The Hidden Root of Back Pain: How Sacroiliac Subluxation and Sacroiliitis Masquerade as Sciatica

By Dr Rakesh Ayureshmi, Ayureshmi Ayurveda Wellness Centre, Kollam, Kerala, India

The Overlooked Joint That Cries in Silence

Did you know that up to 30% of chronic low back pain cases are actually caused by a tiny joint most doctors overlook? The sacroiliac (SI) joint, where your spine meets your pelvis, is often the “missing link” behind persistent low back pain and sciatica-like symptoms. Yet, it remains one of the most misdiagnosed and mistreated sources of pain. In an era where lumbar disc herniation is blamed for nearly every radiating leg pain, the subtle dysfunction of the SI joint quietly disables millions. Understanding it is not just clinical — it’s transformational for those living with daily agony.

1. The Sacroiliac Joint: The Silent Foundation of Spinal Stability

The sacroiliac joints are paired weight-bearing joints that connect the sacrum (base of the spine) to the iliac bones (pelvic wings). They bear immense load—transmitting forces between the spine and legs.

When the joint alignment is slightly disturbed, a condition known as sacroiliac subluxation, or when it becomes inflamed, called sacroiliitis, pain radiates across the lower back, buttocks, and even down the leg — mimicking sciatica.

Unlike a true disc herniation, SI dysfunction doesn’t always appear clearly on MRI. Hence, patients are often misdiagnosed, leading to years of unnecessary medication, physiotherapy, or even surgery.

A classic study published in Spine Journal (2009) estimated that SI joint pain accounts for up to 25% of chronic low back pain cases in the general population. Another 2014 study in Pain Physician emphasized the need for clinical provocation tests and image-guided diagnostic blocks to confirm the diagnosis — yet these remain underused in routine practice.

2. Why It’s So Often Misdiagnosed: The Pain That Deceives Even Experts

The pattern of SI pain overlaps with lumbar disc or nerve root irritation. The discomfort often begins at the posterior superior iliac spine—the dimple at the lower back—and radiates down to the thigh, resembling sciatica. But unlike true sciatic pain, it rarely crosses below the knee and doesn’t follow a dermatomal pattern.

However, MRI or X-ray findings of lumbar spondylosis, disc bulge, or facet degeneration often distract clinicians from the real culprit. As a result, SI dysfunction remains hidden under the shadow of more “visible” spine pathologies.

Dr. Dreyfuss et al., in a landmark Spine (1996) paper, confirmed that clinical diagnosis of SI pain based solely on symptoms is challenging, requiring specific tests like FABER, Gaenslen’s, or the Sacral Thrust test. Yet in traditional Ayurveda and marma chikitsa (vital point therapy), the “Kati and Trika marma regions” — corresponding anatomically to the SI joints — have long been recognized as centers of mechanical and pranic balance.

3. The Ayurvedic and Marma Perspective: Where Energy and Anatomy Meet

In Ayurveda, the Trika sandhi (the sacroiliac joint complex) is described as the junction of Vata’s kinetic force—the seat of movement and nervous coordination. When Vata becomes vitiated due to strain, trauma, sedentary habits, or imbalance, it accumulates here, leading to “Kati shoola” (low back pain) or “Trika graha” (stiffness of sacral region).

Marma therapy recognizes the sacroiliac region as a vital energetic crossroad where the structural, neural, and pranic currents converge.

By applying gentle, precise manipulation and activation of Trika marma, alignment and energy flow can be restored. This approach harmonizes well with modern chiropractic methods, which focus on joint adjustment and neuromuscular rebalancing.

When properly executed, marma–chiropractic integration decompresses the SI joint, realigns the pelvic girdle, and alleviates radiating pain without the need for invasive intervention.

A 2021 review in Journal of Bodywork and Movement Therapies found that manual therapy techniques targeting pelvic alignment resulted in significant improvement in mobility, reduced inflammation, and better pain control compared to standard physiotherapy.

4. Sacroiliitis: The Inflammatory Twin of Subluxation

When the joint inflammation predominates — termed sacroiliitis — symptoms may include deep dull pain, morning stiffness, and discomfort after sitting or climbing stairs.

It may be unilateral or bilateral and can be linked to autoimmune conditions like ankylosing spondylitis, psoriatic arthritis, or infections.

Ayurvedic medicine identifies this pattern as Ama-vata (toxic inflammatory disorder), where undigested metabolic wastes deposit in joints, causing stiffness and pain.

Treatment focuses on reducing inflammation and detoxifying the system using Panchakarma, medicated bastis (enemas), and anti-inflammatory herbs like Guggulu, Shallaki (Boswellia serrata), and Eranda taila.

Modern studies echo this wisdom. Phytotherapy Research (2020) reported that Boswellia extracts inhibit 5-lipoxygenase, reducing inflammatory mediators responsible for joint pain.

5. The Chiropractic-Ayurveda Bridge: Realigning the Root Cause

While modern medicine often offers steroids or painkillers for sacroiliitis, these provide only temporary relief. Chiropractic and marma-based interventions aim at correcting biomechanical dysfunction.

Pelvic alignment techniques relieve the abnormal torque on SI joints.

Myofascial release and marma activation restore neural and pranic flow.

Postural retraining, yoga, and Vata-balancing diet prevent recurrence.

A pilot clinical study (2022, Journal of Integrative Medicine) demonstrated that combining Ayurvedic Panchakarma with chiropractic manipulations led to significant improvement in chronic low back pain, outperforming either therapy alone.

This integrative path doesn’t just silence pain—it restores balance, posture, and emotional resilience. The SI joint, when aligned, becomes a symbol of groundedness and strength, both physically and psychologically.

6. Restoring the Foundation: Lifestyle and Prevention

True healing requires daily alignment of body, mind, and energy.

Avoid prolonged sitting and cross-legged posture that asymmetrically load the pelvis.

Practice Pelvic tilts, Setu bandhasana (bridge pose), and Marjariasana (cat-cow) daily.

Massage the lower back with warm Mahanarayana taila to nourish Vata and enhance flexibility.

Keep the gut clean — constipation often aggravates SI pain by increasing intra-abdominal pressure.

Ensure adequate hydration and natural sunlight exposure for bone metabolism.

When lifestyle supports structure, alignment becomes effortless and healing sustainable.

Conclusion: The Joint That Holds You Together—Literally and Energetically

The sacroiliac joint is more than a mechanical hinge; it is the axis of human movement and vitality. Misdiagnosing its dysfunction has led countless patients down paths of needless surgeries and chronic suffering. By merging ancient Ayurvedic insights with modern manual medicine, we can finally see the invisible — the subtle joint that holds the key to spinal harmony.

If your lower back pain or “sciatica” hasn’t resolved despite treatments, it’s time to look deeper — perhaps the foundation of your spine is asking for realignment.

“Not every sciatica is a disc problem. Sometimes, the real culprit hides in your pelvis — the sacroiliac joint. Discover how Ayurveda and Chiropractic together realign pain from its roots.”

#AyurvedaHealing #LowBackPainRelief #MarmaChikitsa #ChiropracticCare #SacroiliacJoint