One of the most common causes of lower back pain is dysfunction of the sacroiliac (SI) joints. The SI joints are where the sacrum and ilium, or hip bones, come together. They are located directly below and on either side of the spine and can usually easily be identified by dimples on both sides of the lower back. Strong ligaments and muscles surround the SI joints giving the lower spine stability and limited range of motion. However, injury or degeneration to these ligaments, or the joint itself, can lead to lower back pain, especially since the SI joint is highly innervated, meaning it has many nerves.
Symptoms of SI Joint Pain
SI joint pain is commonly located in the lower back and buttocks, typically only to one side, but can affect both. In some cases, symptoms can also include pain radiating to the hip or lower leg. Instead of pain in the leg, some people might experience either numbness, tingling or weakness in a leg.
Depending on the person, SI joint pain can range from mild to severe and can last for only a few days, or become chronic and last for an extended period of time. Chronic cases of SI joint pain are usually related to degenerative, or arthritic, changes to the SI joint. The pain is usually made worse by prolonged sitting or standing, walking or climbing stairs. A hallmark of SI joint pain is increased pain when going from sitting to standing.
How Do You Know If You Have SI Joint Pain?
Even if your lower back pain seems to be located near the SI joint, the SI joint itself may not be causing your pain. Other conditions, such as a bulging or herniated lumbar disc, can refer pain to the SI joints. A thorough examination can determine the exact cause of your pain.
This examination will include lower back range of motion, as well as specific orthopedic tests designed to provoke pain. One orthopedic test that is highly specific for SI joint dysfunction is the FABER test. To perform this test, the doctor will have you lay on your back, bend one knee and place your foot on the opposite knee, forming a figure four. Pressure is then applied to the bent knee and opposite hip. If this causes increased pain, SI joint dysfunction is highly likely.
Depending on the case, imaging may be necessary in addition to an examination. X-rays can determine whether there is a postural imbalance that can lead to pain, as well as if any degeneration is present in the SI joints. If there is a history of trauma, or if the pain does not improve with conservative care, an MRI can determine if there is a tear to any of the ligaments surrounding the SI joint.
Causes of SI Joint Pain
One of the most common causes of SI joint pain is a misalignment of the pelvis. When the pelvis shifts out its normal position, increased pressure is placed on the SI joints, leading to pain. Pelvic misalignments can be caused by poor posture, prolonged sitting, pregnancy or childbirth.
Damage or change to the laxity of the ligaments around the SI joint can also lead to pain. If these ligaments are either too tight or too loose, it can lead to pelvic misalignments. Trauma, such as a fall or car accident, can cause tears to these ligaments, causing pain.
The SI joints are also subject to a lot of wear and tear, which over time causes the joints to become degenerative and rub together. Although most people think degeneration only occurs in the elderly, it can occur at any age. Chronic pelvic misalignments, or sustained lack of motion in the SI joints, can lead to degeneration. Although rare, ankylosing spondylitis, is an autoimmune disease that leads to severe degeneration, and eventual fusion, of the SI joints.
Treatment Options for SI Joint Pain
Chiropractic Care
Chiropractic care is a proven effective treatment for SI joint pain, especially if the pain is caused by pelvic misalignments. Using the adjustment, a form of manipulation, chiropractors are able to properly align the pelvis and restore normal motion to the SI joints. Your chiropractor can also give you specific exercises to help stretch and strengthen the muscles that surround the SI joint. You can find more information about chiropractic care here.
Spinal Decompression
Spinal decompression is another effective treatment for SI joint pain. In our office, we use the Back on Trac decompression table, that is particularly effective for people with SI joint pain. In addition to providing an axial stretch, stretching from head to toe, this table also has the ability to move the legs side to side, allowing for greater stretch to the SI joints. To find more information on spinal decompression and the Back on Trac table, click here.
Additional Tips to Help With SI Joint Pain
Use Proper Ergonomics
Since a common cause of SI joint pain is prolonged sitting, especially with poor posture, the use of proper ergonomics is essential to help with SI joint dysfunction. Make sure your workstation is set up as ergonomically as possible and remember to take micro breaks while working. Set an alert on your phone or computer for at least every hour as a reminder to get up, move around and stretch. Ergonomic tips can be found here.
Stretching and Core Strengthening
Many muscles provide stability to the SI joints. If these muscles become too tight, or too weak, they can lead to SI joint pain. Important muscles to stretch include the hamstrings and hip rotators, such as the gluteal muscles. These muscles attach at the pelvis and can cause misalignments. In addition, core strengthening is important to help provide stability. Specific stretches and strengthening exercises can be found here.