Quite literally a pain in the derriere! Sacroiliac pain or dysfunction can be anything from a niggling irritation to a completely debilitating condition that seems like it will never go away. Fear not! We have good news.
In this article we’ll be giving you the benefit of our experience to show that you needn’t fear this condition. We’ll show how in the vast majority of cases appropriate exercises, lifestyle tweaks and the right treatment can get you back to your mobile best.
We’ll explore the wider body to understand why it is that the sacroiliac joint is screaming the loudest. And we’ll be delving in to how your emotions, past or present, can get locked in your body and increase your level of pain.
In short we’re looking to give you the inspiration, self-help ideas and treatment options so if you need to come and see us you’ll be easier to help. And if you commit to the process you may be able to avoid our services altogether. The opposite of marketing!
What Is A Sacroiliac Joint Anyway?
Just listen to the Latin and it will tell you. It is the joint between the sacrum and the ilium. I’ll forgive you for not know what these are! Bascially the red bits in the picture to the side here.
In lay terms the sacrum is the flat bone at the base of the your spine below the ’normal’ vertebrae. The ilium is one of three fused bones which form the pelvis. It’s the upper one around the back. So the sacroiliac joint is simply where the spine meets the pelvis.
To find this on yourself simply reach around to the back of your pelvis and find the most prominent knobbly bit. This is pretty much it running down towards you coccyx from here.
The joint is thought to interdigitate. That is it meets like two corrugated surfaces sitting neatly into each other. Think corrugated roofing or cardboard.
It is widely thought that when this is not quite in the right place or agitated that this can cause swelling leading to pain. But is the whole truth?
Sacroiliac Joint Pain Symptoms
Sacroiliac joint pain symptoms are not straightforward. They can be very localised to your sacroiliac joint or they can refer outwards in and around the glutes (the muscles in your bottom) and down the back or side of your leg. Shown circled in green here. If you want to go into more detail there’s a very good in depth article here.
This is the traditional thoughts on the distribution of pain coming from your sacroiliac joint. But experience has led me to think of things differently…
Is The Sacroiliac Joint Really The Source Of All Your Pain?
My clinical experience would suggest that it usually isn’t. Or if it is there is a lot you can do about it. Here’s a quick excerpt from this research paper which says as much:
“The sacroiliac joint is an accepted source of pain in those with ankylosis spondylitis, those with metabolic disorders with involvement of the sacroiliac joint, and in those with osteoarthritis, infection, or tumors of the sacroiliac joint. The occurrence of isolated sacroiliac joint pain in the absence of these types of diseases is controversial.”
In my experience it’s all about the muscles, fascia and connective tissue. Do they work in such a way to allow the SIJ to work in the way that it is designed. If the muscles that act across this joint are tight then that will increase the load in the joint and contribute to the pain we feel.
This is not just my opinion for the SIJ. This is my general view of the body. Consider a laboratory skeleton as shown here. What is holding it in place? Screws. What happens when we take the screws away? It falls to the floor in a mess. Muscles, fascia and connective tissue determine the positioning of the joints – if we can get them working more optimally then we create more ‘space’ for the joint to do what it’s meant to.
A conventional medical approach would talk about ‘arthrogenic muscular inhibition.’ That is, issues within the joint limit the ability of the muscles to function as required. I’m not disputing that inhibition is a thing. It really is. But in my practice I find it more effective to release muscles that act across a joint rather than just mobilising the joint. This even works when we have confirmed issues within the joint for conditions such as osteoarthritis as I talk about here: Does Arthritis Really Exist?
Sometimes the joint does need some ‘encouragement’ too. If we have aligned the muscles that act across the joint any joint mobilisation work we do will be more effective and longer lasting. Rehab then becomes an exercise in keeping it that way.
This process involves changing your mind and your beliefs. If you believe there is something wrong with the joint or something irreparable then it will feel like that. If you believe that regardless of the state of the joint you can get better then that belief will stand you in good stead for a full recovery.
I see it as our job with our hands on work to help people believe this message and enable them to move more confidently.
Bringing this principle back to the SIJ the standard distribution of pain for SIJ issues looks remarkably like the your gluteus maximus muscle I’ve shown here. Furthermore there is a continuation of gluteus maximus into the muscle on the outside of thigh giving us a more muscular explanation for the pain experienced down the outside of the leg.
This concept is courtesy of the wonderful Anatomy Trains guys who are pioneering the way for a better whole body view of anatomy. You can look at the specific interaction I’m talking about here in what we term the Back Functional Line. Also note how the gluteus maximus is continuous through the fascia across the sacrum into the opposite latissimus dorsi. As a result this opposite latissimus dorsi can be a big contributor to pain experienced across the SIJ.
If we are more wound up then we increase the load on our SIJ. This leads to pain. This is common in office jobs when reaching too far for the mouse. Equally getting wound up emotionally will also reduce your tolerance to misalignment as we speak about in another previous article here: Do You Think Stress Causes More Pain?
Clinically I have had much success with this concept. Releasing off glute and lat tension to ease what might appear to be SIJ dysfunction. Suggesting it wasn’t the joint at fault after all. The nerve root of the gluteus maximus and SIJ is also the same, further evidencing a reciprocal relationship.
This is one idea. When we see clients individually of course we have to work it out specifically for them. How wonky is their body? How is the alignment we see putting pressure on the SIJ? What levels of stress are they currently under? How sensitised is their body right now? Most importantly, what can we do about it?
If you think your stress levels could be a factor in your current pain levels here’s a link to our latest Wellbeing advice from lockdown.
Another idea we’ve had a lot of joy with over the years is the idea that tension in the front of the body will cause the muscles in the back body to overwork. The ones in the back are working harder as they are working againsts gravity. So generally we see more issues in the back than the front. Even though it’s the front that is the underlying cause.
There are many reasons for muscle tension at the front. The two most common being bad posture or emotional anguish. I’ll let you decide which is most relevant! Here’s a link to the Anatomy Trains Superficial Back Line to help you visualise this idea.
Can The Joint Still Be The Primary Problem?
Yes, I would never say never. That would be silly. But clinically we seem able, in the vast majority of cases, to alleviate pain in the sacroiliac region whether there is underlying issues within the joint or not.
The consensus on medical evidence would seem to agree. Saying a condition is specifically and unequivocally due to the sacroiliac joint is hard. The most reliable way of confirming this seems to be through guided injection.
Sacroiliac Joint Inflammation – Does It Inflame?
Inflammation in many conditions is thought to contribute to pain. So does the sacroiliac joint swell?
Well, the top bit of the SIJ is a symphysis. That is a fibrocartilaginous fusion between two bones. In plain English. A joint that moves a bit, but not much. There are lots of strong structures to make sure this is the case. As such these joints are not inflammatory. Although structures around them can of course inflame.
However, the lower section of the joint does have some synovial joint properties and so can swell.
The question for me is not so much whether it does or or doesn’t swell, it’s more about what we can do about it.
What Can We Do About Inflammation?
A successful medical approach appears to be guided analgesic injection.
From my alternative perspective I would question the long term benefit. If you still have the same movement pattern and same exposure to stress will this condition not come back over time? My honest appraisal? You might get lucky, you might not.
In some cases the relief people get from such procedures enables them to walk better and in so doing form a better movement pattern. Perhaps the stress component of the condition has abated somewhat and so quality of life can be improved.
Our approach would be more holistic. Assess and address the biomechanical patterns that are causing the symptoms and reduce the overall sensitisation to the condition caused by beliefs around the condition or overall stress levels. For some people focusing on the physical is more important. For others the stress component is more important. A lot of us are more stressed than we think!
Can stress really increase the amount of inflammation in your sacroiliac joint? I would say yes. We see evidence of this day in day out in our work. Until recently this would have been considered controversial. However, there is a growing body of evidence to back up our view.
The most easy to consume is this article from Science Daily. If you want something a bit heavier and more research based then here’s some links to some articles here and here. This concept is fascinating and a real cornerstone of the work we do. It is a whole article in itself.
For now let’s just say that less stress equals less inflammation in the body which equals less pain and less overall sensitivity.
Sacroiliac Joint Pain Tests
As with so many orthopaedic tests (that’s when we pull you into various positions to try to work out what’s going on) they are as much use as chocolate teapot! He said bitterly. I guess you’ve got to be examined on something to get your qualification! This piece of research says as much. MRI is the investigation of choice… but there’s so much you can do before you need to go down that route.
My less flipant more balanced view of orthopaedic tests would be that they help rule things out. They guide our intuition and further afield help us identify which structures may or may not be contributing to the pain you feel in the sacroiliac region.
Sacroiliac Joint Pain Exercises
So this is where I give away all the free stuff! Why? Because I’m intensely aware not everyone can afford private treatment. Equally you may not be able to get to us – although we do now offer video assessments.
Equally I’m just trying to get an alternative way of thinking to as many people as I can to give more hope. For some of you our approach and ideas will strike a chord. For some they won’t. My aim is to get us all thinking and hope to send people in the direction that ultimately will be most suited to them.
Before I start a few housekeeping points.
Disclaimer 1: If you break yourself doing this stuff it’s your fault ok? Done correctly this is all really safe stuff. The only way you will damage yourself is if you go gung-ho and don’t follow the instructions. So don’t blame us! If you are in anyway nervous about trying any of these simply don’t attempt them! Please seek medical guidance if you are unsure about your ability to perform any of these.
Disclaimer 2: These exercises are in no way a replacement for one to one sessions that are tailored for you by professionals. These exercises are to address to most common causes we have seen over the years to give you hope that you don’t need medical intervention. If you can afford private treatment whether that is with ourselves or anyone else I would recommend that in the first instance.
Disclaimer 3: Don’t expect to be cured immediately! I mean it can happen. But it’s unusual. If you want to see changes work these into a routine at least 3 times a week. Look at your life. Is there any way you can reduce the amount of pressure on yourself? Or take better care of yourself?
All of these exercises and treatments not to pain please. Take the stretches to the point where you feel a nice stretch and use your breathing to work into those further. The longer you can hold the stretches the better in my opinion. But build up gradually just in case you get delayed aggravation from any of the stretches.
Work some relaxation breathing into your daily schedule. For more information on this check our previous article: Does Relaxation Breathing Really Ease Pain. In case you’re wondering, the answer is yes!
2. Self-Treatment To Reduce Tension At The Front
Follow these two videos on how to release your front. Not as good as having it done by a trained professional but it will get you started. Happily the muscles affected will normally help reduce the sensitivity of your nervous system so you may feel calmer afterwards. The longer you stay calm the less you feel pain.
3. Glute Stretching
Here’s a video of a glute stretch to help you release those tight buns to reduce the load on the SIJ. Other glute stretches are available and if you find those more effective by all means dive in. I’ll be updating this section in due course with a best of glute stretching compilation specifically for sacroiliac joint issues.
4. Lat Stretch
My personal favourite stretch for all kinds of reasons and conditions. In relation to SIJ issues we spoke about the reasons why above. Give it a go and feel the joy! If this is relevant you should find that the opposite side to your SIJ issue is tighter. This stretch can mildly reproduce your symptoms. In these cases just push to the point you are aware of it. Not to pain.
5. Half Moon
An excellent all-rounder. Stretches the obliques which are a continuation of the lats and therefore affecting load across the SIJ. An excellent variation for any yoga buffs out there is triangle pose. I’ll be filming that in due course and inserting into here.
6. How To Sit With Sacroiliac Joint Pain
Finally a preventative measure. All this stretching and clean living is all good and well but if your posture keeps tightening you up and increasing load on your sacroiliac joint then we’re wasting our time. Here’s our tips on how to sit as best you can. If it’s too hard / painful to sit with a neutral pelvis as shown in this video then find a compromise between neutral and your normal posture that is comfortable.
That’s about all I’ve got to say on sacroiliac dysfunction. Another pretty epic post as is my way. I hope you’ve found some inspiration and hope in this article that will ultimately set you on the right path to getting rid of whatever pain it is that ails you.
If you’re able to get to us we’d love to help you with your issue in person or if not online via a video session. You can get in touch with us by pressing the button below:
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This post first appeared on our Brighton site.