You’ve been dealing with back pain for weeks — maybe months. It’s not quite in the middle of your back, not exactly in your leg, and no matter how you describe it, it just doesn’t seem to fit neatly into a category. Sound familiar? For many patients, the culprit turns out to be one of two commonly misunderstood conditions: SI joint pain or facet syndrome. Both can cause significant discomfort, both are often overlooked, and both respond exceptionally well to chiropractic care — but they are not the same thing.
Understanding the difference between SI joint pain and facet syndrome is an important first step toward getting the right treatment and finally finding lasting relief.
What Is SI Joint Pain?
The sacroiliac (SI) joint is where the sacrum — the triangular bone at the base of your spine — connects to the iliac bones of your pelvis. You actually have two SI joints, one on each side. These joints serve a critical purpose: they act as shock absorbers between your upper body and your legs, distributing the forces of walking, running, climbing stairs, and everything else you do on your feet.
When the SI joint becomes inflamed, hypermobile (too loose), or hypomobile (too stiff), it can generate a surprising amount of pain. SI joint dysfunction is estimated to be responsible for 15 to 30 percent of all lower back pain cases — yet it’s frequently missed or misdiagnosed, even by experienced clinicians.
Common Symptoms of SI Joint Pain
SI joint pain tends to be one-sided, presenting on the left or right side of the lower back and buttock. Here’s what it typically feels like:
Location: Pain centered just below the beltline on one side, often radiating into the buttock, hip, or groin. In some cases, it travels down the back of the thigh, mimicking sciatica.
Aggravating activities: Sitting for long periods, rolling over in bed, getting in and out of a car, climbing stairs, or standing on one leg. Many patients report that the pain is worst first thing in the morning and improves with gentle movement.
Tenderness: There is often localized tenderness directly over the SI joint — roughly where a back pocket would sit on a pair of jeans.
Instability: Some patients describe a sensation of the pelvis “giving way” or feeling unstable during weight-bearing activities.
What Is Facet Syndrome?
Facet joints are small paired joints located along the back of the spine at every vertebral level from the neck down to the lumbar region. Their job is to guide and limit spinal movement, providing stability while allowing you to bend, twist, and rotate. Each facet joint is lined with cartilage and surrounded by a fluid-filled capsule — much like the joints in your knees or fingers.
Facet syndrome, also called facet joint syndrome or facet arthropathy, occurs when these joints become irritated, inflamed, or arthritic. It is one of the leading causes of chronic neck and back pain in adults, particularly in those over 40, though it can affect younger patients as well — especially those with a history of injury or poor posture.
Common Symptoms of Facet Syndrome
Unlike SI joint pain, facet syndrome tends to be felt more centrally along the spine and can occur anywhere from the cervical (neck) region to the lumbar (lower back) region. Common characteristics include:
Location: A dull, aching pain that is usually centered near the spine itself rather than off to one side. In the lumbar spine, it commonly appears in the lower back and may radiate into the buttocks or upper thighs.
Aggravating activities: Bending backward (extension) is often the biggest trigger — this is a key distinguishing feature. Activities like standing up from a chair, arching the back, or lying flat can worsen symptoms. Facet pain frequently improves with forward flexion, like sitting or bending forward.
Morning stiffness: Significant stiffness upon waking that loosens up with movement is a hallmark of facet involvement.
Point tenderness: Pressing directly on the affected facet joints along the spine will typically reproduce the pain.
SI Joint Pain vs Facet Syndrome: Key Differences at a Glance
While both conditions can cause lower back and buttock pain, several distinguishing features help differentiate them:
Pain location: SI joint pain is typically off to one side, over the joint itself or in the buttock. Facet pain tends to be more centered on the spine.
What makes it worse: SI joint pain flares with single-leg activities, rolling in bed, and prolonged sitting. Facet syndrome worsens with spinal extension — leaning or bending backward.
What makes it better: Forward bending often eases facet pain but can aggravate SI joint issues. Light walking typically helps SI joint dysfunction but may have little effect on facet syndrome.
Radiation pattern: Both can refer pain into the buttocks and thighs. However, SI joint dysfunction is more likely to produce groin pain, while facet syndrome more commonly causes diffuse, difficult-to-pinpoint referred pain in the upper buttock or thigh.
Age and onset: Facet syndrome is more strongly associated with age-related degeneration. SI joint dysfunction is common in younger adults, pregnant women, and those who have experienced trauma to the pelvis or lumbar spine.
How Are These Conditions Diagnosed?
Accurate diagnosis is everything when it comes to these two conditions. Because they share overlapping symptoms and can even co-exist in the same patient, a thorough clinical evaluation is essential.
A chiropractor trained in spinal biomechanics will typically assess your posture, range of motion, and movement patterns, and perform a series of orthopedic and neurological tests to isolate the source of your pain. For SI joint dysfunction, specific provocation tests — such as the FABER test, Gaenslen’s test, and the compression/distraction tests — are used to stress the joint and reproduce symptoms. For facet syndrome, extension-loading tests and palpation of the spinal joints are particularly telling.
Imaging such as X-ray or MRI may be used as a secondary tool to assess joint degeneration or rule out other causes, but it’s important to understand that imaging findings alone don’t always correlate with symptoms. Clinical examination is the cornerstone of diagnosis.
How Chiropractic Care Helps Both Conditions
Here’s the good news: both SI joint pain and facet syndrome respond very well to conservative, drug-free chiropractic care — and for many patients, chiropractic treatment is the most effective long-term solution available.
For SI joint dysfunction, chiropractic adjustments are directed at restoring proper joint mobility and correcting pelvic alignment. When the SI joint is stuck or moving improperly, targeted manipulation can restore normal mechanics, reduce inflammation, and relieve pressure on surrounding nerves and tissues. Soft tissue therapy, therapeutic exercises, and stabilization training are often incorporated to address the muscular imbalances that contribute to SI joint instability.
For facet syndrome, spinal manipulation and mobilization help reduce joint irritation, restore range of motion, and decrease the protective muscle guarding that often amplifies pain. A chiropractor may also use flexion-distraction technique — a gentle, non-thrust approach particularly effective for facet-related pain — along with manual therapy and corrective exercise to support long-term joint health.
The goal of chiropractic care in both cases isn’t just to manage your symptoms — it’s to address the underlying mechanical dysfunction driving those symptoms in the first place.
Don’t Guess — Get Assessed
If you’ve been living with unexplained lower back, pelvic, or buttock pain, trying to self-diagnose based on symptoms alone is a frustrating and often fruitless exercise. SI joint pain and facet syndrome can look remarkably similar on the surface, and the right treatment depends entirely on the right diagnosis.
A thorough chiropractic evaluation can identify exactly what’s going on and get you started on a targeted care plan designed to deliver real, lasting relief — without medication, injections, or surgery.
Call our office today to schedule your consultation. Our team is ready to help you get to the root of your pain and back to living your life fully.
Frequently Asked Questions: SI Joint Pain vs Facet Syndrome
Can you have SI joint dysfunction and facet syndrome at the same time?
Yes, it is entirely possible — and more common than many people realize. Since both conditions involve the joints of the lower spine and pelvis, they can co-exist, particularly in patients with long-standing spinal degeneration or a history of trauma. A comprehensive chiropractic evaluation can identify which condition (or combination of conditions) is driving your symptoms.
Is SI joint pain the same as sciatica?
No, though they can feel very similar. SI joint dysfunction can cause pain that travels down the back of the thigh, mimicking sciatica. However, true sciatica involves compression or irritation of the sciatic nerve — most often from a herniated disc or spinal stenosis. A chiropractor can help distinguish between the two through clinical testing.
What does facet joint pain feel like compared to a disc problem?
Facet pain tends to be a dull, aching discomfort that worsens with backward bending and improves with forward flexion. Disc pain, in contrast, is often worsened by forward bending and prolonged sitting, and it more commonly produces sharp, radiating pain or numbness into the leg. Your chiropractor can use clinical tests to differentiate between the two.
Can chiropractic care fix SI joint pain permanently?
Many patients experience long-term relief from SI joint dysfunction with chiropractic care, especially when treatment includes not just adjustments but also corrective exercises and postural rehabilitation to address the underlying causes of joint instability. While individual results vary, chiropractic is widely considered one of the most effective conservative treatments available for SI joint dysfunction.
How long does it take to recover from facet syndrome with chiropractic care?
Recovery timelines vary depending on the severity of joint degeneration, how long the condition has been present, and the patient’s overall health and activity level. Many patients begin to notice meaningful improvement within four to eight weeks of consistent chiropractic care. Your chiropractor will monitor your progress and adjust your treatment plan as needed.
Is facet syndrome the same as arthritis in the spine?
Facet syndrome and spinal osteoarthritis are closely related and often used interchangeably. When the cartilage within the facet joints breaks down over time due to age, wear and tear, or injury, the resulting inflammation and joint irritation is what we call facet syndrome or facet arthropathy. Chiropractic care can help manage symptoms and improve joint function even in the presence of degenerative changes.
Do I need an MRI to diagnose SI joint pain or facet syndrome?
Not necessarily. While imaging can be a useful supplementary tool, both SI joint pain and facet syndrome are primarily clinical diagnoses — meaning a skilled clinician can identify them through examination and specific orthopedic tests. Many patients receive accurate diagnoses and effective treatment plans without ever needing advanced imaging.
For More Information
We would be happy to answer any questions you have about this article, general spinal health or your specific situation. To discuss your symptoms and concerns call (208) 656-8883.
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Orchard Chiropractic
160 E. Valley River Drive #3
Rexburg, Idaho 83440
How We Are Different
Dr. Orchard is a unique Rexburg chiropractor who specializes in difficult cases that have not responded to other care. All treatment plans are highly individualized based on your specific history, needs and goals.
Areas We Serve
We are located in Rexburg and serve the communities that reside in zip codes 83440, 83460, 83442, 83448, and 83445. However, we see patients from a large radius around Rexburg which include Brigham Young University, Rigby, Sugar City, and St. Anthony because of the unique, customized treatment options we offer.