SI Joint Pain… What is it and what to do about it?
Holy smokes. This is a big one. As a Chiropractor, it is no surprise that I see a lot of lower back pain. The SI Joint (the Sacroiliac Joint) can be notoriously tricky to identify and treat. My colleague, Dr Alex Hueston, a chiropractor from Duncan, BC, wrote this great article all about SI Joint pain.
Written by Dr. Alex Hueston. Chiropractor at Young Health Management in Duncan, BC (Vancouver Island). www.younghealthmgmt.com
Sacroiliac joint pain is something I see as a chiropractor on a daily basis. It is a common condition that affects many people over the world of all ages. The sacroiliac joint is the joint between your sacrum at the base of your spine and your ilium (one of three parts of your pelvis). It connects to make up what's called the “posterior chain” and is a focal stabilizer for your body when you walk, bend or move. Unfortunately, this often results in pain for millions of people that are then not able to perform simple daily tasks without pain. In this blog post we will discuss how to identify, manage and hopefully eliminate your sacroiliac joint pain!
The pathway through this topic will be the following (so feel free to jump around!):
1. What is sacroiliac pain
2. How to identify the sacroiliac joint
3. Causes of sacroiliac pain
4. Symptoms of sacroiliac pain
5. Solutions for managing sacroiliac pain
Important Note: Before diving into the rest of this article, it's important that none of this information should be construed as medical advice and should not replace seeing an appropriate healthcare provider. If you are in severe pain please see a healthcare provider to be properly assessed, diagnosed, and treated.
Let’s get started!
What is sacroiliac joint pain?
Sacroiliac pain is essentially inflammation of the sacroiliac joint. The pain is usually over the joint but can also be felt in the low back, buttocks, or hips. The pain can be sharp or a dull ache, typically on one side but can be present on both sides or even shift from one side to the other.
How to identify the sacroiliac joint
To find the sacroiliac joint, start by putting your hands on the top of your hips. This area is called your iliac crest. With your thumbs, move around the edge of your hips toward your back until you find a small dip. This dip is called your posterior superior iliac spine (PSIS) and connects your sacrum to make up your sacroiliac joint (sacrum+ilium).
Causes of sacroiliac pain
There are a wide variety of mechanisms that can lead to sacroiliac pain but commonly they break down into one of these three categories:
Acute trauma: this is the easiest type of pain most of us to understand (i.e. this event happened and now I have pain). This could be a direct force such as a fall on your butt but could also be indirect such as picking up an object or a misstep while walking down some stairs.
Repetitive loading/Postural stress: the silent assassin! The sacroiliac joint is closely connected to movement at the hip and low back. When we are only exploring a portion of the range of motion available for longer periods of time we induce repetitive stress on the joints in an unbalanced manner. Typical examples would be:
Long periods of being seated: when sitting the hip and low back are typically in a flexed position and this puts stress on the sacroiliac joint. Though this stress is not high at any given time the low amount of stress over a long period of time can fatigue the joint to the point of injury.
Bending forward/rotating strenuous activities: Decide to chop some wood for the first time in a while? Did you pull weeds for 4 hours or shovel all that soil that’s been on your driveway for a month?
Instability: the least known about and consequently can lead to many people finding it difficult to get more than temporary relief. Joint instability/lack of stability occurs when the surrounding structures (ligament, tendons, muscles) are unable to maintain the ability of a joint in a safe and stable position. People that are susceptible to stability issues in their SI joints are:
Females pre/post-pregnancy: around pregnancy hormones are released to create laxity in the body which allows the body to move into a greater range of motion.
Highly flexible individuals: with an increased range of motion comes an increased demand to control that range of motion and if that demand is not met that joint can then move into unstable areas.
Symptoms of sacroiliac pain
There are a few ways you can identify whether your discomfort could be related to SI joint dysfunction:
Sharper pain when changing positions (rolling, twisting, bending, moving between sitting and standing)
Dull aching pain with prolonged positions (driving, standing, etc.)
Pain on palpation (touching), tenderness over specific bony landmarks like the PSIS (posterior superior iliac spine).
Pain with transition movements (rolling, sit to stand, getting out of car)
Solutions for managing sacroiliac pain
As a chiropractor I usually approach conservative care from four angles:
1) Damage Control: Healing is much easier when we mitigate aggravating factors. Simple strategies that I always recommend to start with on your own are:
Be cautious of friendly advice. Your family and friends mean well but just because a certain stretch helped them does not necessarily mean it will help you. If you are looking for help seek out a local healthcare provider.
Take micro-breaks from aggravating positions. Pain and aggravation build up over time in many cases so changing positions will mitigate stress over time. If you work at a desk, find a reason to get out of your seat and move around at least every hour
Using lumbar support pillows can be life-savers when driving and are usually dramatically more effective than cranking up the lumbar support in your truck. Click here to grab a pillow.
Using a sacroiliac belt is a temporary strategy that should only be used if aggravation activities are unavoidable but can be very effective in the short term. If you get almost instant relief it is likely there is a stability issue present. Click here to grab a belt.
Treat the Nerve: If you find that simply grabbing the skin over the joint and lifting it away from the SI joint significantly decreases or fully eliminates the pain it is possibly a sign of superficial nerve irritation of what are called the cluneal nerves. Cupping and Taping can be helpful strategies in this case. The good news is there might not be anything wrong with your SI joint!
Treat the Muscle: Your massage or stretching routine might seem like it will work, but if your pain is only temporarily relieved or even seems to get worse afterward this may be a sign that something else needs to happen. If the problem stems from a lack of stability, relaxing/stretching muscles could actually make things worse!
Treat the Joint: Mobilizations of joints including chiropractic adjustments to the SI joint, lumbar spine, and hips can reduce pressure on the joints but by itself may only be a part of the solution. Again, if there are stability issues present, more motion is not the answer.
If these strategies have not worked then, what is the missing piece?
The answer is to start establishing stability through specific exercises. We want to be masters of our movement whether we move a lot or only a little. How do we get started?
Abdominal bracing and breathing exercises 3-5 minutes at a time.
Cat-Cow mobilizations for 3-5 minutes at a time. I prefer doing it in the morning while I wait for my coffee to cool down!
These movements are designed to build awareness of movement (proprioception) from an unloaded position, where the body does not need to maintain our balance like we do when we are in an upright position.
With the two exercises above in play, we can now add additional exercises to the mix.
Click on the links above for some great videos of how to perform these exercises.
Here is an example of how you could start using them:
10-second holds at the position of highest tension
Return to starting position
Immediately go back to position of highest tension
Perform three repetitions on one side, then on the other side, then rest
The next set you will only need to perform two repetitions on each side, then one repetition on the last set.
We will dive deeper in future posts to the benefits of each of these exercises, how to progress them and how to use them to explore other movements. But for now, when doing these exercises, it is essential to challenge yourself only to the point where you can maintain the proper form for the entire exercise. Going to fatigue is not the purpose of these movements and will most likely not create long-term benefits.
Wrapping it up!
Now that you understand what sacroiliac pain is, the causes of it, and how to get started on your road to recovery, are you ready to book an appointment? If so, click here or give us a call. We’re happy to answer any questions or concerns over email at any time if needed too!
Author:
Dr. Alex Hueston is a Chiropractor in Duncan, BC at the Young Health Management clinic. www.younghealthmgmt.com