Low back pain is the most common reason a person will see their healthcare provider. Studies show that 80% of the population suffers from low back pain. Your sacro-iliac joint, or SI joint, can often be a cause of what is perceived as low back pain.

What is the Sacro-iliac Joint

The Sacro-iliac (SI) joint is the joint between the sacrum (lowest part of your spine) and the ilium (pelvis) . This joint is unlike other joints as there is typically very little motion at this joint (1-2 degrees). Yet, this joint can be a source of discomfort for many. Pain is often felt low in the low back, glutes, and hips. Pain can be dull and achy or even sharp. Sometimes numbness and/or tingling can be felt in the glute area or back of the upper leg.

False Sciatica

SI joint dysfunction can often cause false sciatica. A true sciatica will typically send pain and/or numbness and tingling down the entire leg into the foot. False sciatica symptoms typically reside in the glute and back of the upper leg only and do not pass the knee. With SI joint dysfunction, the piriformis muscle is usually tight and inflamed. Because the sciatica nerve passes through the piriformis muscle, when this muscle becomes tight and inflamed, it can irritate the sciatic nerve.  Unlike a disc herniation that puts direction pressure on the sciatic nerve, with SI joint dysfunction the nerve is just irritated.

Common Causes of SI Joint Pain

  • Anatomical leg length discrepancy (ALLI):
    • About 20% of the population has one leg shorter than the other. This can be hereditary (genetic) or acquired (through trauma or after a hip replacement surgery). When one leg is structurally shorter than the other this will cause the sacrum (base of the spine) to become  unlevel. This un-leveling will in turn put abnormal stress and strain on the surrounding joints and muscles , including the SI joint.
  • Pregnancy:
    • Your body changes a lot during pregnancy. Increased loads on the spine due to weight gain from the pregnancy can be a cause of stress to the SI joint. During pregnancy your body also makes a hormone called relaxin. Relaxin helps to loosen the ligaments to prepare your body for delivery. However this can also cause the SI joint to become hyper mobile and unstable. This can then lead to pain in the SI joint during pregnancy.
  • Hypermobility:
    • Some people (usually women) are more flexible than others. Increased flexibility isn’t always a good thing. More flexibility can mean less stability. There are also genetic disorders that cause hyper mobility of the joints (EDS). When a joint becomes hyper-flexible or hyper-mobile it can lead to chronic pain.
  • Trauma:
    • Falling onto your backside or lifting heavy objects with bad form (like with a twisting motion) can injure your SI joint.

Home care for SI Joint Pain

  • Yoga: there are many Yoga poses that are great for SI joint pain such as supine pigeon, child’s pose, gentle Yoga twist, and cat/cow.
  • Strengthening: strengthening the supporting muscles can help to stabilize the SI joint. Exercises like pelvic tilts, bridge pose, triangle pose, and walking are great for supporting the SI joint.
  • Pillow between knees with side sleeping: sleeping with a pillow between the knees will help to keep the hips aligned and take stress off the SI joint area.
  • SI joint belt : for those with hyper flexibility and hyper mobility, the SI joint belt can offer some stability. I don’t recommend wearing it all day however. A couple hours during the day to give some relief is a good goal to aim for.

*Exercises and stretches should be done with caution and immediately stopped if symptoms worsen. 

Chiropractic care for SI Joint Pain

Chiropractic care can be an effective treatment for SI joint pain. Finding out the root cause of the pain is of importance to the correct treatment solution.

If there is a true leg length discrepancy, being fitted for a proper shoe /heel lift is necessary. In order to be certain of a true ALLI , a specific X-ray is required. Unfortunately you can not eyeball or measure correctly from the outside a true ALLI. Once the accurate film is taken, your CBP certified chiropractic will be able to accurately assess the amount of the un-leveling and prescribe you with the proper lift.

For hyper mobile patients , proper posture and spinal alignment is of critical importance. Any deviation from the normal, healthy alignment can put undue stress and strain on the SI joint. A common postural abnormality that I see with SI joint pain is pelvis rotation. This can also correlate with foot issues as well as pelvis rotation will often cause at least one foot to pronate (turn onwards) and another to supinate (turn outwards). By realigning the abnormal posture back into a healthier alignment, the abnormal stress and strain can be relieved off of the SI joint allowing it to heal and function properly.

Bottom Line

SI joint pain can be problematic for many and can interfere with activities of daily living. It can limit your ability to sit, stand, exercise, and enjoy social activities. Having healthier spinal alignment and posture can help your SI joint to function better and improve your quality of life.