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SIJ Pain Treatment – Find The Best Ways To Relieve Pain And Stop It Coming Back

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What Is SIJ Pain / Sacroiliac Joint Pain?

Do you have deep-seated pain in your low-back or buttocks area that is typically one sided and travels down the side of your tailbone or radiates across the base of your lower back? Is this pain aggravated by arching your back, twisting in bed, long car journeys, prolonged sitting or running? You may be experiencing sacroiliac joint pain. In this blog post, we’ll explore the causes of sacroiliac joint pain (known as SIJ pain or SI joint pain), the role of pelvic stability, recognise SI joint dysfunction symptoms, and discuss the most effective SIJ pain treatment options.

Sacroiliac Joint (SIJ) Anatomy

Sacroiliac joint pain physio Sydney Surry Hills

The sacroiliac joints are located on each side of the spine between the two pelvic bones (the iliums) which attach to the sacrum (the sacrum is the base of your spine). The main functions of the SI joints are to provide stability and shock absorption where the spine joins onto the pelvis, and to transmit forces between the upper body and the lower body. They typically only have very limited movement (approximately 4 degrees), but the SI joint experiences many types of forces including shearing, torsion, rotation, and tension.

There are 3 large lever arms involved in producing force across the SIJs – the trunk and the two legs, and movement of these levers transmits significant forces through the SI joint. Because of this, walking, running and jumping impacts what is happening at the sacroiliac joint. It is also important to be aware that there are many muscles and ligaments around this area that play a role in sacroiliac joint pain and pelvic stability. This includes the ligaments around the sacrum, muscle slings (which we will discuss below), and your pelvic floor muscles.

Understanding Pelvic Stability And SIJ Pain

Pelvic stability refers to the ability of the pelvis to maintain its position and alignment during movement. The pelvis consists of several bones, including the sacrum, coccyx, and two “hip” bones. The two “hip” bones are made up of three parts – the ilium, ischium, and the pubis. All of the pelvic bones are connected by strong ligaments, muscles, and the SI joints. When the pelvis is stable, it provides a solid base for the rest of the body to move efficiently and effectively. On the other hand, an unstable pelvis can lead to poor biomechanics (movement) and encourage compensatory (sub-optimal) movement patterns, increasing risk of injury.

Let’s take an example of running. When you run, you want your hips to stay stable underneath you and allow your leg to push off behind you without tilting your hips forward or rocking your hips side to side. If your ligaments and muscles don’t have the control or co-ordination to work together to keep your hips still and do this, you will create suboptimal biomechanics. This potentially can cause compensatory movement patterns and abnormal force distribution with every stride – Do this for 10,000 steps, and there is no wonder that this shearing moment can lead to pain.  

How To Improve Pelvic Stability

Proper co-ordination between the muscles that stabilise our pelvis is crucial. Just being “strong” isn’t always enough. We need to co-ordinate the contraction of many muscles, including your glutes, core muscles, pelvic floor, hip flexors and hamstrings, to allow us to do complex and fast movements like running and jumping while still maintaining a stable pelvis. So yes, you may be strong, but are these muscles working together to support your pelvis and sacrum and allow optimal pelvis biomechanics?

As well as doing strength-based exercises, doing specific exercises to improve stability and co-ordination are sometimes needed. This may include sport-specific drills, for example runners may need to do some single-leg strength exercises like single leg deadlifts or single leg squats, with appropriate technique correction to maintain correct pelvic alignment, to help them to be able to maintain pelvic control while only one leg is on the ground.

What Does Force Closure and Form Closure Mean For SIJ Stability?

Two main movements of the sacrum occur when the sacrum moves relative to the pelvis. Nutation  describes when the sacrum is rotated forwards relative to pelvis and counternutation describes when the sacrum is rotated backwards relative to the pelvis. Nutation is the close-packed, most stable position for the pelvis.. This normally occurs during increased load-bearing situations e.g. standing and sitting, to increase stability. So, what controls these movements, and how does the sacrum stay stable relative to the ilium?

The sacrum and the ilium each have one flat surface and one ridged surface which interlock together, promoting stability. The symmetrical grooves and ridges allow the highest coefficient of friction to protect the joint against shearing. The position of the bones in the SIJ creates a “keystone-like” shape which adds to the stability in the pelvic ring. This “keystone” shape is created, as the sacrum is wider at the top and narrower at the bottom, which allows the sacrum to be “wedged” in between the pelvic bones. This means that the SIJ has a high level of stability from this self-locking mechanism which comes from the anatomy and shape of the bones in the Sacrum and pelvis. This idea is known as form closure.

It is not just form closure that is important. It is essential to have strong muscles stabilising the SIJs to control their mobility. This muscle-driven joint compression and stabilisation system is known as force closure. i.e. active muscle forces acting on the joint to provide stability. Force closure is particularly important during activities such as walking and running, when unilateral loading of the legs creates shear forces.

Muscles involved in providing stability to the SI joints are divided into “muscle slings”, meaning that they work in a co-ordinated way with each other to provide optimal movement and compression.

  1. Anterior oblique sling (AOS): external oblique, internal oblique, opposite adductor, transverse abdominus
  2. Posterior oblique sling (POS): Latissimus dorsi, opposite glute max and the thoracolumbar fascia
  3. Deep Longitudinal sling (DLS): Erector spinae, multifidus, thoracolumbar fascia, sacrotuberous ligament and biceps femoris:

If muscles within these theoretical slings are tight, weak, or not working in co-ordination with each other, this is generally where we will see SIJ pain and dysfunction.

Do The Pelvic Floor Muscles Affect SIJ Function?

Your physio may also ask you about or assess your pelvic floor muscles. Suboptimal recruitment, weakness, or overactivity of pelvic floor muscles can influence stability at the sacroiliac joint and contribute to pain. Specifically two muscles in your pelvic floor (levator ani and coccygeus) work together with the transverse abdominus to increase the compressive load across the SIJ to resist shearing forces. So, weak, overactive/tight pelvic floor muscles change the compressive loading on the SI joint.

A 2018 study with 85 women with pelvic pain (so not specifically SIJ) showed 95.3% were determined to have some form of pelvic floor dysfunction. specifically, 71% of the participants had pelvic floor muscle tenderness, 66% had pelvic floor weakness and 41% were found to have a pelvic organ prolapse.   

Who Gets SIJ Pain?

Anyone can experience SI joint pain, as it is caused by high-impact accidents, including car accidents and general trauma to the area following a fall, hard running, sudden twisting or awkward lifting, repetitive shear and torsional forces e.g. golf; pregnancy, and repetitive loading. However, there are particular groups of people who are more likely than others to present to physiotherapy with SI joint pain.

  • Pregnancy causes sacroiliac joint pain from; 1. weight gain and increased lumbar lordosis (anterior pelvic tilt) 2. hormone-induced laxity (flexibility in soft tissue) in the third trimester, and 3. the trauma associated with delivery
  • To compensate for the increased anterior load, most mothers will adopt an exaggerated anterior pelvic tilt in standing (increased arch in lower back). As the lumbar spine moves into greater extension (arch); the sacrum moves into greater nutation. The result of this is increased compression at the SI joint in upright postures.
  • Hormone induced laxity – during pregnancy, there is an increase in hormones progesterone and relaxin. This sacrifices some ligamentous stability to allow for the pelvis to expand for the baby, but also therefore influences force closure.
  • Trauma of delivery: delivery itself may affect the structural integrity of ligaments and muscles in the sacrum. For example, weakening or injuring the abdominal muscles – which therefore also affects force closure.

Pregnant or not, women are 8 to 10 times more likely to experience sacroiliac joint dysfunction than men due to differences in our anatomy and body chemistry. Just some of the risk factors include:

  • Women have one less sacral segment than men to lock into the pelvis and stabilize it. This difference enables us to birth children.
  • Women have wider hips than men, which increases torque across the SI joint when walking or running. This, too, is related to having children.
  • Our sacroiliac joint surfaces are shallower than men’s, which also diminishes the stability of the joint.
  • Hormonal changes during menstruation, pregnancy and lactation can all make our ligaments more flexible (again, so we can bear children). This can leave the SI joint too mobile, causing pain and inflammation.
  • Repetitive, asymmetric loading with poor biomechanics
  • Tight hip flexors pulling into anterior pelvic tilt
  • A runner with poor pelvic control and tight hip flexors is probably the worst
  • Inflammatory forms of arthritis, such as ankylosing spondylitis and psoriatic arthritis, may increase the risk of sacroiliitis.
  • Inflammatory bowel diseases, including Crohn’s disease and ulcerative colitis, also may increase the risk.
Physio for SIJ pain in Sydney, Surry Hills. SIJ pain in pregnancy and running and sports

What Does SIJ Pain Feel Like?

Sacroiliac joint pain is typically localised to the lower spine and/or upper-inner buttocks region. It will generally be on one sided and deep-seated and may travel down the side of your tailbone. Pain can sometimes radiate down into the leg however, this is less common, and the pain is usually well localised to the low back and buttock region.

SIJ pain can be very sharp and intense, stopping you moving or making you feel hesitant to move or walk. It can also be a relatively constant dull aching pain, or a mix of dull aches with sharper pain on movement Additionally, sometimes you might feel muscle spasms throughout gluteal (butt) muscles, or pain across the base of your lower back. Isolated SIJ problems rarely give you neurological symptoms like pins-and-needles, numbness or weakness (except due to pain).

What Increases Sacroiliac Joint Pain?

Pain is normally aggravated by activities like arching your back, twisting in bed, long car journeys, walking up hills and going up or down stairs, landing after jumping, prolonged sitting or standing or heavy single leg strength work. Pain occurs when the joint is mechanically stressed, so high-impact activities like running can worsen your pain, as the area is unable to cope with high levels of shearing and loading. Symptoms normally feel better with rest, and avoiding such aggravating activities.

SIJ Pain Treatment – What Are The Best Ways To Manage Sacroiliac Joint Pain?

If you are feeling pain that sounds similar to the above description, and want to take control of your sacroiliac joint pain, your best bet is to book in an initial consult with a physio. Physios are experienced in treating SIJ dysfunction and pain, and through education, manual therapy, exercise, Clinical Pilates and self-management strategies can help you to take control and relieve your pain.

  • Physiotherapy has been shown to be the most effective treatment for sacroiliac joint pain. In a landmark research study based in Sydney, 1200 patients were diagnosed with SIJ incompetence both clinically and on CT scan (SPECT). Of these patients, 80 per cent went on to overcome their issues with a comprehensive physiotherapy program, without requiring further specialist injections or surgery.
  • Research published in the British Journal of Sports Medicine in November 2012 showed that pelvic pain caused by SIJ dysfunction can be 95 per cent resolved by musculoskeletal physiotherapy

Your physio will get you on the right exercise program, and relieve your pain using manual therapy (hands-on treatment). Regaining your full muscle strength and co-ordination is the key to long-term relief from SIJ pain. Your physio may also use taping to reduce your initial pain, and if you are pregnant or have recently had a baby they may discuss whether wearing a sacroiliac joint belt may be helpful in managing your symptoms.

Sometimes, it is necessary to avoid or modify certain aggravating activities for a short period of time. This may involve modifying your training load, or in more severe caes, you may have to stop your normal sport or exercise for a while to let things settle. Your physio will guide you in formulating a plan for your training so that you can keep as active as possible while still managing your pain.


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