Monday, April 26, 2021

SI Joint Dysfunction: How You Can Fix It Forever

Disclaimer: This post contains an affiliate link.

Got low back pain? While there are different types of low back pain, one of the most common causes, especially in women, is problems with the sacroiliac joint. SI joint pain usually occurs on one side of the low back. There are a variety of reasons for SI joint dysfunction including injury, repetitive high impact activities, muscle weakness, hormonal changes, such as with pregnancy; and arthritis. 

I experienced SI joint dislocation several years ago after lifting a wreck bag during a CrossFit workout. This was not my first time experiencing pain in that area, but it was the most severe. Luckily, there was a physical therapist in the class, who assisted me with putting the joint back in place. She gave me exercises to do, which helped control some of the pain, but the issue never completely resolved. This past winter, I began experiencing increasing pain on the affected side with walking and running. My gait and my ability to strength train with proper form was altered as I attempted to control the pain. After discussion with my rheumatologist, I sought care from a physical therapist who specializes in women's pelvic health. 

There are a variety of treatments for SI joint dysfunction. I'll be sharing some of the more common remedies as well as my experience with pelvic health PT.

What is the SI joint?

The sacroiliac (SI) joints sit on either side of the lower spine, between the sacrum (the area of the spine right above your tailbone) and the ilium (upper hip bones). There are strong ligaments to hold these joints in place. The main job of the SI joint is to support the spine and absorb shock. Most of the time, the pain associated with SI joint dysfunction is dull and does not radiate down the hip or the leg. It can become quite severe, mimicking other problems such as sciatica or piriformis syndrome. 

By BruceBlaus. Blausen.com staff (2014). Medical gallery of Blausen Medical 2014 WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. - Own work, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=27796934


How is SI joint dysfunction diagnosed?

SI joint dysfunction is often mistaken for other issues, making it challenging to diagnose. Many people who experience pain in the low back search their symptoms on the internet and come up with other diagnoses and remedies, delaying the time to proper treatment. Some of these recommended treatments may even exacerbate the problem. 

SI joint dysfunction is best diagnosed by a skilled medical provider, such as a physician, nurse practitioner, or physical therapist. Most providers can diagnose SI joint dysfunction by several specific physical maneuvers, rather than by x-ray. Some physicians will inject an anesthetic into the joint in an attempt to relieve the pain. If that is successful, the diagnosis of SI joint dysfunction is confirmed. 

How is SI joint dysfunction treated?

Initially, most providers will instruct patients with SI joint pain to take anti-inflammatory medications, such as NSAIDs. Corticosteroid injections are sometimes given into the joint as well. While medications are helpful to reduce inflammation and pain, they don't address the cause of the problem. Surgery should always be considered a last resort in the treatment of SI joint dysfunction.

There are braces and belts meant to support the SI joint that can be really helpful, especially when experiencing pain. These devices can provide gentle compression to the joints, helping to stabilize the region. I used this belt at the beginning of my treatment and found it to be really helpful while doing my daily activities. 

This SIJ belt is low profile and comfortable!

Exercises can help reset the SI joint. After my initial injury, I was given several exercises to do at home. The simple knee-to-chest maneuver on the affected side is really helpful to reset the joint and provide some pain relief. I also found it helpful to hug both knees to my chest. There is a great Yoga with Adriene class for low back pain on YouTube which incorporates several very gentle maneuvers that really helped calm my back pain. I would advise yogis to avoid any twising poses that may aggravate the joint.

Knee to chest pose can help reset the affected side.

Physical therapy is the main treatment for SI joint dysfunction. Physical therapists are skilled at evaluating the problem and addressing the factors causing the pain. Once the diagnosis is made, the PT will work with you on flexibility and strengthening the muscles supporting the joint. I was surprised to find out that I had a weak gluteus maximus on the affected side, considering all the strength training I do! As I did my research for this post, I learned that a weak gluteus maximus is a common contributing factor to SI joint dysfunction. She gave me very specific exercises to target that muscle, both to do when I'm with her as well as at home. 

My PT also noted that my costophrenic angle (where the ribs meet) is narrower than it should be. This is due to the muscle tightness all along the affected side, which she said was due to me adapting to the pain from the SI joint. Yikes! She performs deep tissue massage on that side and on my abdomen when I am there. This is quite painful! But it has also been helpful as I continue to improve. Maybe this also means no more side stitches?

Belly breathing is something that I had to relearn. Breath patterns change in people with SI joint pain and I was no different. The abdominal muscles work with the muscles around the SI joint to stabilize it. Coordinating the breath and using the abdominal muscles can help relieve SI joint pain.

It was important to me to find a PT who specializes in pelvic health. A pelvic health physical therapist not only has a doctorate in PT, but also has completed a year-long fellowship in women's pelvic health.  While I was a little nervous about the kind of treatment I would receive, I had been experiencing pain for so long and was open to trying just about anything. The SI joint is part of the pelvis, and it made sense to me that addressing all the muscles in that area would help with my SI joint pain. Without being TMI, I have to share the muscles she works on also include the pelvic floor, and require internal manipulations. 

credit: Wikimedia commons

Within 2 weeks of starting treatment, my SI joint pain was gone. I was so impressed. Going forward, my treatment focused on addressing my imbalances and muscle tightness and working on strengthening my gluteus maximus.

Full disclosure: The treatment for SI joint dysfunction is not painful but it can be uncomfortable. My PT is very sensitive with her approach. In addition to helping my SI joint pain, she has also helped me with some issues I've had with IBS. It's all related, you know. 😉 Pelvic health physical therapy is also useful for women who experience urinary incontinence as well as internal organ prolapse.

I could not be more pleased with the results of my SI joint treatment. The key to preventing the pain from returning is to continue to do exercises as prescribed and remembering to belly breathe. If you have SI joint issues and haven't gotten relief from traditional PT or chiropractic, I would highly recommend seeing a PT who specializes in pelvic health. Feel free to PM me if you have any questions!

Have you ever suffered from SI joint or low back pain? What did you try? What helped? Would you consider seeing a pelvic health PT?

I'm linking up with Kim and Zenaida for Tuesday Topics and with the Runners' Roundup: DebbieDeborahJenLaura, and Lisa.  

 

32 comments :

  1. So glad that you got the help you needed, Wendy!

    In general I don't suffer with low back pain -- although my Dad & my sister do/did -- chronic pain is no fun. I have heard that most women's pelvises are really twisted and we just don't know it.

    Interesting that internal adjustments were required!

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    1. First of all, women's pelvises aren't 'twisted', lol. It's all about muscular imbalances, which is why the internal adjustments are helpful. The vagina is also a muscle. It'a really all part of the pelvic unit.

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  2. Gosh, how scary that must have been dislocate the joint in class, but also so great that there was a PT present who could assist. Thankfully, I don't have any lower back paint or SI joint issues but I really appreciate all the information you've shared. I also love that there are people who specialise in pelvic health.

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    1. It was frightening when I hurt my back like that! I'm grateful to the PT at my CF box as well as the pelvic health PT who helped me get realigned.

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  3. I'm so glad you found relief! Sounds like you got great care. Back pain is no fun and it seems so rampant.

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    1. I could not be happier. I was shocked at how quickly I got relief. It's all about going to the right kind of provider.

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  4. Wow, I've never had any issues so far but you never know!
    Thanks for this interesting write up.

    I'm curious: what kind of exercises did you get to strengthen the gluteus maximus? I'm thinking weighted glute bridges, booty lifts, banded fire hydrants, etc.

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    1. The exercises are really targeted--I'm doing side lying hip adductions and prone leg raises with leg straight and then with knee bent. The key is to really focus on the glute and not engage the hamstring, which can be challenging. It's a small movement too.

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  5. You really got some GREAT treatment, that got to the root of the problem. I thought about going to a pelvic floor specialist because after my daughter was born I literally couldn't run ten steps without peeing. I ended up doing some exercises at home that helped tremendously, but sometimes wonder if there are still underlying issues.
    I'm so glad you solved this problem!!! Thanks for sharing this information.

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    1. I highly recommend seeing a pelvic health PT for low back issues as well as incontinence. It has been such a great experience!

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  6. These are really great tips Wendy - thanks so much for sharing! I feel like I hear so many people - runners, OTF members, crossfit members - speak about this type of issue.

    I'm glad that you now have relief from your SI joint pain.

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    1. Thank you Kim! I think this is such a common issue, especially for women, and I hope my experience helps others.

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  7. I have dealt with piriformis issues, and they are a total pain. Thankfully, it's been awhile. My lower back has been cranky lately, though. Climbing out of bed (sometimes) is tough...but once I'm up and moving, all is well. That knee-to-chest pose really feels good!

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  8. Wonderful Post!! Very well thought out and easy to read. I am thankful you received relief and spoke with the correct parties involved. Interesting belt as well and good on you for continuing to perform the much need exercises. If you don't mind, would like to take this time to piggy back on a few tips for your readers.

    Structurally; the SI Joint becomes an issue under loads and alinement. I give clients the example of how the Sacrum marries the imagine of the spade of a shovel. When you dig out back in the garden, the shovel digs in, you heel down on one side, normally with the domineering foot, and the spade dives deep into the soil. Same with the hips after weight is distributed through the pelvis. This helps paint a related or relatable picture for the client.

    Anatomy; Another two major muscle mover that effect the SI Joint would be the fight or flight Psoas Muscle. The Psoas Muscle is the only muscle that crosses the hip joint and when shortened causes havoc on the low back and SI Joint. Example of that is when folks stand up after watching a movie. Their hands go towards their low back as they stand and believe that its their back. But it is actually that tight Psoas. The other muscle is the Quadrates Lumborum and that is our tango dancing muscle. This muscles tends to cause bilateral issues in the hips. i.e. the right QL becomes shorten/weak and the left SI Joint suffers from impingement.

    Body Metaphors; This is something I am in love with and makes sense in my model of the world. Might not resinate with others so good judgment is key when addressing. The meaning behind a body metaphor would simply be an issue or chronic pain that stems from a past situation. Example that I give clients and referring back to the shovel would be when you are digging a hole and hit the irrigation pipe. Very unfortunate and one of the first things we do is grab the back of our neck. The back side of our neck holds guilt from the past. We have all witness someone making a mistake and rubbing their neck afterwards or while explaining their problem with embarrassment across their face. Each bone, muscle group, organs, zones, glands, planes, and areas of the body have about four or five metaphors. The lower leg, specifically the calf, carries the Body Metaphor of Hesitation. I have worked with runners and this injury. A gal that was all upset with the injury dropped her jaw when I ran the metaphor by her. Her and her husband were concerned about the purchasing price range of a home. Now for the Pelvis/Hips!! Loyalty, Relationship, Security, Survival, & Sexuality. Lower Back!! Maturing, Security, Gracefully Growing Older, & Uprightness. Both SI Joints reflects Mobility, Flexibility, Taking In Rigid Stance, Being Inward, & Balance.

    If I still have your attention, one step further now, Chakras and related Metaphors. The Pelvic/Naval Chakra ( Water ) Pleasure, Desire, Giving And Receiving, Change, Emotions, Family, & Movement.

    In closing, your post is most excellent. You even pointed out that a proper evaluation performed by a professional is necessary. Please please please do not take the above information as a personal attack or challenge. After practicing body work for over a decade and now Ortho-Bionomy for quite some time now, the body opens new avenues for healing from within under the most brilliant circumstance. And Yes, SI Joint Pain Is Immobilizing And Trends To Linger. That reminds me of the Arndt-Schultz Law.

    Thank You Wendy For Being You - Stay Strong - And Continue To Seek The Best Possible Outcome
    Cheers

    P.S. Ask all the questions you have and will happily answer with what I know, experienced, believe, or have seen first hand

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    1. Psoas I was saying...pardon the pun, lol. When I wrote this post, I was thinking of you and hoping you'd weigh in. I knew you would have a lot to offer and I am so grateful you did. I sought treatment from the pelvic health specialist because I knew she would address issues that a regular PT would not. I am almost finished with my treatment and am so grateful to be feeling better. I agree with you that an evaluation by a qualified professional is so important. The worst thing runners can do is google their symptoms and self-diagnose. Thank you again so much!

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  9. Oh my, that would have freaked me out to dislocate a joint during a workout! Glad you had someone there to help.

    This is an interesting post; I've seen some posts about pelvic floor PT's and how valuable they are. I also didn't know about the connection between IBS and the SI joint, but I guess it makes sense!

    The value of science and medicine- incredible :)

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    1. Right? I learned so much during this process. The pelvis and everything within is so intimately related.

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  10. I've had SI joint issues forever! Well I think I have...it was my first diagnosis, but everyone I've seen has had a different opinion. I do think my SI joint has some dysfunction, but who knows what the initial cause of my problems was. Funny enough, it actually didn't bother me when I was pregnant! I saw a pelvic floor PT during my last 2 months of pregnancy and really didn't find it helpful. If I pursued it again I would go somewhere else. Strength training, core stabilization, and proper breathing have all helped me the most with managing it!

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    1. I'm glad you've been able to keep your symptoms under control. I feel like I hit the jackpot with my PT and I would wish for everyone to find someone as good!

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  11. last month I was experiencing some lower back pain in that general area. After doing much more stretching and getting some serious massage, it seems to be abating. It takes a lot of work to keep us aging runners up and running

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    1. NO KIDDING! I was just saying something similar to my husband. I've become so high maintenance!

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  12. I've noticed more lower. back pain these past few weeks but I blame it on my work set up at school. I am always learning forward to see more clearly my students on the monitor. I don't know why I didn't just move it closer to me.

    I am thinking a massage would also help!

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  13. This is all so interesting. I have occasional back pain, usually when I wake up in the morning and not throughout the day, thank goodness. It's actually much better since I started teaching my twice weekly stretch classes (forced to stretch lol). I don't think I have issues with my SI joint but it's definitely something to consider. Thanks!

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    1. You had mentioned you wanted to hear more about my treatment. It's been amazingly helpful!

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  14. That's interesting. The only time I ever have lower back pain is when I do things like v-ups, but I think it's more from my tailbone than joint pain. It usually passes quickly, thank goodness.

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  15. That's great to hear that you have found relief from your SI joint pain and I hope it doesn't return. It's a tough one to figure out and even though I've thought I've had SI joint issues, it could have been sciatica since I'm so prone to it.

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    1. I feel like i hit the jackpot with my PT. She's really done a great job addressing my issues. i'm feeling so much better!

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  16. Great post! I am seeing a PT next week for my SIJ issues; I have IT band issues on the other side, so I suspect something must be amiss with my psoas or glute meds. The knee to chest stretch helps so much and brings relief when it starts to irritate me!
    I also started doing Pilates again; that kept me free of pain for years, and only after stopping it (just so much to do) have issues like these cropped up.

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    1. I'm curious to hear how you are doing after seeing the PT!

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