Lower Back Pain? Or could it be Your Sacroiliac Joint?

Ryan LaCorte Christina Gilson, Publications

Experts estimate that 80% of the population will experience back pain at some point in their lives. If you have ever had back pain you will attest that it interferes with everything that you do in your daily life, but was the pain actually coming from your back? Or could it have been coming from your sacroiliac (SI) joint(s)?

Your SI joints are formed by your left and right ilium and your sacrum. Your sacrum is the triangular bone at the base of your spine and the two ilia are what make up your pelvis. The SI joints, therefore, are what connect your back to your pelvis. You can see the location of these joints from the back by noting the “dimples” on both sides of the back at the belt line. These joints are held together by very strong ligaments, therefore, there is normally not a lot of movement at the SI joints. These bones are also the site of attachment for a number of back and lower extremity muscles.

What are the symptoms of SI joint dysfunction?

The symptoms of SI joint dysfunction are lower back pain, buttock pain, pain that radiates down the leg (usually only to the knee), pain in the groin, pain in the hips, and/or muscle spasm in the hips or lower back. As you can see these are very similar to symptoms of lumbar disc herniation, sciatica or back injuries in general.

So how can you tell if your pain is coming from your back or from your SI joints?

Your orthopedist or your physical therapist can perform a number of tests to differentiate the cause of pain. Sometimes your SI joints can become “dysfunctional” or not aligned properly due to an imbalance in the flexibility or tightness of the muscles that attach to them or due to a fall that shifts things out of place. Another source of dysfunction is a motor vehicle accident. Having your foot up on the brake at the time of impact causes forces to be transferred up through your leg into your pelvis. This can cause a shift at the SI joints that tends not to “shift back” on its own.

Physical therapists are trained to diagnose these dysfunctions by palpating, or feeling, for the alignment of the ilium in reference to the other side or in reference to the center of your body. This palpation, along with a number of special tests help them to determine which way the SI joint has shifted. It can be rotated forward or backward or it can be flared in or out. Depending upon which way it has moved, the therapist will perform a muscle energy technique or MET. These techniques are very gentle and use the muscles that attach to the bones of the SI joint to pull the bones back into alignment. Once the joint is realigned, the muscles need to be retrained or released, or both depending on the length of time that the symptoms have been present and the nature of the problem. Often when there is a dysfunction and the bones have been out of alignment, there will be muscles that have been in a lengthened position. This position causes the muscles to overwork and develop increased muscle tone. There will be other muscles that have been in a shortened position and have not been able to fire properly and may be inhibited. Physical therapists, who are experts in anatomy, know which are the likely culprits of this increased tone and they can use a technique called myofascial release (myo = muscle and fascia = connective tissue) to allow the muscle tone to be restored to normal. Once back to normal length these muscles need to be retrained to fire properly to stabilize the pelvis during upright posture, moving from sitting to standing, and walking to name of few every day activities.

Another time when the stability of the SI joints are compromised is during pregnancy. Hormone levels increase during pregnancy which cause the strong ligaments of the pelvis to relax in preparation for the birth of the baby. However, before birth this relaxation of the ligaments can allow shifts in the SI joints that lead to low back pain and pelvic instability. In this case physical therapists can help by realigning the pelvis (as above) and providing an SI belt, which is a support to maintain the stability of the pelvis until normal hormone levels are restored. Sometimes in the case of a person who is not pregnant, but has had a number of SI issues a similar SI belt can also be helpful to provide stability to the pelvis while the muscles are being retrained and strengthened.

At All-Care Physical Therapy the physical therapists have the knowledge and the skills to determine the source of your low back pain. They will develop an individualized treatment plan to alleviate your pain and help you return to your normal daily activities!

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