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 it’s 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 it’s 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 you’re 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 won’t 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 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 don’t really need to understand) - are what allow shock absorption to occur. and counter-nutation . 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 what’s 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 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. in 1989 determined that muscle "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 isn’t 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 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. SIJ, we need to focus on the 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 you’re beating up your SIJ without doing the work to keep it healthy, you’re 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 doesn’t 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. https://nydnrehab.com/what-we-treat/back-pain-and-neck-pain/sacroilliac-joint-pain-tr eatment-nyc/