The sacroiliac joint (SIJ) is often regarded as a controversial and enigmatic structure, serving as a source of explanation for various pain conditions and functional limitations that are otherwise difficult to categorize. This article provides a detailed examination of the SIJ’s anatomy, biomechanics, and the role of the pelvic ring. The SIJ is a synovial joint with limited mobility, crucial for weight transfer from the trunk to the hips. The article emphasizes the significance of ligamentous structures surrounding the SIJ and highlights the diagnostic and therapeutic approaches combining manual medicine and neural therapy, particularly focusing on the treatment of ligamentous structures. Techniques for the injection of ligaments in the SIJ region are discussed, offering effective conservative treatment options for sacroiliac dysfunction. The review also includes detailed examination procedures and identifies the common sources of pain associated with the SIJ.