SI joint issues or sacral stress fracture? What are the differences?

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I can't answer your questions, but I will say what you're describing sounds exactly like what I recently dealt with, which ended up being a sacral sfx confirmed by MRI (x-ray was clean). Pain (lower back/glute on one side) came on during a run, limped home and I knew for sure I couldn't run another step. Sitting, sleeping and standing were perfectly normal, but couldn't hop on one leg on the affected side and walking with any type of speed hurt and felt abnormal. I'm now about 6 weeks out. Took it very easy for the first 2-3 weeks (no running/limited walking), after which I could walk again without pain. The first two weeks were especially rough but by day 15 things started rapidly improving. After 3 weeks I could hop again without pain. This week (week 6) I've done a few shorter/very easy runs without any of the same pain. I honestly have no idea how it occurred either, no one event or impact caused it, though I assume it was building. Best of luck, hope this is helpful.

Hop test = likely sfx but give it a day or two could be bad back strain or piriformis. Anti inflammatory meds and roll out butt, hammy, IT, quads and reevaluate in 1-2 days

Got a sacral stress fx.
I think it happened in the middle of a short 4 mile run where my left calf was hurting and I was running funny to compensate for it. Suddenly my right Glute got really tight and painful and I thought all it needed was rolling on a lacrosse ball or massage but it wouldn’t go away even weeks later. Weeks later I was still able to run 2-3 miles on a treadmill/soft terrain, but each time I landed on my right leg my upper right glute would hurt. Running on road hurt a lot just going 0.75 miles and turning around. I did a hop test at the doctors office on right leg and it hurt (upper right glute). MRI of pelvis confirmed sacral stress fracture

Thanks for the response and sorry to hear about your injury… I’ve been testing various movements to see what hurts/doesn’t, and I can do the following things without pain:

-body squats

-single legged squats on the effected side (this one is confusing me)

-leg lifts and flutter kicks

-supermans

-clams

Were you able to do any of these things without pain when it first happened?

The hop test was quite painful though. And like I said even walking is very painful.

SI joint issues are often caused by a misalignment of the pelvis. Have someone check your hip alignment.

Another possible injury creating pain in the upper butt/lower back to could be from the gluteus medius.

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Do you have pain doing glute bridges and deadlifting?

I had a sacral stress fracture in 2018; pain came out of no where at mile 4 and by mile 8 i had to call it an was difficult to make it home just walking. it took much longer than any other stress injury I had to heal due to the inability to do any weight bearing at all due to no access to Alter G or Lever treadmill weight support device which I used for other stress injuries of the legs. Took around 10-12 weeks to heal and I felt like Bambi for a long time learning to run again after. Wishing you good luck for this... the sudden onset of your troubles makes me nervous that you might have a bone problem on your hands.

Thanks. The positive thing is this will heal without surgery.

Except for the single legged squats, which I didn't try, I could do all of those things without pain. I didn't over do the squats because I think weighted squats with poor form prior to the injury may have been a contributing factor (adding these was the only thing I changed in the couple of months prior). That said, the movement of non-weight bearing squats didn't bring on any pain. It was really just walking, stepping off curbs and jumping.

Wow, I added weighted squats into my training about 2 months ago too. After a multi-year hiatus from lifting. Wonder if there is a link there. Though I haven’t touched a weight in the past 2 weeks.

You can rule out a sacral stress fracture with the "hop test". Hop on one foot of the side that feel injured and if it hurts to do that, it could be a stress fracture. If that doesn't bother it but other things do, it is more likely SI Joint.

Leave everything else alone and work on this little monster of a muscle called the Glute Medius. Use bands to do abduction work. Google and Youtube Glute Medius exercises.

Hop test produces pain on liftoff and landing, equally

Did you do what I said to do?

Thanks for the advice - I actually already incorporate a lot of band work that hits the gluteus medius. Did you have similar symptoms as me that turned out to be a GM issue?

Update: MRI confirmed sacral sfx

Sorry to hear. Take it easy the next few weeks and you should hopefully see rapid improvement. My Dr also suggested I take a Vitamin D supplement, so maybe something else to look into (my blood test results were normal, but he still suggested I take the supplement). I'm 8 weeks out from my injury today and have been back running for 3 weeks now. I started doing just 1 mile (slowly) and adding a 1 mile every few days to see how the body reacts. So far so good - got up to an 8 mile run/25 for the week this week. For reference I was passing the hop test by week 3. Good luck with your recovery!