Have you spent weeks or months dealing with persistent hip stiffness, an annoying clicking in your hip socket, or deep groin and pelvic pain that refuses to budge? If you have tried conventional physical therapy, rest, stretching, or even cortisone injections with zero relief, it is incredibly frustrating.
At Progressive Physical Therapy and Rehabilitation, we treat more than 100 patients with SI joint dysfunction each year. When hip and groin pain doesn’t respond to standard care, the joint itself may not be the true problem. Instead, the pain can be related to the foundation directly below your spine: the sacroiliac (SI) joint and the pelvis.
Watch Michael McKindley, DPT, explain how the pelvic foundation can contribute to nagging hip, groin, and lower back symptoms.
What to Know: Hip, Groin & Pelvic Pain and the SI Joint
- Where you feel the pain isn’t necessarily where the problem starts.
We see patients who have been told they have a hip problem when the bigger issue is actually coming from the >pelvis and SI joint. Pain can show up in the hip, groin, buttock or piriformis even when the underlying problem is somewhere else. - If the usual treatment isn’t working, look beyond the painful area.
Hip bursitis, hip flexor pain, piriformis pain and other hip or groin problems can persist when the underlying pelvic mechanics haven’t been addressed. A patient can keep treating the painful area without ever finding the reason it keeps getting irritated. - The missing piece may be pelvic alignment.
The pelvis forms the foundation between the spine and the hips. When the SI joint and pelvis aren’t functioning normally, they can affect how the hip moves and how forces are transferred through the leg. Sometimes addressing the pelvic and SI joint mechanics changes the entire picture.
How the Pelvis Drives Hip, Groin, and Pelvic Pain
The pelvis is made up of three main bones: the sacrum (tailbone) in the middle and the ilium (hip bone) on each side. Your ilium is also the socket for the ball-and-socket hip joint.
Unlike an elbow or knee, where smooth bones glide freely without friction, the SI joint connects the sacrum and ilium like rigid, interlocking puzzle pieces. As Michael McKindley, DPT, explains: “The sacrum itself is actually rigid and the ilium is rigid and they fit together like a tight puzzle piece not designed to move ever—except when women give birth. This is the hinge to the birth canal.”
While the joint is inherently built for stability, it can shift. When it does, the ilium slips upward on the sacrum, resets high, and rotates. For example, if the left side shifts up and rotates forward, the right side automatically compensates by rotating backward. This rotational torsion creates a massive mechanical shift:
- Joint Jamming & Pelvic Pain: As the bones rotate unevenly, they create “excessive pressure applied or jamming of the joints together on one side,” triggering persistent pelvic, low back, and groin pain.
- Altered Hip Mechanics: Because the ilium forms the hip socket, rotation directly changes how the hip fits and tracks. As Dr. McKindley notes, “the ilium can rotate changing the congruence of the socket and that can create symptoms in the hip”—leading to deep groin pinching, stiffness, clicking, or snapping sensations.
- No Relief From Rest: Sitting or standing continues to direct body weight into the jammed, unlevel joint, which is why medications, injections, and basic rest fail to help.
Why It Is Commonly Missed on X-Rays and MRIs
If you have already had imaging done, a clean scan does not mean your pelvis is aligned. “This is the most commonly misdiagnosed problem that we see,” Dr. McKindley added. “Most physicians are not looking for this problem. Why? Because this joint is so stable it’s assumed it’s not moving anywhere, and it’s most commonly missed on X-ray or an MRI—even if you’ve had an X-ray or an MRI of your pelvis.”
Because diagnostic imaging is static, subtle rotational shifts and pelvic jams are routinely overlooked. Furthermore, many clinics treat hip and back symptoms as separate issues rather than addressing how the pelvic bones interact with the hip socket.
Restoring Alignment for Lasting Relief
Resolving chronic hip, groin, and pelvic pain requires putting the structural foundation back in place.
“Once this is corrected, the pelvis can go back into a neutral position,” Dr. McKindley added. “It’s treated quite easily and really without any pain. When rotated into a flat neutral position, the stress is taken away and thus your symptoms can be reduced. Same happens with the hip: when the ilium is rotated, the congruence or normal position of the hip is restored, so your range of motion or snapping can be reduced.”
At Progressive Physical Therapy, our physical therapists assess pelvic symmetry, mobilize the shifted joint, and restore neutral alignment to eliminate mechanical stress off your spine and hips. For patients who require specialized pelvic floor physical therapy, Anna Reiser, PT, DPT, treats patients out of our Irvine clinic.
We are Here to Help
If you have failed PT elsewhere, not seeing improvements or reduction of pain in your current exercise program, or looking to get started and need a little help with setting up a program customized for your situation, give us a call today to schedule an evaluation.