SI Joint Pain

If you experience pain when twisting at the waist or bending over, you may be suffering from Sacroiliac joint pain. The two sacroiliac joints are often not recognized or appreciated by most people because of their “bigger brother” located next door:  the lumbar spine.  Meanwhile, the true importance of the SI joints cannot be understated.  When these joints become symptomatic you will quickly realize their contributions to your normal motion.
These joints are the only two bony connections between the entire lower spine and the pelvis and lower extremities.  Think about that for a minute: that means all the weight of your spine, shoulders, head, arms and anything you are holding in your arms has only two small joint surfaces to technically bare the forces of all that weight in the SI joints!  That is just one reason why any disturbance of the sacroiliac will be painful and considerably impair your ability to perform normal movements without pain.

Found on the backside of the pelvis just above the large and strong buttocks or gluteus maximus muscles, the two SI joints can be located when examining just below the beltline on the back of the pelvis.  There you will feel one bony pump on each side approximately 4 to 6 inches apart.  Those bony landmarks are called the posterior superior iliac spines (PSIS) and the sacroiliac joints are located just inside of the PSIS.  Often these landmarks are tender to touch and swollen.

The sacrum is a larger triangle shaped bone that is positioned below the lumbar spine and between the two SI joints.

Why is SI Joint Difficult to Treat?

SI joints are vital connections that allow three-dimensional motion of the pelvis, hips and low back.  Motions such as twisting, bending and squatting are great examples of how the SI joints naturally assists the function of the entire lower extremity, pelvis and low back.  In conjunction with the one pubic symphysis, located at the front of the pelvis, painfree function becomes effortless.

Understanding the sacroiliac joint motion and pathologies is not easy.  Because of the complexity of the anatomy and movement patterns of the SI joint and low back, the evaluation and treatment of sacroiliac dysfunctions is still controversial.

SI joint dysfunction is a sports medicine term that is often used when describing various injuries involving the SI joint. A biomechanical problem that creates physical symptoms in the SI joint and surrounding tissue,  typically the problems of this dysfunction can be related to the sacroliliac joint being too still (hypo-mobile) or loose (hyper-mobile).  Because of the complexity of the SI joint and the joints above and below the pelvis, too little or too much movement of the SI joint will create pain and physical limitations.

Signs & Symptoms of an SI Joint Injury

  • Various levels of pain in the low back below the beltline and off to either side of the midline.
  • Discomfort and slight swelling noted with palpation of the area just medial or inside to the PSIS above the buttocks muscles.
  • Commonly associated with excessively tight hip flexors and hamstring muscles.
  • A sense of the pelvis “being off” or “rotated on one side” with activity.
  • With severe or chronic conditions, radiating pain can be experienced into the lateral low back, buttocks region, groin and lower extremity.
  • Restricted movement with extreme flexion, extension and/or rotation.
  • An increase in symptoms after prolonged period of time in a soft chair or bed.
  • Movements related to a combination of low back and hip rotation such as putting on socks, twisting in bed and getting out of a car tend to create a catching sensation in the low and lateral back below the beltline.
  • A leg length discrepancy is common as either a cause or a result of a sacroliliac joint dysfunction.
  • There may be tenderness on palpating of the ligaments that surround the joint.

Treating Sacroiliac Pain

  • You’ll want to rest the low back, pelvis, hips and upper legs in a prone (face down) position with ice on the low back and posterior pelvis.  You should also avoid prolonged sitting, soft beds and chairs, activities that create symptoms and any one-legged positional movements.  In addition, three ways you can reduce or eliminate your pain are to seek:
  • Massage and soft tissue work to relax the hip flexors, groin muscles, lateral hip rotators, back extensors and hamstrings.  Massage techniques vary greatly and the benefits for sacroliliac pain cannot be understated.
  • Progress with a core-stabilizing program that improve both the strength and the function of the entire abdominal region.  The objective here is to perform stabilizing exercises that address the needs of the athlete without creating any symptoms in the SIJ, low back or hips.  Progress as tolerablable.
  • A biomechanical evaluation to determine if a muscle imbalance, leg length discrepancy, poor flexibility or other factors are contributing to the SI joint dysfunction.

Questions to Ask to Eliminate SI Joint Pain

Especially because the treatment of SI joints are so difficult to treat, it’s vital you receive clear direction on how to safely treat your pain.  Here are the questions a saavy professional athlete with sacroliliac pain will ask his sports medicine specialist to ensure he can safely return to his sport as quickly as possible:

  1. Are you certain of the diagnosis?
  2. Do I need an MRI to rule out any disc, nerve or bony pathology that is contributing to this injury?
  3. What are the warning signs with this injury that will tell me that my back injury is getting worse?
  4. What can I expect with this injury for the next 2, 4 and 6 weeks?
  5. Who do you consider to be the expert lumbar spine and pelvis rehab specialist in this area?
  6. Will I be given a detailed rehabilitation protocol to direct my rehab for both my therapist and me?

Sports Medicine Tips For Your SI Joint Pain

  • The Patient is Usually Right – You’re the patient and it’s your back so listen to yourself!  Sure the doctors and sports medicine specialists have some pretty cool diplomas on the wall and a lot of initials after their name but no one knows your low back like you do.  Trust your insight.
  • SI Joint Phobia – I’ll let you in on a secret that many in the sports medicine world do not like to admit:  The sacroiliac joint is not understood by a majority of doctors and for good reason.  It’s confusing and very complex and unless you work with it first hand every day, most will “shotgun it” with a little of this and a little of that. Therefore, it’s helpful to seek out a specialist with experience in this area before you schedule an appointment.
  • Body Mechanics WILL Make the Difference – Look at the way you move doing the little things like tying your shoes or picking up the newspaper.  If you’re losing your lordotic curve or sway-back curve, you’re loading both your SI joints and your low back.  Excess stress at either location is a bad thing.  Maintain that curve doing everything and chances are your SI joint will allow you to do what you want to do.
  • Ice is Your Friend – I know, I know…here we go again…Ice hurts but it’s exactly what you need for this injury.  Sure, Ice will make your back stiffer and that will require some additional time to warm-up.  But ice will decrease inflammation and pain which are two key steps to recovering from any back injury.  The Pro’s will tell you that ice is their best teammate.  Stop avoiding this extremely beneficial remedy and do what you know you need to do…ICE and lots of it.
  • Find the Source – A hyper mobile sacroiliac joint is often related to a traumatic episode to the low back or an alignment problem elsewhere when compared bilateral.  Get with a specialist who can find the source of the problem to determine if the sacroiliac pain is merely a symptom.  Orthotics, chiropractor care or more aggressive core stability are just a few of the options to be considered.