Pain at the SI Joint.

Pain at the SI Joint. 

Tommy Conway - Chartered Physiotherapist and Director at OneHEALTH

Have you been told that you have an SI joint problem? Have you had someone tell you, your SI joint is “Out of alignment? Do you struggle to drive long distances? Are you struggling to stand for long periods? Is it painful on one side only, a constant ache which never leaves you, the pain doesn’t move, doesn’t travel down your leg, it just stays in the same spot. This painful spot never changes even if you are constantly prodding  and poking it, sticking your thumb into it when standing and sitting trying to ease the soreness. It sounds to me like you have SI joint pain,SI joint dysfunction or SI Joint syndrome. Really doesn’t matter the wording, what it means is you have persistent pain and discomfort at the area of the SacroIliac Joint (SI Joint). This condition is common in pregnancy and more recently desk based jobs, which I have seen a lot of since the pandemic. Anyone can develop SI joint pain and What I want to show you today is the role of the SI joint in the human body and how it becomes a problem area.

What is the SI Joint? 

The Sacroiliac joint is the meeting point of the hips and the spine. Your spinal column has three different sections, cervical spine(Neck) thoracic spine (Mid back) and Lumbar spine (Lower back). Then the next piece down is called the Sacrum (See picture attached), it is triangular in shape and connects to the two hips. The area at which the sacrum connects to the hip is called the Iliac crest, hence the name sacroiliac Joint (SI Joint). 

The sacrum stays connected to the hips by a web of strong dense ligaments (See pic attached) These ligaments are integral to keep your hips strong and allow you to move freely and avoid pain. 

The Sacrum moves in a number of directions. It can tip towards the ground and this is called Nutation ( See picture) and it can tip up towards the sky and this is called counternutation ( see picture). It can turn to the left and also turn to the right. If you combine these movements, it can turn down to the right and also turn up the left and vice versa. 

So the question is why does it become painful? The answer is, it simply can’t move as it should! What do you think happens when someone pushes the sacrum “back into place” and “realigns you”. Is this technique magic, no! It simply pushed you in one of the above directions that you couldn't move in before. Don’t believe me, are you reading this article while sitting? Do you have pain in your lower back? Is it the SI Joint? DO this:

TEST 1: 

1: In sittings, place your feet flat on the ground, hip width apart and knees bent to 90 degrees.

2: Is the painful spot still there? 

3: Now, don’t move your feet and slide your right knee a fist ahead of your left. 

4: This will turn your SI Joint left 

5: Did it increase or decrease the pain? 

6: Now repeat it on the other side. 

If you do this activity and it decreases pain on that “spot”, you know which way the sacrum needs to turn to relieve your pain. Instead of thinking about the sacrum being out of place, which makes absolutely no sense, start thinking about it as stuck and not being able to move as it used to. 

Test 2: 

Pick two seats: 

What seat is the most comfortable to sit on? 

1: Pick two seats

2: Sit on a seat where your hips are level with your knees. You need nutation of the sacrum to be able to sit on this level seat comfortably. 

3: Sit on a seat with your hips below your knees, you need counternutation of the Sacrum to be able to sit on this level seat comfortably. 

Whichever seat height you struggle to sit in will be the movement you need to restore and no I don’t need to “crack” your back to restore it. 

The most important thing I want you to get from this article is there is no such thing as dysfunction. The sacrum is designed to move in specific ways. The problem is that you sometimes get reliant on using only one or two of these specific movements and underutilise the other movements. For example, say when you are queuing in a shop, do you put all your weight on your right leg? Well that is going to be a turn of the sacrum to the right. If you do that for the majority of your life, you are going to have a SI joint that is not used to turning left. The sacrum may become painful but it is not “dysfunctional” or “Out of place”, it is simply overused on one movement rather than the other. 

I hope you do the above tests and take note of what happens and I hope this helps 

You can email me [email protected] if you have any questions.