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Sacro-Iliac Joint

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Is your Sacro-Iliac Joint (SIJ) contributing to your back pain?

Lets start talking about this blog with some anatomy of the Sacro-Iliac Joint or SIJ as it is commonly shortened to. The SIJ are two joints that make up the back of the pelvic circle. We have two halves to our pelvis that join at the front of the pelvis to make the Symphysis Pubis Joint and join at the back on each side of the sacrum bone to form the SIJ’s.

This makes a very stable and secure ring of bone to the ligament that hardly moves. There is a small amount of movement at the SIJ and symphysis pubis joints but it is very minimal. This is important as we require a strong and stable pelvis in order to walk and move as we do on two feet.  There are also a lot of muscles that work by pulling and moving from the pelvis.

Often, people have been informed that their pelvis is ‘out of alignment’ or ‘shifted’ and they attend therapy appointments and have treatment sessions with the idea that they require being ‘put back into place’. This can be misleading as usually people’s bodies are not symmetrical. Generally , we are not perfectly aligned or symmetrical throughout our bodies but rarely is this a new or changeable occurrence. Usually, these joints provide only millimeters or less of a shift and movement, as they are so strong. This movement has been proven to be unreliably measured by human sight and tests that look to assess the ‘alignment’ of the SIJs and some might ask, why is it important at all to address these natural asymmetries, as they are often not the cause of any symptoms.

Symptoms and Exercises:

Sometimes, the SIJs can be the cause of significant pain and symptoms around the back, pelvic area and into the legs. A common time to experience these symptoms is during or closely after pregnancy and childbirth. This is likely due to the change in ligament flexibility that occurs naturally during pregnancy to allow safe and natural birth to take place. Combine this change to the ligaments with the altered postures and weight of being pregnant, and it can lead to extra stresses and strains on parts of the back and pelvis that they are just not used to.

Activities such as crossing your legs or feet often, putting on your shoes, socks and trousers whilst standing on one foot or doing a lot of walking, particularly up and down any stairs all have the potential to increase side to side strain to the pelvis and so can lead to overload in tissues of the body that are not used to those strains. This can sometimes present as pain.

We are often asked to offer advice to pregnant women about how to avoid these pelvic related pains. We suggest trying to sit down to put on shoes and socks so you are not stood awkwardly on one foot. Try limiting your walking a little to regular flat short walks in comfortable footwear if you are experiencing aches around your pelvis and try to avoid crossing your legs when sitting.

All these small changes can make an effective difference to the symptoms you are feeling. Another time when the SIJ can be a contributor to pain is when there has been a trauma or injury to the body that might involve a shunting force through one side of the body such as a car accident or heavy stepping due to a fall. It may be due to a rotational stress through the pelvis such as falling and rolling or altering the way we move due to pain in a foot or knee for a long period of time. It usually requires a large force due to the strong and stable nature of these joints. Sometimes this is confused or mixed up with the symptoms of low back pain as these two areas of the body are so closely related and share so many ligaments and muscles.

A careful assessment by a therapist will enable pain provocation testing of the SIJs to determine if they are contributing to your symptoms. These battery of tests have been shown to be reliable in picking up SIJs related problems or ruling out when they are not contributing. Your therapist will then be able to offer you simple and effective strategies on how you might manage these symptoms. Often these types of exercises or small modifications in the way that you are doing certain activities can help.

When trying to determine if you have an element of SIJ related pain, consider the following simple questions: Are you pregnant? Have you had a shunting or trauma force that may have affected one side of your body more than the other? Do you have pains around the lower back, sitting bone or top of the legs? If the answer is yes to any of these then you need to consider that your SIJ may be contributing to your symptoms.

Leanne Plenge

Specialist MSK Physiotherapist