. Problems can occur when the joints move too far. The ridges and valleys then become “stuck” out of their normal alignment. This can cause pain and inflammation of the joint, with spasm of local muscles. These imbalances can then cause secondary problems in the lumbar spine and other areas.


Unfortunately, many healthcare professionals are not trained to diagnose or treat the SIJ. SIJ problems do not commonly show up on x-ray or MRI, so many people with SIJ dysfunction are treated for lumbar spine or other problems, without treating the primary problem. Many of these treatments fail, leaving the patient with ongoing pain.

Correcting the joint malalignment is the priority in treatment, as well as re-education of the supporting muscles.

So, what are the 7 signs that my back pain might be coming from my pelvis? I only see 6 symptoms listed.

The 7th sign is that you have had treatment for your low back pain which has failed.

I have seen hundreds of people with SIJ malalignment, the majority of whom respond well to joint realignment and exercise programmes.

In future posts we will look at the anatomy and biomechanics of the region, causes and types of SIJ dysfunction, and how to treat the condition.

Russell Baragwanath, Chartered Physiotherapist