Hurts to Sit with Sacroiliac Joint Pain? Here’s How to Feel More Comfortable

Sacroiliac joint pain, or low back or butt pain, can be — well, a pain in the butt. It can make walking, climbing stairs, sitting, sleeping, running — everything — uncomfortable if you don’t know how to treat it. Although sacroiliac (SI) joint pain can be challenging and inconvenient, you don’t have to just live with it. It’s very treatable, and it’s more common than you may think, affecting as much as 30% of people with low back pain. “It’s pretty common, especially among my pregnant or postpartum patients,” says Heather Broach, PT, DPT, a physical therapist at Hinge Health. 

SI joint pain can be related to a lot of factors, including pregnancy, ankylosing spondylitis, and more, and it can affect people's lives in a lot of different ways. The most common effect it has on people, though, is how uncomfortable it can be to sit with SI joint pain. And if you have to sit for long periods of time — say, for work — this can make for a long day. 

Here, learn what you can do to manage SI joint pain with sitting and how to prevent it from interfering with your day. 

Common Causes of Sacroiliac Joint Pain 

Sacroiliac joint pain, also known as sacroiliitis, is due to inflammation and pain in one or both of your sacroiliac joints. These are the joints that connect your sacrum (the base of your spine) with your ilium (the top part of your pelvis). They support your trunk and upper body when you stand or walk, and help take pressure off of your spine.

There are many things that can cause inflammation of the sacroiliac joint. Some of the most common ones include:

• Pregnancy. “When you’re pregnant, your body releases a hormone called relaxin that relaxes your muscles, joints, and ligaments during pregnancy,” explains Dr. Broach. This helps your pelvis widen and opens your birth canal so baby can come out. So relaxin is a very good thing, but it does stay in your body for a while after pregnancy, which leaves your pelvis more mobile than usual, Dr. Broach adds. “This means that normal postpartum movements like leaning over a crib to pick your baby up or toting them around on your hip puts more pressure on the SI joints because your ligaments are still a little loose.”

• High-impact sports. SI joints are strong and can handle a lot, but high-impact activities can put extra strain on them and contribute to inflammation in some cases. “We see this a lot in gymnasts and cheerleaders,” notes Dr. Broach. It can also happen from an impact injury: “You fall and land on one leg, and that impact puts a lot more force on the SI joint than it’s used to.”

• Arthritis. Different forms of arthritis — including osteoarthritis, ankylosing spondylitis, and psoriatic arthritis — can affect the sacroiliac joints (among others). In the case of osteoarthritis, the cartilage that cushions joints gradually changes and loses volume, which may contribute to pain in the SI joint for some people. In other instances, arthritis can cause inflammation in the SI joint or the joints of the spine and contribute to low back and hip pain or stiffness.

Sitting With SI Joint Pain

You may notice SI joint pain when sitting. Maybe you only notice it when sitting, or perhaps your symptoms just become more noticeable in a seated position. It may get worse if you sit for a long period of time, or if you move from a sitting to a standing position. “You sit on your sacrum (just above the tailbone), which often pushes on one side of the pelvis more than the other. This allows the other side to drop down and can put some added strain on ligaments,” explains Dr. Broach. 

There’s no right or wrong way to sit, but if you have increased SI pain when seated, there are a few things you can try to help ease the pain:

• Get a little lumbar support. An easy way to do this is to roll up a towel and prop up the sore side of your body with it, says Dr. Broach. Another option is to use a lumbar pillow which supports your low back and can help prevent and alleviate pain. 

• Adjust the height of your chair. If you work at a desk, it may help to adjust the height of your chair so that your hips sit level with or just slightly higher than your knees. This can reduce back discomfort for many people. 

• Use a footstool. This allows your feet to rest on something, so they don’t dangle which may increase strain on the SI joints. It also makes it easier to switch positions while you sit. You can alternate between propping your feet up and resting them on the ground, which can give some muscles a break and prevent soreness from setting in. 

• Use a cushion. If you like to sit on the floor — or find yourself there frequently — a cushion can help. You could also come to a kneeling position, resting the backs of your thighs on your calves with a cushion between the two. This helps you sink back and rest on your sit bones (bottom of the pelvis) and lengthen your spine for a good stretch. 

• Keep it moving. Sore joints love movement since it helps prevent pain from setting in, and it alleviates joint aches if you get sore from being in the same position for a long time. Try to get up periodically to stand or stretch. (Note: It helps to distribute your weight evenly across both feet when standing up or sitting down to avoid irritating an already inflamed SI joint.) If possible, a standing desk can help a lot, or you can prop a laptop on a cabinet for a few hours of your day. Even shifting how you’re sitting can make a big difference. 

Standing With SI Joint Pain

While sitting can aggravate SI joint pain for some people, standing may have the same effect on you. “Standing can definitely irritate SI joints, especially if you have to do it for a long time or tend to consistently put more weight on one side of your body,” says Dr. Broach. This is particularly common with new parents who get used to holding a baby on their hip. “This can affect the balance of the SI joint, especially if the ligament is very lax, say, shortly after delivery,” explains Dr. Broach.

There’s no right or wrong way to stand, but if you have worsening SI joint pain while standing and you also tend to bear most of your weight on one side of your body, consider whether you’d be able to stand with your weight evenly balanced across both feet for a period of time. If you notice that helps, how might you make a plan to be mindful of your standing habits? It also helps to try and change your position frequently so that you’re not standing one way for too long, Dr. Broach advises.

Sleeping With SI Joint Pain

You may notice that your SI joint pain gets a little worse at night. This is usually because you put weight on the SI joint when lying down, or because changing positions in your sleep irritates it, says Dr. Broach. Another factor: You're not active in your sleep, so inflammatory chemicals can pool in the joints and make you feel stiffer when you first wake up, before you start moving around. This is particularly true for some people with arthritis.

If you notice worsening SI joint pain when sleeping, here are some tips you could try:

• Avoid lying on the side of your body that’s affected. This can put extra stress on the affected SI joint and make it more challenging to get on top of your pain when you wake up. Try to sleep on your less painful side if possible. If you find that you roll to your affected side in your sleep, you can place pillows behind your back to prevent that. Some people also find that placing a pillow between the legs decreases back discomfort when they wake up. 

• Pump up the pillows. If you’re a back sleeper, rejoice. Research shows that back sleeping can be a very friendly position for people with SI joint pain — it tends to put less pressure on the joints. Placing a pillow underneath your knees and thighs may put even less pressure on the SI joint. 

• Consider your mattress. Everybody is different. Some people with SI joint pain do really well with a softer mattress; others prefer something more firm. Generally speaking, most people with SI joint pain shoot for the Goldilocks rule: not too soft and not too hard, but just right. Not sure if your mattress is working for you? Try placing a piece of plywood under your mattress or putting your mattress on the ground. If you notice an improvement in your pain, you may do better with a firm mattress. To test whether you do best with a softer mattress, sleep with a mattress topper for a few nights. 

Keep in mind that you may have to go through a little bit of trial and error to find the best sleep position that works for you and your SI joint. “It can change, too: You may find that what worked for you last week isn’t working so well this week,” says Dr. Broach. “But once you find the right position, it’s like floating in water — it feels comfortable and easy.”

There are a number of simple exercises you can do that can help relieve SI joint pain. The given exercises recommended by Hinge Health physical therapists strengthen and stretch the lower back and the structures around the SI joints, making you more resilient to pain and discomfort when sitting, standing, sleeping, and going about your day. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Other Treatments

If your SI joint pain persists, your doctor may recommend any of the following for SI joint pain relief:

• Over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for SI joint pain. It’s important to make sure that you are safely able to take these medications, based on your medical history.

• Physical therapy. A physical therapist can teach you range of motion and stretching exercises to help keep your low back and hips more flexible. Strengthening exercises can also help protect your SI joint and take weight off of it. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

• Pelvic belts. These are intended to help stabilize the pelvis and may help relieve pain in the low back and pelvic region. Pelvic belts are sometimes recommended if your SI joint pain flares up during pregnancy.

• Shoe inserts. Sometimes, people have one leg that is shorter than the other — and in many cases this goes unnoticed. Sometimes, though, this can contribute to extra pressure being put on one of the SI joints. A shoe insert in the shorter limb can help level the playing field and reduce pressure. 

Keep in mind that if your SI joint pain is due to arthritis like psoriatic arthritis or ankylosing spondylitis, you’ll want to work with a rheumatologist on a treatment plan. You may benefit from medication to address pain or treat the underlying inflammation, such as biologics.

PT Tip: Be Leg Aware

Putting more weight on one leg than the other — sometimes due to standing habits, carrying heavy objects or children around, or getting in and out of a car — can cause or exacerbate SI joint issues. “As you go through your daily routine, check in with yourself periodically to see how you’re standing,” Dr. Broach advises. As you cook dinner, are you putting more weight on one leg? When you bend down to pick something up off of the floor, do you balance on one leg instead of both equally? When you get out of a car, do you put your weight on one foot first instead of distributing your weight evenly across both feet? Taking note of these habits can give you insight into areas where you can make small adjustments to manage SI joint symptoms and prevent them from flaring in the future.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Barros, G., McGrath, L., & Gelfenbeyn, M. (2019). Sacroiliac Joint Dysfunction in Patients With Low Back Pain. Federal Practitioner, 36(8), 370–375.

2. Cary, D., Briffa, K., & McKenna, L. (2019). Identifying relationships between sleep posture and non-specific spinal symptoms in adults: A scoping review. BMJ Open, 9(6). doi:10.1136/bmjopen-2018-027633

3. Sacroiliitis. (2018, March 13). Cleveland Clinic https://my.clevelandclinic.org/health/diseases/17736-sacroiliitis

4. Pfeiffer, J., Kobayashi, Y., & Gottschalk, A. W. (2022). Sacroiliac Joint Pain in the Athlete. Ochsner Journal, 22(1), 6–9. doi:10.31486/toj.21.0152

5. Why Is My Sacroiliac Joint Pain Worse at Night? (2022, February). Weill Cornell Medicine. https://comprehensivespine.weillcornell.org/why-is-my-sacroiliac-joint-pain-worse-at-night-2/