Is It Your SI Joint or Your Lower Back? How to Tell the Difference in Edmonton

Pain on one side of the lower back can be confusing.

Some patients are told it’s a “disc.”
Others hear it’s the “SI joint.”
Some are advised it’s muscular.

The challenge is that symptoms often overlap.

Research suggests that accurately diagnosing the exact source of low back pain can be complex, particularly in cases classified as non-specific (Foster et al., 2018). However, clinical examination patterns can help guide management decisions.

At Dr. Harman Braich, Chiropractor, operating out of Creekwood Physiotherapy in Southwest Edmonton, assessment focuses on movement patterns, load tolerance, and symptom behaviour — not just labels.

This article explains:

• What the SI joint is 
• How SI joint pain differs from lumbar spine pain 
• Why imaging alone rarely provides clarity 
• How a movement-based plan may help 

What Is the SI Joint?

The sacroiliac (SI) joint connects the sacrum to the ilium of the pelvis.

It functions primarily in load transfer — especially during:

• Walking 
• Running 
• Single-leg stance 
• Rotational sports 

The SI joint allows minimal motion, but that small movement plays a meaningful role in force distribution between the spine and lower limbs.

How Common Is SI Joint Pain?

Estimates suggest that the SI joint may contribute to 15–30% of persistent low back pain cases (Laslett, 2008).

It is more commonly suspected in:

• Pain localized to one side 
• Pain aggravated by prolonged standing 
• Postpartum individuals 
• Individuals with prior lumbar fusion 
• Runners or asymmetrical athletes 

However, definitive diagnosis requires careful clinical assessment.

Typical SI Joint Pain Pattern

SI joint-related symptoms may include:

• Pain just below the belt line 
• Discomfort localized to one side 
• Pain when transitioning from sitting to standing 
• Tenderness over the posterior pelvis 
• Symptoms aggravated by single-leg loading 

Pain may refer into the buttock or posterior thigh but typically does not extend below the knee.

Provocation test clusters (Laslett et al., 2005) may increase diagnostic confidence when multiple tests reproduce familiar symptoms.

Typical Lumbar Spine Pain Pattern

Lumbar spine pain may present with:

• Central low back discomfort 
• Pain with sustained flexion or extension 
• Morning stiffness that improves with movement 
• Possible radiating symptoms into the leg 
• Increased pain with prolonged sitting 

Disc-related irritation may involve nerve sensitivity, including numbness or tingling.

However, research suggests imaging findings such as disc bulges are common in asymptomatic individuals (Brinjikji et al., 2015). Structural changes alone do not confirm pain source.

Why Imaging Rarely Settles the Debate

Systematic reviews suggest degenerative spinal findings increase with age — even in people without symptoms (Brinjikji et al., 2015).

MRI may show:

• Disc protrusions 
• Facet degeneration 
• Joint changes 

Yet none of these findings automatically indicate the source of pain.

Clinical correlation remains essential.

The Role of Movement Assessment

Differentiation often comes from:

• Symptom behaviour during repeated movements 
• Response to load transfer testing 
• Tolerance to single-leg stance 
• Directional preference patterns 
• Hip mobility assessment 

For example:

• Pain reproduced with SI provocation tests and single-leg load suggests pelvic load transfer sensitivity. 
• Pain centralizing with repeated lumbar extension suggests discogenic involvement. 

Patterns matter more than isolated findings.

Why the Distinction Matters

Although early management principles overlap — mobility restoration, endurance training, load management — exercise selection and emphasis differ.

For SI Joint-Related Sensitivity:

• Gluteal strengthening 
• Load transfer training 
• Single-leg stability work 
• Pelvic control drills 

For Lumbar Disc Sensitivity:

• Direction-specific mobility 
• Core endurance progressions 
• Gradual spinal loading 
• Activity modification during acute flare 

A tailored Rehabilitation & Exercise Therapy plan improves precision.

The Role of Chiropractic Care

Manual therapy may provide short-term relief in certain cases of both SI joint and lumbar spine pain (Paige et al., 2017).

Within a broader strategy, Chiropractic Care may help:

• Improve joint mobility 
• Reduce pain sensitivity 
• Facilitate movement retraining 

However, long-term outcomes depend heavily on progressive loading and endurance development.

When Is Additional Care Needed?

Consider further evaluation if symptoms include:

• Progressive neurological changes 
• Persistent leg weakness 
• Loss of bowel or bladder control 
• Trauma-related onset 

Structured care pathways exist for:

• Motor Vehicle Accident Care 
• Workers’ Compensation Board (WCB) cases 

These involve staged rehabilitation and documentation protocols.

What About Athletes?

Rotational sports — golf, hockey, soccer — may stress both lumbar and pelvic structures.

As a former captain of the University of Alberta Golden Bears soccer team, Dr. Braich understands the performance demands placed on the spine and pelvis.

Athletic populations often require:

• Rotational control training 
• Load symmetry correction 
• Hip mobility restoration 
• Progressive return-to-sport planning 

Label accuracy supports better programming.

Practical Signs It May Be SI Joint–Related

• Pain when rolling in bed 
• Pain with long periods of standing 
• One-sided buttock discomfort 
• Relief when sitting 

Practical Signs It May Be Lumbar Spine–Related

• Pain aggravated by prolonged sitting 
• Symptoms worsening in the morning 
• Pain central in the spine 
• Leg symptoms below the knee 

These are patterns — not absolutes.

Localized Care for Southwest Edmonton Residents

Dr. Harman Braich, Chiropractor proudly serves:

Creekwood Chappelle & Chappelle Gardens
Ambleside, Keswick & Windermere
Glenridding Heights & Glenridding Ravine
Heritage Valley, Paisley, Desrochers & Jagare Ridge
Rutherford, Callaghan, Allard, Cavanagh & Blackmud Creek
Richford, Macewan & Blackburne

Operating out of Creekwood Physiotherapy in Southwest Edmonton, care emphasizes accurate assessment and long-term function.

Final Thoughts

SI joint pain and lumbar spine pain often overlap.

The difference lies not in the label — but in how symptoms behave under load.

Research suggests that movement-based rehabilitation combined with targeted manual therapy may improve outcomes in persistent low back conditions (Foster et al., 2018).

If you are unsure where your pain originates, a structured assessment may provide clarity.

Visit the All Services Page to learn more or book directly at braichchiro.com.

 

Research & References

Brinjikji W, et al. Imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015.

Foster NE, et al. Prevention and treatment of low back pain: evidence and challenges. Lancet. 2018.

Laslett M. Evidence-based diagnosis and treatment of the painful sacroiliac joint. J Man Manip Ther. 2008.

Laslett M, et al. Clinical diagnosis of sacroiliac joint pain: provocation test cluster. Spine. 2005.

Paige NM, et al. Spinal manipulative therapy for acute low back pain. JAMA. 2017.