Much like completing the Sunday crossword, living with a stubborn case of back pain is no easy task.
Some activities are okay, while others are certain to inflame your symptoms. Resting seems to help for a short time, only for the pain to reassert itself quickly after returning to activity. It seems like there is no winning.
There are a myriad of potential causes of low back pain, but one source that is often overlooked is the SI joint (sacroiliac joint).
This article provides you with the quick and dirty on SI joint pain, what activities can aggravate your SI symptoms, and how to combat your SI joint discomfort.
- What is the SI joint?
- What are common causes of SI joint pain?
- How do I know if my low back pain is actually SI joint pain?
- 7 exercises to avoid when you have SI joint pain
- How to alleviate SI joint pain?
What is the SI joint?
The SI joint is the small joint that attaches the sacrum (tailbone) to the iliac bones of the hip.
There are two SI joints, one on each side of the sacrum and both are supported by thick, powerful ligaments. These help stabilize the joint and prevent it from experiencing too much movement.
The SI joint plays a unique role in your body. It is located at the transition point from your lower extremities to your spine.
In essence, your SI Joint gets hit twice by stress and strain. Your SI joint has to counteract both the gravity acting on your spine and the forces generated in your lower body when you move.
These forces can be substantial during walking and running, making the SI joint susceptible to injury and pain.
What are common causes of SI joint pain?
SI joint pain, commonly referred to as SI joint dysfunction (SJD), is fundamentally the result of two conditions:
- The joint is too rigid
- The joint is too loose
While injuries that occur from an overly rigid joint do exist, they are not nearly as common as injuries that occur from an unstable joint. Instability in the SI joint can occur for many reasons:
During pregnancy, or even a normal menstrual cycle, a hormone called relaxin is released into the bloodstream that cues the ligaments of the pelvis and hip to relax.
This relaxation allows the pelvic ligaments to ease, facilitating the birthing process. While this is a natural and important process, it can lead to SI joint discomfort by introducing too much movement in the joint.
Too much sitting
Because of its role as a support and connection to the lower back, the SI joint can become irritated if exposed to prolonged bouts of sitting.
When in a poor pelvic position such as sitting on a wallet, or with your legs crossed, the pelvis gets forced to accommodate the positions and overloads one side of the SI Joint.
Also, too much sitting can lead to large muscle groups pulling the pelvis into an anterior pelvic tilt. This is another complex issue that can potentially stress the SI joint.
Acute injuries experienced from a car crash, bad fall, surgery, or repeated impact can cause pain by overloading the SI joint.
Moreover, the inflammation associated with injury causes a condition called sacroiliitis. The SI joint is relatively small and inflammation can cause excessive fluid build up (swelling), which can be quite uncomfortable.
If you fall into this category, you should seek medical attention from a proper health care professional.
Abnormal muscle tension
The SI joint is surrounded by extremely powerful muscle groups, such as your hip flexors and buttock muscles. These muscles place a large amount of force on the SI joint.
If you are an athlete, lifter, under constant stress, or hold an intensive manual labor job you may have probably developed unhealthy muscular imbalances that overload the SI joint.
This condition can be difficult to address, since the overload comes from unconscious firing of certain muscles.
Mind-body therapy, muscle-releasing yoga practices, static stretching, massage, and foam rolling are excellent tools to combat this condition.
Too much mobility
The SI joint should have a small degree of movement, however too much movement can place stress on the joints and cause discomfort.
If the SI joint is not properly stabilized by your core musculature (deep gluteal muscles, lower core, transverse abdominis) then you may experience discomfort in any movement requiring prolonged pelvic stabilization.
These core muscles fight to hold the pelvis in a healthy position against the pull of the powerful muscles group attached at the lower back and pelvis. If your core muscles are too weak then there is too much SI joint movement.
Degeneration of the joint
As the wear and tear on our body accumulates, the cartilage within joints can become worn down. This cartilage acts as a buffer between bones to ensures smooth movement within the joint.
It is possible to wear the cartilage of the SI joint down to the point that bones of the pelvis and sacrum rub together. This condition causes significant pain that extends beyond a normal ache.
Leg length discrepancy
If you suffer from a leg length discrepancy then you may be placing an uneven burden on the SI joint. However, true leg length discrepancies are rare.
Most people suffer from tight muscles in the back and a misaligned pelvis that creates a disparity between leg lengths. Massage, yoga, or a manipulation from the proper health professional are good tools to address this issue.
How do I know if my low back pain is actually SI joint pain?
Unfortunately, getting an accurate diagnosis on low back pain is difficult. Many ailments associated with the lower back mimic each other.
Sciatica, SI joint pain, and a bulging disc all radiate and can present with similar pain. Tools like X-rays or an MRI can help identify the condition of the SI joint and can also eliminate other conditions as the cause of your pain.
The location of your pain can also be a key to understanding if the SI joint is involved. Very rarely does SI joint pain reach the knee or below. Normally shooting or radiating pain, tingling or numbing, and weakness will be felt in the lower back, buttocks, leg, and groin area.
SI joint pain may worsen with activities such as walking up stairs, twisting, lifting, prolonged standing or sitting, sleeping in a poor position, and even during a normal menstrual cycle.
7 exercises to avoid when you have SI joint pain
As a general rule, you should avoid any activity that causes your symptoms to get worse.
Pain is a powerful means of communication between the body and the brain that keeps us from further injuring ourselves. So listen to it and give yourself time!
Any activity that requires the SI joint to assume an uneven distribution of force will aggravate the joint. Here are some common examples:
Sports like tennis or golf require an immense rotating force and large power transfer from the lower body into the trunk.
Powerful muscles fire at different times pulling on the pelvis in multiple directions. The SI joint absorbs all of this sheer force and can become inflamed and overloaded as a result.
Exercises that exert a downward force on the spine should be avoided. This includes heavy squats, overhead presses, and olympic lifting movements that are common in CrossFit.
If the cause of your SI joint pain is too much movement, then adding weight further destabilizes weak muscles around your SI joint, magnifying your pain.
Instead of adding big lifts and heavy weights, try to introduce deep core and gluteal strengthening exercises to help support your SI joint.
If you are hell bent on continuing overhead lifting, try lowering the amount of weight and focusing on perfect technique.
Improper technique when lifting weights is bad for the entire body, but especially bad for your SI joints. Not only does it place uneven stresses on the SI joint and causes pain, but improper technique also instills inefficient movement patterns that translate into our everyday life.
Proper technique ensures that the pelvis is neutral, the core is engaged, the gluteal muscles are engaged, and posture is perfect.
Any form of biking is going to stress the SI joint because the seated position on a bike forces you to slouch.
This will shift the pelvis into an anterior pelvic tilt and introduce a strain on the lower back. This position paired with the constant pedaling motion can aggravate SI joint symptoms.
Avoid running until you have strengthened the deep core muscles needed to stabilize the pelvis that we discussed above. The impact and twisting motion on the pelvis during running will quickly aggravate your symptoms.
While you rest and rehabilitate, research proper running technique, proper running footwear, and insoles. Try to incorporate those lessons into your stride. Better technique when running can help you prevent injuries further down the line.
Lunges are a great exercise for building hip, core, and leg strength. However, a lunge is more complex than most would assume.
If the lunge is performed incorrectly, the pelvis can be pulled into a dangerous position, placing undue strain on the SI joints which could further aggravate your symptoms.
Hip flexor strengthening
Tight hip flexors may be a source of your SI joint pain.
The hip flexors attach at the lower spine, run down through the pelvis and attach at the top of the thigh bone. They are the primary movers for lifting your leg to your chest.
Too much sitting paired with exercises like crunches can create an extremely tight hip flexor group that will torque down on your lower back.
This uneven pull on your spine will force the pelvis into an anterior pelvic tilt. This tilt could further compromise an already stressed SI joint.
Sports with a high likelihood of contact, like rugby, football, hockey, or lacrosse, should be avoided until symptoms have subsided. The jolts of force from the impacts can exacerbate an already compromised SI joint.
How to alleviate SI joint pain?
There are many options to help solve SI joint dysfunction.
- Cease any movements that continually and consistently cause symptoms to arise.
- Practice the RICE (Rest-Ice-Compression-Elevation) method and take NSAIDs, both of which can help reduce inflammation but may not offer a long term solution.
- Talk to your doctor about lidocaine or cortisol injections into the joint. While these can provide short term relief, like the ICE method, they may not help a truly stubborn cases of SI Joint discomfort in the long run.
- Try an SI joint belt to alleviate the symptoms of SI joint dysfunction. These belts tighten around the hips and offer another source of support by squeezing the iliac bones in to the sacrum. A good SI joint belt can be found with a quick search on Amazon.
- Consider visiting a physical therapist or chiropractor to help strengthen and stabilize the proper muscles and to address motor behavioral issues like improper gait and muscle tension.
- Focus on strengthening the deep core and transverse abdominus muscles. Research suggests a strong core has highest success rates in defeating SI Joint Pain.
- Practice living an active lifestyle by exercising regularly and maintaining a healthy weight. This will reduce the stress on the SI joint.
- Focus on your posture when sitting and standing to avoid distributing uneven loads on the SI joint for long periods of time.
- Consider adding mind-body therapy to your usual fitness routine, both as a preventative and rehabilitative strategy.
SI joint dysfunction is a persistent, nagging injury that is often mistaken for run-of-the-mill low back pain.
Unfortunately, SI joint pain is unlikely to resolve itself without proper knowledge and guidance. Thankfully, there are many options available to help you defeat SJD.
While you rehabilitate, avoid any activities that aggravate the SI joint, and be cautious when lifting, running, or competing in any sports. These endeavors can have a detrimental effect on your recovery.
SI joint dysfunction is a beatable condition! Continue to seek guidance and strengthen your weaknesses to ensure a happy, pain-free life!