Is Your Hip Pain from Arthritis or Sacroiliac (SI) Hip Pain?

Hip pain is a common condition, especially with advanced age or repetitive stress on the joints that support the spine and legs.

What makes diagnosis tricky is that several structures sit close together in the lower back and pelvis. When one of them becomes irritated, you may feel pain in nearly the same spot.

At Palm Beach Pain Institute, Dr. Marcie Merson and our interventional pain team see this overlap every day. Two frequent culprits are hip arthritis and sacroiliac (SI) joint syndrome. Their symptoms can look almost identical, but their causes and treatments differ.

Getting the diagnosis right matters because treating hip arthritis and SI joint syndrome the same way rarely leads to lasting relief.

What causes hip arthritis?

Hip arthritis typically develops when the cartilage that cushions the ball-and-socket joint wears down. Over time, this joint can become inflamed, stiff, and painful.

Age-related degeneration is the most common cause, but injury, repetitive strain, structural abnormalities, and inflammatory conditions can all contribute.

People often describe hip arthritis as a deep ache in the front of the hip or groin. The pain may worsen after sitting, first thing in the morning, or when rotating the leg.

What causes sacroiliac joint pain?

The sacroiliac joints are just below the lower spine, connecting the sacrum to the pelvis. These joints move only slightly but absorb significant forces with every step, twist, or lift. When they become irritated, inflamed, or overly stressed, sacroiliitis or SI joint syndrome can develop.

Common causes include repetitive strain, differences in leg length, traumatic injury, pregnancy-related ligament changes, and types of arthritis that affect the pelvis. Ironically, both too much and too little motion in the joint can lead to pain.

Unlike hip arthritis, SI joint pain usually affects the lower back, upper buttock, or back of the hip. It often worsens with getting up from a chair, climbing stairs, or standing for long periods.

How to tell the difference: Location and pattern matter

Even though these conditions can mimic each other, a few clues often help distinguish them.

If arthritis is the issue, pain typically:

• Feels deep in the groin or front of the thigh
• Shows up during weight-bearing movement in the hip
• Causes stiffness or reduced range of motion

When SI joint dysfunction is responsible, pain more often:

• Sits at the back of the hip, the buttocks, or the lower back
• Feels worse when standing, walking uphill, or moving from sitting to standing
• Radiates into the hip or groin but rarely below the knee

Because these patterns overlap, a thorough physical exam and targeted testing are essential. Dr. Merson evaluates how each joint moves, where the pain starts, and whether certain motions trigger or relieve your symptoms.

Why the correct diagnosis changes your treatment options

Hip arthritis and SI joint dysfunction may feel similar, but their treatments aren’t interchangeable, which is why identifying the root cause is crucial.

Hip arthritis treatments

Whether you have osteoarthritis, rheumatoid arthritis, or post-traumatic arthritis, Dr. Merson can identify the type, target the source, and get your damaged joint moving again. Your treatment may include:

• Physical therapy to strengthen the surrounding muscles
• Hot and cold therapy
• Anti-inflammatory medication to ease joint irritation
• Injections to reduce inflammation inside the hip joint

Complicating matters, more than 100 types of arthritis can attack any joint — including spinal arthritis, which can also cause hip pain — each requiring different approaches. Although there’s no cure for arthritis, we can slow the progression and ease the pain. 

SI joint syndrome treatments 

Early treatment focuses on reducing irritation and improving daily movement. That may include:

• OTC medications
• Education about posture and activity habits
• Lifestyle changes that reduce joint stress
• Focused stretching to ease tight muscles around the pelvis

Once pain settles, we shift toward stabilizing the SI joint:

• Core strengthening
• Pelvic girdle stabilization
• Osteopathic manual therapy

If symptoms persist, Dr. Merson may shift to more advanced procedures:

• Corticosteroid or anesthetic injections to calm inflammation
• Radiofrequency ablation to temporarily interrupt pain signals for longer-lasting comfort

If your hip pain is stubborn, inconsistent, or not responding to what you’ve tried, the underlying issue may not be what you think. Whether the problem is arthritis, SI joint dysfunction, or both, the right diagnosis is the first step toward meaningful relief.

Dr. Merson brings years of experience evaluating and treating complex hip and pelvic pain. Her goal is to pinpoint the source of your discomfort and tailor a treatment plan to your needs.

Call Palm Beach Pain Institute in Delray Beach, Florida, or schedule an appointment online to find out what’s causing your hip pain — and take your first step toward lasting comfort and mobility.