Sacroiliac Joint Dysfunction (SI Joint Pain)

Examine the causes of sacroiliac joint dysfunction and the treatment options
available for sufferers of hip pain and low back pain caused by the SI joint.
Dysfunction in the sacroiliac joint, or SI joint, is thought to cause low back and/or leg
pain. The leg pain can be particularly difficult, and may feel similar to sciatica or pain
caused by a lumbar disc herniation.
Anatomical Source of Sacroiliac Joint Pain
The sacroiliac joint lies next to the bottom of the spine, below the lumbar spine and
above the tailbone (coccyx). It connects the sacrum (the triangular bone at the
bottom of the spine) with the pelvis (iliac crest).
The joint typically has the following characteristics:
Small and very strong, reinforced by strong ligaments that surround it
Does not have much motion
Transmits all the forces of the upper body to the pelvis (hips) and legs
Acts as a shock-absorbing structure
While it is not clear how the pain is caused, it is thought that an alteration in the
normal joint motion may be the culprit that causes sacroiliac pain. This source of
pain can be caused by either:
Too much movement (hypermobility or instability): The pain is typically
felt in the lower back and/or hip and may radiate into groin area.
Too little movement (hypomobility or fixation): The pain is typically felt on
one side of the low back or buttocks, and can radiate down the leg. The pain
usually remains above the knee, but at times pain can extend to the ankle or
foot. The pain is similar to sciatica, or pain that radiates down the sciatic nerve
and is caused by a radiculopathy.
This condition is generally more common in young and middle-aged women.
Background on Sacroiliac Joint Dysfunction

For decades, the sacroiliac joint was suspected to be a common cause of low back
and/or leg pain, although difficulty in proving it with standard diagnostic tests left
many in the medical profession skeptical.
Also, over the last twenty to thirty years, the medical profession has focused more on
discogenic pain (herniated disc, degenerative disc disease) as a common cause of
low back and/or leg pain. In fact, to this day sacroiliac joint dysfunction remains
difficult to diagnose, but anesthetic injection blocks specifically applied to the SI joint
are considered the gold standard.
Why Your SI Joint Is Such A Pain (And 4 Exercises To Fix It)
The sacroiliac joint can get really beaten up in some people, leading to pain
and injury. We call this joint the SIJ for short, and its basically where your sacrum
and pelvis come together.

The sacroiliac joint can get really beaten up in some people, leading to pain
and injury. We call this joint the SIJ for short, and its basically where your sacrum
and pelvis come together.

Anyone who has suffered from SIJ pain knows that it can be a real pain - in the
back, in the hip, and even down the leg. It can make day-to-day activities such as
rolling over or getting in and out of a car difficult, and it can lead to pain while training
if youre not in tune with how to exercise properly without further injuring your SIJ.
So what is it with this joint that causes it to be so problematic for some
people?

Anatomy of the SIJ

To understand, first you need to know a little bit of anatomy. For a long time it was
thought that the SIJ was immobile, and looking at its anatomy it is easy to see
why. It is a very inherently stable joint. However, it is now known that mobility and

movement of the SIJ is not only possible, but also essential for shock absorption
during weight-bearing activities and to relieve some of the strain on the lumbar spine.
What this motion looks like varies between individuals, but the quantity of motion is
always small.

"In addition to strong ligaments, there are a number of incredibly strong muscles that
surround the SIJ, including the erector spinae, psoas, quadratus lumborum,
piriformis, abdominal obliques, gluteal muscles, and hamstrings."
I wont get into all of the complex anatomy of the SIJ, but know that its
anatomical configuration, along with extremely strong ligaments, make the
joint very stable. And that these features seem to be more pronounced in men as
compared to women. Meaning, women often have less stable joints than their male
counterparts (though this is not always the case).
In addition to strong ligaments, there are a number of incredibly strong muscles that
surround the SIJ, including the erector spinae, psoas, quadratus lumborum,
piriformis, abdominal obliques, gluteal muscles, and hamstrings. Though these
strong muscles surround the joint, none of them actually act directly on it to
produce active movements. Instead, movements are produced indirectly by gravity
and by these muscles acting on the trunk and lower limbs.

A number of incredibly strong muscles surround the SIJ, including the erector
spinae, psoas, quadratus lumborum, piriformis, abdominal obliques, gluteal muscles,
and hamstrings.

The Purpose of the SIJ

Given its structure, the SIJ is designed to relieve stress and forces. It acts as a
buffer between the hip and lumbar spine. It transmits forces from the spine sideways
into the pelvis and then into the lower limbs (and vice versa). This is accomplished
through that minor but essential movement we were talking about before.

"Given its structure, the SIJ is designed to relieve stress and forces. It acts as a
buffer between the hip and lumbar spine."
The two major ways the SIJ does this are called nutation and counter-nutation.
Nutation simply refers to when your sacrum (the bottom of your spine) rotates
forward against the other two bones of your pelvis. Counter-nutation is the opposite.
The sacrum posteriorly rotates against the other bones. These movements coupled with even smaller movements (such as gliding, and tilting, things you
dont really need to understand) - are what allow shock absorption to occur.

How Important Is the SIJ, Really?

A fantastic study completed by Dr. Stuart McGill looked at the forces transmitted to
the SIJ during a 27kg squat. He found the total force transmitted to this SIJ
during this activity was 6.5 kN - which is enough to lift a small car off of the
ground!
What this actually translated to was 1,461 pounds of force going through the SIJ.
And that was with a smaller lift of only 27kg. Now imagine whats happening in
our powerlifter friends who are lifting significantly more load than that.
So, what goes wrong and how do we fix it? SIJ dysfunctions fall in to two
categories:
1. Hypermobility or instability
2. Hypomobility or stiffness
Simply put, if the joint moves too much, it is hypermobile, and if it moves too
little, it is hypomobile.
Research published in Clinical Biomechanics in 1989 determined that muscle
balancing is key, and that in order to have optimal SIJ stability (and movement) you
need to focus on what they called the powerful two - the gluteus maximus and biceps
femoris - as they exert shear and torsion loads proportional to the strength of their
contraction.

"A fantastic study completed by Dr. Stuart McGill looked at the forces transmitted to
the SIJ during a 27kg squat. He found the total force transmitted to this SIJ during
this activity was 6.5 kN - which is enough to lift a small car off of the ground!"

These researchers also determined that weakness in the posterior chain (glutes
and hamstrings) and tight psoas muscles can lead to aberrant SIJ motion and
loading. And, as with anything in the body, it isnt always as simple as that, as the
lats and connecting thoracolumbar fascia can also play a role in indirect stability to
the SIJ

This means that in order to correct a hypermobile SIJ, we need to focus on the
surrounding muscles, especially those in the posterior chain, and correct any
imbalances. Most commonly this means improving the strength of the gluteals,
hamstrings and lats, but individual cases may vary.
Fixing a hypomobile SIJ can be a bit trickier, but believe it or not fixing muscle
imbalances is exactly what we want to do in this situation, as well. We need
everything to be working optimally around the joint to solve this problem.

In Summary
The SIJ is meant to be an extremely stable joint, one that has little movement.
Though it is stable, it is crucial some movement does occur in order to absorb
large forces headed for our lumbar vertebrae.
Muscles imbalances absolutely affect the SIJ, even though none of these
muscles directly act on the joint.

 Issues usually arise when the joint is either too mobile or not mobile enough.
If you have SIJ pain, or you think you have SIJ pain, the best thing is to see a
trained professional who can diagnose you, let you know exactly where your
pain is coming from, and help you develop a plan to fix it. But regardless of
whether you have a hypermobile or hypomobile SIJ, there are techniques and
exercises you can do to alleviate and ultimately eliminate your pain and restore
proper functioning of your SIJ.

"To keep your SIJ functioning properly and pain free, you need to work on optimizing
your posture, core stability, hip mobility and stability, along with strength and motor
control."
Until then, if youre beating up your SIJ without doing the work to keep it
healthy, youre going to regret it. Remember what Dr. McGill found? That is a lot
of force to be messing with, and if your SIJ is not working properly that force has to
go somewhere - which is going to mean pain and injury for you.

Recommended Exercises
To keep your SIJ functioning properly and pain free, you need to work on
optimizing your posture, core stability, hip mobility and stability, along with
strength and motor control. Even more, working on reciprocal movement patterns
that challenge the core as well as work the contralateral lats and glutes is key here.
My recommendations are simple, but effective:

Bear walk
Glute bridge variations
Plank variations
Dead bugs

Watch the videos below for more instruction. Try working these into your regular
routine and see if it doesnt make a difference in how you feel.
SACROILIAC JOINT PAIN

The sacroiliac (SI) joint is a strong weight bearing joint in the pelvis that connects the
sacrum and pelvis. There are two joints, one on each side of the sacrum. This joint is
reinforced by strong surrounding ligaments. Both joints move together as single unit
to transmit upper body forces and provide shock absorption for the spine. A series of
ridges and valleys in the joint fit together like a lock and key, much like if you put
your knuckles together. There is a small amount of movement in this joint to allow for
a walking gait pattern in normal human locomotion. Just like other joints in the body,
this joint can become inflamed, unstable and dysfunctional.

PAIN GENERATOR
Over the past several years, there has been increasing awareness and recognition
of SI joint pain as a potential and common source of low back pain. A 2009 study
published in Spine by Sembrano et al. found that up to 25% of patients presenting to
a spine clinic had significant pain from the hip or SI joint. In 2011, DePalma et al in
Pain Medicine identified the SI joint as a low back pain generator in 43%, and
possibly as high as 61%, of patients with continued back pain after a lumbar fusion.

SYMPTOMS

Pain can be from inflammation of the sacroiliac joint, called sacroiliitis. This is
commonly felt as pain on one side of the lower back to the right or left of midline
where the joint is located. The inflamed joint can become dislocated, as if the lock
and key grooves are in the wrong position. When SI joint dysfunction is severe, pain
can refer to the hip, groin, buttocks, and even down the back of the thigh. Pain may
be worse with movements that stress that joint, such as standing up from a seated
position, walking up an incline, elliptical exercise, prolonged sitting or walking, or
twisting when rolling in bed at night. SI joint dysfunction or inflammation can mimic
pain similar to degenerative hip disease, hip bursitis, lumbar disc herniation, or
pinched nerves.

SI JOINT PAIN TREATMENT

Initial conservative treatment options for the SI joint typically involve physical
therapy, medication and injection management. Physical therapy works on manually
readjusting the SI joint when it is immobilized or dislocated and provides stabilization
exercises to long term management. Medications such as NSAIDs may be used to
decrease overall inflammation. Localized steroid injections into the SI joint can
provide targeted therapy to reduce pain and inflammation and allow physical therapy
to make further progress. If the SI joint favorably responds to steroid injections but
the benefits only last temporarily, another non-operative treatment exist called
radiofrequency ablation, RFA.
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eatment-nyc/