You’ve been dealing with back pain for weeks — maybe even months. It’s not quite in the middle of your back, not exactly in your leg, and no matter how you try to describe it, it just doesn’t seem to fit neatly into a category. Sound familiar? For a lot of people living with this kind of pain, the culprit turns out to be one of two commonly misunderstood conditions: SI joint pain or facet syndrome. Both can cause serious discomfort, both are frequently overlooked, and both can respond very well to conservative chiropractic care — but they are not the same thing.
At Desoto Upper Cervical in Southaven, MS, Dr. David Hall and Dr. Troy Reistroffer work with patients every day who are struggling with exactly this kind of hard-to-pin-down lower back and pelvic pain. Understanding the difference between these two conditions is a great first step toward getting the right care — and finally finding the lasting relief you’ve been looking for.
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What Is SI Joint Pain?
The sacroiliac (SI) joint is where your sacrum — the triangular bone at the base of your spine — connects to the iliac bones of your pelvis. You actually have two of them, one on each side. These joints do an important job: they act as shock absorbers between your upper body and your legs, helping distribute the forces of walking, running, climbing stairs, and basically everything else you do on your feet.
When an SI joint becomes inflamed, too loose (hypermobile), or too stiff (hypomobile), it can generate a surprising amount of pain. In fact, SI joint dysfunction is estimated to be responsible for 15 to 30 percent of all lower back pain cases — and yet it’s frequently missed or misdiagnosed, even by experienced clinicians.
Common Symptoms of SI Joint Pain
SI joint pain tends to show up on one side, presenting in the lower back and buttock on either the left or the right. 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 can travel down the back of the thigh, which can make it feel a lot like sciatica.
Aggravating activities: Sitting for long periods, rolling over in bed, getting in or out of a car, climbing stairs, or standing on one leg. Many people notice the pain is worst first thing in the morning and eases up a bit with gentle movement.
Tenderness: There’s often localized tenderness right over the SI joint itself — roughly where a back pocket would sit on a pair of jeans.
Instability: Some people describe a sensation of the pelvis “giving way” or feeling unstable when bearing weight.
What Is Facet Syndrome?
Facet joints are small paired joints located along the back of the spine at every vertebral level, from the neck all the way down to the lower back. Their job is to guide and limit spinal movement, providing stability while still allowing you to bend, twist, and rotate. Each facet joint is lined with cartilage and surrounded by a fluid-filled capsule — similar to 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’s one of the leading causes of chronic neck and back pain in adults, particularly in those over 40, though it can affect younger people too — 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 neck down to the lower back. Common characteristics include:
Location: A dull, aching pain that’s usually centered near the spine itself rather than off to one side. In the lower back, it may also radiate into the buttocks or upper thighs.
Aggravating activities: Bending backward (extension) is often the biggest trigger — this is one of the key distinguishing features. Things like standing up from a chair, arching your back, or lying flat can all worsen symptoms. Facet pain frequently improves when you lean or bend forward.
Morning stiffness: Significant stiffness when you first wake up that loosens 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, a few distinguishing features help tell them apart:
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 tends to flare with single-leg activities, rolling over in bed, and prolonged sitting. Facet syndrome gets worse 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 send pain into the buttocks and thighs. However, SI joint dysfunction is more likely to also produce groin pain, while facet syndrome more commonly causes a diffuse, hard-to-pinpoint ache in the upper buttock or thigh.
Age and onset: Facet syndrome is more strongly associated with age-related degeneration. SI joint dysfunction is more common in younger adults, pregnant women, and people who have experienced trauma to the pelvis or lumbar spine.
How Are These Conditions Diagnosed?
Accurate diagnosis is everything with these two conditions. Because they share overlapping symptoms — and can even co-exist in the same patient — a thorough clinical evaluation is essential.
At Desoto Upper Cervical, Dr. Hall and Dr. Reistroffer will carefully 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 compression/distraction tests — are used to stress the joint and reproduce symptoms. For facet syndrome, extension-loading tests and hands-on palpation of the spinal joints are particularly useful.
Imaging like X-ray or MRI may be used as a secondary tool to assess joint degeneration or rule out other causes, but it’s worth knowing that imaging findings alone don’t always tell the whole story. The clinical examination is the cornerstone of diagnosis.
How Upper Cervical Chiropractic Care Can Help
Here’s the good news: both SI joint pain and facet syndrome can respond very well to conservative, drug-free chiropractic care. And at Desoto Upper Cervical, the approach goes deeper than just addressing the local joint — because spinal mechanics are interconnected from top to bottom.
The upper cervical spine — specifically the top two vertebrae, the atlas (C1) and axis (C2) — plays a central role in how the rest of your spine functions. When there’s a misalignment (subluxation) at this level, it can alter posture, shift the pelvis, and create compensatory stress throughout the lower back, SI joints, and facet joints. Dr. Hall and Dr. Reistroffer use Atlas Orthogonal and Orthospinology techniques — precise, gentle approaches that correct upper cervical subluxations without forceful twisting or cracking — to restore proper spinal alignment from the top down.
For SI joint dysfunction specifically, correcting upper cervical alignment can help normalize pelvic balance, reducing the mechanical stress that contributes to SI joint irritation. For facet syndrome, restoring proper spinal alignment takes pressure off the facet joints and helps reduce the chronic irritation that drives symptoms.
The goal isn’t just to manage your symptoms — it’s to address the underlying structural dysfunction that’s causing them 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 is a frustrating 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 evaluation at Desoto Upper Cervical 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.
Ready to find answers? Call Dr. David Hall and Dr. Troy Reistroffer at (662) 393-4848 or visit us online to schedule your consultation. You can also find us at 1134 Church Rd W, Southaven, MS 38671. We’re here 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, and it’s more common than most 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 evaluation at Desoto Upper Cervical 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. Dr. Hall and Dr. Reistroffer 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, by contrast, is often worsened by forward bending and prolonged sitting, and it more commonly produces sharp, radiating pain or numbness into the leg. Specific clinical tests can help differentiate between the two.
Can chiropractic care provide long-term relief from SI joint pain?
Many patients experience long-term relief from SI joint dysfunction with chiropractic care — especially when treatment addresses the underlying structural causes, including upper cervical misalignment that may be contributing to pelvic imbalance. While individual results vary, conservative chiropractic care is widely considered one of the most effective options available for SI joint dysfunction.
How long does it take to recover from facet syndrome with chiropractic care?
Recovery timelines depend 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 care. Dr. Hall and Dr. Reistroffer will monitor your progress and adjust your plan as needed.
Is facet syndrome the same as arthritis in the spine?
Facet syndrome and spinal osteoarthritis are closely related and are 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 when degenerative changes are present.
Do I need an MRI to diagnose SI joint pain or facet syndrome?
Not necessarily. While imaging can be a helpful 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.
How does upper cervical chiropractic care differ from general chiropractic?
Upper cervical chiropractic focuses specifically on the relationship between the top of the spine (the atlas and axis vertebrae) and the rest of the body’s structural alignment. At Desoto Upper Cervical, Dr. Hall and Dr. Reistroffer use the Atlas Orthogonal and Orthospinology techniques — highly precise, instrument-assisted corrections that are gentle and targeted, without the twisting or popping associated with traditional chiropractic. Because the upper cervical spine influences the alignment of the entire spine and pelvis, correcting misalignments at this level can have a profound effect on conditions like SI joint dysfunction and facet syndrome throughout the lower back.
