An Eye on SI Joint Pain

Updated: Feb 12, 2020

There is a steady increase of Sacroiliac (SI) Joint pain cases cropping up here at Heritage Manual Therapy. A number of my patients present some form of low back pain or pathology. Fortunately, my conservative care methods, which avoid invasive options such as surgery or injections, have been highly successful in relieving and preventing re-occurrences of these annoying and painful conditions.

The sacroiliac joint lies between the sacrum and the ilium bones of the pelvis. The joints between these bones fit and form together, one on each side of the arrowhead shaped sacrum. These three bones of the pelvis fit together like a puzzle and are joined by tension provided by a variety of very thick and strong stabilizing ligaments and muscles. This is one of the most important joints in the body, as it connects the spine to the hips. This joint absorbs impact when walking, jumping, running, and lifting, and when it is overstimulated our favorite activities are quickly halted. SI joint pain is one of the most common ailments found at yoga studios with overachieving yogis (a phenomenon with which I am personally familiar).

"Approximately 90% of the population will experience or present to a clinic with some form of low back pain/pathology. About 10% to 25% of these patients are thought to be experiencing pain from the sacroiliac joint (SI joint). The majority of SI joint pathologies affect the adult patient population.” - May 12, 2019

There are many reasons that patients encounter "SI Disfunction,“ SI joint syndrome, and SI strain or inflammation. Unfortunately, these labels are ambiguous; they don’t tell the full story as to what is going on in the patient’s body and specifically what is happening in their posture. Sacroiliac pain starts in the lower back and hips. Symptoms may worsen over time with standing, transitioning from seated to standing posture, and particularly with loading of the joints in standing yogic postures like Triconasan or Triangle Pose. SI pain can also flare up during side lying. Intervention is necessary before it becomes a chronic and daily discomfort. This article is for those who are looking for conservative interventions like structural rebalancing to gain a pain free posture. If your condition has escalated from a serious car accident, fall, tear or fracture, imaging studies, such as X-Ray, CT, or MRI may need to be ordered to help in the diagnosis or treatment of serious spine and hip related problems.

Beliefs that these issues result from normal "wear and tear,” or that "we are just getting older" or worse, that "I never fully recovered from a back strain years ago" are both common and erroneous and undermine of the intelligence of our body. We as a culture are heading into a downward spiral of habitual compensation patterns, leading towards severe tissue restrictions and a resulting loss of vitality. Ultimately, movement suffers. Some of us may be getting older, but habits speak louder than words. If you experience low back pain pathology, muscle imbalances in your back and hips are likely exacerbating the issue and making your SI pain worse.

There is a tug of war between tensional forces happening in your hip and it hurts. I often hear that one side of the back of the hip feels tight and hard while the other side feels flat and unresponsive. If you experience these sensations, this article is for you. You need structural body work, end of story! Just kidding (maybe)… Perhaps you have a collapsed arch or (a conversation for another post coming soon) or you have been told you overpronate your foot on one or both sides. Perhaps your arches are perfectly supported and there is lift through your core. Do you favor the strength or power in one leg over the other, or perhaps have preference and precision of throw or reach in one arm? Maybe the standing leg does not move through Abduction before the transfer of weight into launch during gate (walking). Consider that these imbalances in your limbs affect your back muscles and are a major feature of your low back pain. If one side is concentrically short — often described as restricted and tight — and the other side is long can you guess what is happing to the stabilizing muscle at the bottom of your spine, your beloved and sacred sacrum? Your sacrum is your temple and when there is chaos going on above from these tensional imbalances, eventually pain follows.

One of the most common sources of SI Joint pain in healthy, active individuals is the piriformis muscle, one of the deep muscles of the hip. The piriformis is considered to be the biggest and strongest of the hip because it ties together origins deep from within the skeleton to the more superficial bony landmark on the outside of the top of your leg. Piriformis is a savior of sorts and responsible for the perseverance of your SI joint. Movements anywhere along your spine trigger compensating micro adjustments of the piriformis. If the forces on the spine become imbalanced, this compensating function puts continuous asymmetrical strain on the piriformis, leading to pain.

Because the root of the problem typically lies elsewhere, simply adjusting the hips, attempting to stretch and lengthen the piriformis, or standard chiropractic adjustments will at best only provide temporary relief.

We are creatures of habit and some of us are overachieving perfectionists, so muscle imbalances are unavoidable over time. We have a multitude of props and self-care is trending. A few sessions with a competent structural strategist can set you on the path to pain-free life. Following initial corrections, the trick is to sustain your now more mobile and adaptable body. Your Structural Integrator or strategist should help you build an awareness of your body’s patterns, and careful planning to maintain healthy patterns is key. Structural body work, regardless of the techniques employed, should be tracked and documented for follow-up, and a healthy exercise and strength training regimen is an important part of maintaining structural improvement for the long term. For example, master strength trainer Bert Massey, CSCS, FMS of Adapt Fitness Austin specializes in movement and strength programs that are targeted specifically at maintaining healthy structural balance.

At Heritage Manual Therapy, we specialize in finding the root causes of structural issues such as SI Joint pain and addressing them for both the short and long term using effective, customized course of treatment.

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