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Sacroiliac joint dysfunction is complex with numerous etiologies. Proper stabilization of the sacroiliac joint allows for effective transfer of loads between the trunk and the lower extremities during static and dynamic activities, while maintaining a freely nutating motion. A loss of integrity of the stabilizing soft-tissue structures inhibits the ability to transmit axial loads and creates uneven stresses on the joint and surrounding tissues. Hypermobility of the sacroiliac joint can be caused by ligamentous instability or secondary to adaptive biomechanical changes and increased stresses affecting the joints of the pelvis. This article examines the current evidence related to the loss of stability on sacroiliac joint pain and dysfunction. A review of exercise goals for the hypermobile joint is included., (© 2019 American Academy of Physical Medicine and Rehabilitation.)