Sacroiliac Joint Pain vs. Sciatica: Understanding theDifference Before Treatment

Let’s talk about back pain.
Not the kind that goes away after a good stretch, the kind that sticks around, deep in your lower back, making everything harder.
You wake up stiff, sitting becomes uncomfortable, and standing doesn’t help either. Then suddenly, there’s that moment, a sharp pain that shoots down your leg, and you think, great, I’ve got sciatica.

But here’s the thing: not all pain that travels down your leg is sciatica.
Often, it’s something else entirely, something a lot of people (and even some doctors) overlook, your sacroiliac joint.

Knowing the difference between sciatica pain and sacroiliac joint pain isn’t just about names. It’s about finding the right treatment, so you can finally stop guessing and start healing.

So, What Is the Sacroiliac Joint?

The sacroiliac joint — or SI joint — sits at the base of your spine, connecting it to your pelvis. It doesn’t move much, but it plays a crucial role in absorbing shock every time you walk, run, or stand.

When it gets irritated or misaligned, it can cause deep, nagging pain that feels like it’s coming from your lower back or hips. Some days, it even creeps down your thigh and that’s when the confusion with sciatica pain begins.

Here’s how SI joint pain often feels:

• A dull, deep ache in your lower back or buttocks
• Pain that gets worse when standing or sitting for long periods
• Stiffness when you wake up or get up from sitting
• Sometimes pain that feels like it’s to your thighs or groin area

If this sounds familiar, you’re not alone. A lot of people walk around thinking they have “nerve pain,” when it’s really their SI joint crying for help.

 Understanding Sciatica Pain

Sciatica originates from the sciatic nerve, the largest nerve in your body. It can also originate from compression to your nerve roots by your lumbar spine (low back), such as from a bulging disc. When these nerves are compressed, often by a herniated disc or spinal narrowing, you feel sharp, intense pain.

It can feel like:

• A sharp, shooting pain down one leg
• Tingling or numbness in your calf or foot
• A burning sensation that flares when you bend, sneeze or cough

If SI joint pain feels like a dull ache, sciatica typically feels like electricity, fast and sharp.

How to Tell the Difference

Here’s an easy side-by-side comparison of the typical presentation:

	Sacroiliac Joint Pain	Sciatica
Where It Starts	Pelvis or lower back	Lower spine (nerve root)
Pain Type	Dull, deep ache	Sharp, shooting, electric
Where It Travels	Buttocks, hips, thighs	Down the leg to the foot
Worse When	Sitting or standing too long	Bending, coughing, sneezing
Numbness or Tingling	Rare	Common

While they can overlap, noticing where the pain starts and how it feels is key to accurate diagnosis.

 Why Correct Diagnosis Matters

You’d be surprised how often people spend months, even years, chasing the wrong treatment.
They stretch their hamstrings, take nerve pain meds, or try every online exercise without relief. Why? Because the problem wasn’t the nerve, it was the joint.

It’s like trying to fix a leaky pipe by painting over the wall. You’ll cover it up, but the underlying problem remains.

That’s why getting the right diagnosis is so important.

At TOPS Doctors, specialists use advanced imaging and guided diagnostic injections to pinpoint the source of your pain. Once that’s clear, the treatment becomes precise, and you start to feel better faster.

Finding Relief: Sacroiliac Joint Injection

If your doctor finds that your SI joint is the troublemaker, they might suggest a Sacroiliac Joint Injection.

It’s a simple, quick, image-guided procedure. The doctor injects a mix of local anesthetic and anti-inflammatory medicine right into the joint.

What it does:

• Confirms the diagnosis
• Calms inflammation
• Reduces pain
• Helps confirm that the joint is the source

For many patients, relief comes within days. Some describe it as finally being able to move without wincing.

It’s not magic, it’s precision. The right treatment, in the right spot.

If one gets only short-term relief with the SI injections, there are other options to consider as well including PRP and RFA.

Platelet-rich plasma (PRP) for the sacroiliac (SI) joint is an autologous biologic injection that concentrates a patient’s own platelets to deliver growth factors aimed at reducing inflammation and promoting tissue healing at the SI joint.

Radiofrequency ablation (RFA) of the sacroiliac (SI) joint is a minimally invasive procedure that uses targeted thermal energy to disrupt pain-carrying nerves and provide longer-term relief for SI-mediated pain.

 

Chronic Pain Solutions: Spinal Cord Stimulator

But what if you’ve tried everything — therapy, injections, medication — and the pain still won’t let go?
That’s where technology steps in.

A Spinal Cord Stimulator (SCS) can make a huge difference for chronic pain.
It’s a small device that sends gentle electrical signals to your spinal cord, blocking pain messages before they reach your brain.

You don’t feel the shocks, just reduced pain
For many people, it’s the first time in years they can sleep through the night or take a walk without constant discomfort.

 Everyday Habits That Support Healing

Here’s something most people underestimate; the way you move, sit, and sleep matters as much as medical treatment.

A few small changes can make a world of difference:

• Move more often. Even gentle walking helps.
• Stretch every day. Keep your hips and lower back flexible.
• Watch your posture. Slouching puts strain on your SI joint.
• Build a strong core. It supports your spine better than anything else.
• Choose the right mattress. Too soft or too firm can both cause problems.

Think of it as working with your treatment, not against it.

When to See a Doctor

If your pain has lasted longer than a couple of weeks, or if it’s stopping you from living normally, that’s your sign.
Pain isn’t something to “just live with.” It’s your body asking for help.

The earlier you figure out the real cause, the faster you can heal, and the less likely it is to turn into something chronic.

The Takeaway

Here’s what really matters:

• Not all leg pain is sciatica — sometimes your sacroiliac joint can be the hidden cause.
• The difference isn’t just technical — it changes everything about how you treat it.
• A Sacroiliac Joint Injection can bring real relief and help confirm the diagnosis.
• For stubborn, long-term pain, a Spinal Cord Stimulator can make life livable again.
• And no matter what, posture, strength, and movement always matter.

So before you assume that shooting pain is “just sciatica,” pause and ask yourself:
Could it be my sacroiliac joint instead?

Because sometimes, the smallest joint can cause the biggest problems, but with the right care, you can regain your mobility and quality of life.