Sacroiliac Joint Pain (SIJ)

Sacroiliac Joint Pain

Article by John Miller

Sacroiliac Joint (SIJ)

What is Sacroiliac Joint Pain?

Your Sacroiliac Joints (SIJs) are a critical linkage system between your lower spine and pelvis. The sacrum (tailbone) connects on the right and left sides of the ilia (pelvic bones) to form your sacroiliac joints. Due to the substantial weight-bearing forces placed upon this area, your sacroiliac joints are a reasonably stiff link between the pelvic bones and allow only a few degrees of movement. But that subtle movement is healthy and very important.

When your sacroiliac joints are not moving generally due to either stiffness or excessive movement, it is k as Sacroiliac Joint Dysfunction or SIJ Dysfunction, which commonly results in sacroiliac pain. It would be best if you had both normal SI Joint movement and muscle control around this area to avoid SI Joint pain and injury.

In some people, due to trauma, muscle weakness or just extra mobility, your sacroiliac joints can have excessive uncontrolled motion. This new motion allows your sacroiliac joints to adopt an abnormal or stressed joint position, which may result in sacroiliac joint pain.

What Causes Sacroiliac Joint Pain?

sacroiliac joint

There are two main groups of sacroiliac dysfunction that cause SI Joint pain:

  1. Hypermobility / Instability / Dynamic Muscle Weakness
  2. Hypomobility / Stiffness

Hypermobility issues are the most common and will be discussed further in this article.

Hypomobility is typically associated with pathologies that tend to stiffen your sacroiliac joints, such as in Ankylosing Spondylitis.

What Causes Sacroiliac Joint Hypermobility?

Your sacroiliac joints should move a few degrees for normal movement. Like most joints, your surrounding muscles act to stabilise your sacroiliac joints during stressful or vulnerable positions. The most crucial sacroiliac stabilising muscles are your deep abdominal core muscles and your deep gluteal muscle groups.

Your core muscles: specifically the transversus abdominis and oblique abdominals, through their attachments to the iliac bones, help the pelvis closure and improve the position, control, and stability of the sacroiliac joints. Researchers have discovered that contraction of the transversus abdominis muscle significantly stiffens and supports your sacroiliac joints. This improvement is more significant than that caused by an abdominal bracing action using all the lateral abdominal muscles (Richardson et al., 2002).

Further to this, researchers have discovered that your deep gluteal (buttock) muscles are essential for controlling the lateral and rear aspects of the pelvis and hip. (Grimaldi et al.). Any of your gluteal muscles can be weak and affect your SIJ control.  Your gluteal muscles that can be affected include gluteus maximus, medius and minimus, plus a few other muscles that are less well known. These include piriformis, gemellus superior and inferior, obturator internus and even quadratus femoris.

When these muscle groups are weak or lack endurance, your sacroiliac joints are potentially vulnerable to excessive movement, which can lead to SIJ hypermobility dysfunction or instability and subsequent sacroiliac joint pain.

Sacroiliac Joint Symptoms?

Sacroiliac joint dysfunction can mimic numerous other back and hip injuries. It can cause lower back, hip, groin, buttock and sciatic pain. Sacroiliac pain is typically worse with standing and walking and improved when lying down, but not always. SIJ dysfunction can sometimes be painful to sit cross-legged and usually is painful to lie on your side for extended periods.

Bending forward, stair climbing, hill climbing, and rising from a seated position can also provoke sacroiliac pain, but this is variable. Sacroiliac pain potentially increases during sexual intercourse and menstruation in women, but this is highly variable once again.

How is Sacroiliac Joint Pain Diagnosed?

Accurately diagnosing sacroiliac joint pain & dysfunction can be difficult because SIJ symptoms can mimic other common back conditions. These include other mechanical low back pain conditions like facet joint syndrome or a bulging disc.  Many other systemic conditions affect this region, including the reproductive and neurovascular structures.

X-rays can exclude some other pathologies, but an MRI is probably the diagnostic test of choice. MRI may show signs of sacroiliac joint inflammation or eliminate potential pathologies, especially within the pelvis-hip complex.

A thorough physical examination by your experienced physiotherapist is still one of the best methods to assess sacroiliac joint pain or instability thoroughly.

Sacroiliac Joint Pain Treatment

The successful treatment of SI Joint pain remains multifaceted. Your sacroiliac joint is a weight-bearing joint. It is controlled and supported by your lower core abdominal muscles (anteriorly) and your gluteals (posterolaterally). Any weakness of these muscles will contribute to potential SIJ instability.

When your SIJ physiotherapist examines you, they will be looking at your:

  • SIJ alignment and motion
  • SIJ dynamic control
  • SIJ passive stability
  • Lower kinetic chain function

Your SIJ rehabilitation can be complicated, and it is best managed by a healthcare practitioner well versed in the function and control of SIJ’s.  Your SIJ physiotherapist has a particular interest in sacroiliac joint function.  Please seek their opinion regarding your rehabilitation.

Is Exercise Good for Sacroiliac Pain?

SIJ physiotherapists highly recommend an SIJ-focused exercise protocol explicitly prescribed to your assessment findings and the identified deficits. Weakness dominates as the leading cause of sacroiliac joint pain, so addressing your specific gaps usually is highly effective in both the short and long-term relief from SIJ pain.

Is Walking Good for Sacroiliac Pain?

Sacroiliac pain and how it responds to walking is variable. There does appear to be two distinct groups of SIJ dysfunction. One SIJ group ends to improve with walking. Sadly, there is another group that walking annoys. Your physiotherapist’s assessment is essential to determine which group you fall into and adapt your treatment accordingly.

Is Running Good for Sacroiliac Pain?

Running is a common cause of SIJ pain, so it is not recommended as a treatment option until your SIJ physiotherapist has assessed your dynamic muscle control and its ability to cope with running safely.

Does Stretching Help Sacroiliac Joint Pain?

Stretching of tight muscles within the hip-pelvis complex can sometimes help ease SI Joint pain. However, it would be best if you asked WHY your piriformis repeated tightens. If it is the only muscle working effectively, albeit excessively, then the long-term solution to your sacroiliac joint pain may not be to stretch your piriformis muscle continuously. In particular, the piriformis muscle regularly overworks, being tight or overactive.

Is Massage Good for Sacroiliac Joint Pain?

Massage, dry needling and trigger point therapy of tight muscles within the hip-pelvis complex can sometimes help ease SI Joint pain. As mentioned earlier, hypertonicity needs to be addressed along with muscle strengthening, especially in chronic or persisting SI Joint pain cases.

Can Weightloss Help Sacroiliac Joint Pain?

It makes sense that losing weight will decrease the SI Joint forces and increase your ability for your muscles to control your body weight through the SI Joint complex. Weight loss is a positive long-term solution.

How To Sit With SI Joint Pain?

Due to the structure of your pelvic, asymmetrical sitting may strain your SIJ. Cross-legged sitting may increase SI joint pain, so please avoid it. One of the theories is that we always cross our legs in a preferred way, making certain motions more flexible, whereas the opposite leg cross is more restricted.

How Long Does It Take For Sacroiliac Joint Pain To Go Away?

The success of sacroiliac joint pain treatment via pelvic joint realignment and subsequent dynamic stabilisation via in-depth abdominal and hip core stability control programs is excellent. This program will result in an equal SI joint range of motion that then needs only requires effective muscular control to maintain. Often there is instantaneous relief and improvement in function after the successful symmetrical realignment of your SI Joints. On day one of your SI Joint treatment, relief is a very favourable sign that your SI Joint position was causing your pain and dysfunction.

The long-term success then depends upon the effectiveness of the specific strengthening regime prescribed by your SIJ physiotherapist to support and control your sacroiliac joints. Please seek their advice specific to your needs.

Common SIJ & Buttock Pain Sources

The following conditions may cause buttock pain or SIJ issues.

Joint Injuries

Pregnancy-Related Pain

Muscle-Related Injuries

Lateral Hip Pain

Nerve-Related Injuries

Bone-Related Injuries

Article by John Miller

SIJ & Buttock Pain Treatment Guidelines?

While SIJ and buttock pain treatment will vary depending on your specific diagnosis, your physiotherapist will have the following aims.

PHASE I - SIJ Pain Relief & Joint Protection

Pain Relief

While pain relievers or anti-inflammatory medications are often prescribed for acute SIJ dysfunction, they will not address the actual cause of SIJ pain. A healthcare practitioner who has a comprehensive understanding of the biomechanics and muscular control of your SIJ, pelvis and hip complex should thoroughly assess chronic cases of SIJ dysfunction. Managing your sacroiliac pain is the main reason that most people seek treatment for sacroiliac joint dysfunction. In truth, it was the final symptom that you developed and should be the first symptom to improve in most cases. If this is the case, the prevention of a recurrence becomes your priority.

You can often achieve natural short-term pain relief using ice or heat packs applied to your SIJ's.

Reduce Inflammation

You are managing your inflammation. Sacroiliac joint inflammation is best eased via ice therapy and techniques or exercises that unload the inflammed structures. Your doctor may recommend a course of non-steroidal anti-inflammatory drugs such as ibuprofen. Some seronegative arthritis conditions can predispose you to sacroiliitis. Your doctor can arrange special blood tests to assist in diagnosis in these conditions. Prolonged morning stiffness is a common complaint. See Ankylosing Spondylitis.

SIJ Protection & Support

Sacroiliac joint instability occasionally requires additional passive support until your muscles successfully control the joint. Supportive taping is often beneficial during the initial pain reduction phase.

SIJ Stability Belt

You may manage longer-term instability with a sacroiliac joint stabilisation belt. However, an exercise protocol to specifically address your SIJ issue usually is more effective.

If you have any questions, please seek the advice of your SIJ physiotherapist.

PHASE II - Restoring Normal ROM and Strength. Early Hip Core Exercises.

As your SIJ pain and inflammation settle, your physiotherapist will turn their attention to restoring your normal pelvic joint alignment and normalising the dynamic muscle control that affects the SI Joints.

Your physiotherapist may commence you on a lower abdominal core stability program to facilitate your important muscles that dynamically control and stabilise your lower back and pelvis. They will also implement a similar activation and strength program that addresses your deep gluteal muscles. These muscles are sometimes referred to as your hip core muscles. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for your specific needs.

PHASE III - Restoring Full Function

Your physiotherapist will turn their attention to restoring your normal pelvic alignment and maintaining sacroiliac joint range of motion during more functionally stressful positions. They will also work on your muscle power, proprioception, balance and gait (walking pattern). Depending on your chosen sport or activities of daily living, your physiotherapist will aim to restore your SIJ function to allow you to return to your desired activities safely.

Everyone has different demands for their sacroiliac joints that determine what specific treatment goals you need to achieve. For some, it is simply to walk around the block. Others may wish to run a marathon. Your physiotherapist will tailor your sacroiliac joint rehabilitation to help you achieve your own functional goals.

PHASE IV - Preventing a Recurrence

Sacroiliac joint dysfunction does tend to return if a thorough muscle control program is not undertaken. The main reason it is thought to be chronic and specific muscle weakness. Your physiotherapist will assist you in identifying the best exercises for you to continue indefinitely or periodically.

In addition to your muscle control, your physiotherapist will assess your SIJ, spine, hip and lower limb biomechanics and correct any deficits that may predispose you to SIJ pain and dysfunction. Fine-tuning and maintenance of your sacroiliac joint stability and function are best achieved by addressing deficiencies and learning self-management techniques. Your SIJ physiotherapist will guide you.

More information: SIJ Pain & Dysfunction