SI joint pain in runners is often a problem for our patients who sit most of the week but also enjoy running. Frequently, a new patient will walk into our office complaining of “back pain” while pointing to their sacroiliac joint. When I ask about their exercise routine and they tell me they’re a runner, I know exactly where this conversation is headed.
Runners with ongoing back pain located to one side and just below their belt level are usually dealing with SI joint pain. The sacroiliac joint can feel like low back pain, just lower and usually on one side only.
These two joints, one on each side, are in heavy use when you run. Ideally, they glide back and forth during a normal stride. If the joint becomes stuck, or just isn’t moving the way it’s supposed to, you’ll start to “swing” that side of your pelvis in order to run.
That swing can lead to back pain and even hip, knee, or ankle pain on the side of the malfunctioning joint. SI joint pain is sure to follow as your body compensates for the poor mechanics. You have several options when dealing with SI joint pain, and the same treatment works great as a prevention measure.
SI joint pain in runners begins with poor mechanics
When I run a 5k or half marathon and get to watch the stride of hundreds of runners, I can spot the ones with SI joint problems almost immediately. The pelvis doesn’t move symmetrically and you can see the swing in action.
If we sat down and studied how the pelvis moves, you’d see one side glide up and down cleanly while the other side looks stuck and doesn’t match. It’s only a matter of time before pain begins for runners with these mechanics. This is how SI joint pain in runners starts.
The one thing almost no other chiropractor checks: your leg length
Here’s where we do things differently than nearly every other chiropractor in Houston. When a runner comes in with one-sided low back pain that keeps coming back no matter how much they stretch, one of the first things I do is a leg length evaluation.
Most offices skip this entirely. They adjust your back, you feel better for a few days, and then the pain returns because the real driver was never found. A leg length discrepancy, even a small one, changes how your pelvis sits and how those SI joints glide with every single stride. When you’re running, you’re loading that imbalance thousands of times per mile. Your body compensates, one side of the pelvis swings, and the SI joint takes the beating.
I check for this on x-ray so I’m measuring your actual alignment instead of guessing by feel. Some discrepancies are structural, meaning one leg bone is genuinely longer. Others are functional, caused by pelvic rotation or a stuck joint. The fix is completely different depending on which one you have, and you can’t tell them apart without looking. Picture a Greenway Plaza attorney who runs Memorial Park three mornings a week and can’t figure out why the left side of their back flares up every time. Nine times out of ten, nobody ever measured their legs. That’s the detail that ends the every-few-weeks adjustment cycle instead of just renting you relief.
SI joint pain in runners continues due to tight hip rotators
If your job keeps you sitting all day, both your hamstrings and your hip rotator muscles like the piriformis get tight. Add running on top of that and the problem compounds. Here’s what you can do about it.
Stretch your hip rotators. These are a fan of muscles underneath your glutes. One stretch you can do right at your desk is the seated hip rotator stretch. (Video below.) Another simple one is to lie on your back, pull one knee up to your chest, then slowly draw it across your body. It feels like a glute stretch, but it reaches deeper than that.
Stretch consistently and hold each one for several minutes to make real gains in flexibility. Patients who stretch for just 10 to 30 seconds feel some initial relief but won’t improve their flexibility much beyond a couple of minutes.
Foam roll the right spots. Most runners roll their hamstrings and quads but completely ignore their hip rotators and SI joints. Move that foam roller a little higher and hit the problem areas. Cross one foot over the opposite knee to really zero in on the hip rotators.
Foam rolling works before and after a run. Before, it warms up the muscles. After, it speeds up recovery.
Get adjusted. Chiropractors get stuck joints moving again. Adjusting the SI joints is a regular occurrence in our office, needed most often by runners and new moms. If stretching and foam rolling aren’t cutting it, a couple of adjustments usually make the difference.
Where our treatment goes further
Adjusting the joint is step one, but we don’t stop there like a lot of offices do. Once we’ve measured your leg length and restored the SI joint, we go after the tissue and disc pressure driving the whole pattern.
For runners whose joints and discs have taken years of compression from sitting plus repetitive impact, spinal decompression gently opens up the space between vertebrae and pulls pressure off the discs and nerves. Then we bring in PEMF and HEIT for the chronically tight hip rotators and low back muscles that manual work alone can’t reach. PEMF drives recovery at the cellular level. HEIT runs on a similar electromagnetic principle but at much higher energy and deeper penetration, so we can get into that dense hip musculature that keeps pulling your pelvis out of position after every long run.
Long term relief of SI joint pain in runners
For lasting relief, get on a consistent adjusting plan. This usually starts with more frequent visits early on, then tapers to less and less often as the mechanics of your SI joint improve.
Managing the right movement of your SI joints changes everything across a range of exercises. Runners with this problem struggle with squats, lunges, and even lifting a leg to tie their shoes. SI joint pain in runners is completely avoidable if you start now and stay consistent with preventative care.
If one side of your low back keeps flaring up on your runs, don’t keep chasing it with stretches alone. We have three Houston locations in the Galleria, Greenway Plaza, and Memorial City. Schedule an appointment and let’s start with the one measurement almost nobody else takes.