5 Steps to Addressing SI Joint Pain | the Truth About SI

Do you suffer from sacroiliac (SI) joint pain and you’ve been told that your SI joint is out of place? Maybe you are trying to put it back in or wearing an SI joint belt? Perhaps you just can’t seem to resolve it. Let’s discuss the anatomy of the SI joint and how you can help to address your SI joint pain.

The SI joint comprises the triangular bone, the sacrum, with the two ilium’s, pelvic bones. It is also reinforced with a lot of ligamentous structures. All of these connective tissue structures and the SI joint are primarily responsible for shock absorption between the upper body, and the pelvis and legs.

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The sacroiliac joint has very little motion. It has approximately four to six degrees range of motion, so there is a subtle forward bending and back bending even just with our breath alone. However, just as much as it needs to be stable and have proper sequencing and coordination of all the deep stabilizers of the pelvis, it also needs proper mobility. We need the pelvis to be able to move freely in forward bending, backward bending, side bending, and rotation. This is crucial for gait.

Speaking of gait, how we interact with the ground influences our SI joint. Walking is one of the best assessments of movement efficiency. It tells us how well we can load forces and unload forces, and how well we can transfer energy through the body. We do that through our fascial tissue, and we have different fascial lines that are transferring this energy through our body, crossing over the SI joints.

One of the primary subsystems o the SI joint is the deep longitudinal line. This starts at the bottom of the foot comes up the lateral side of the leg, up into our hamstring, or biceps femoris, into our sacrotuberous ligament, which is one of the ligaments of the SI joint, and then right into the SI joint and up along the spine. This is where we’re transferring energy and this line is mainly responsible for shock absorption. When our breathing is compromised, and we’re not able to have proper sequencing and pelvic control of our gait, then we will see SI joint pain and dysfunction.

Now let’s talk about five different things that you should consider with your SI joint. 

1) Breathing

More specifically, diaphragmatic breathing. That means as we’re inhaling through the nose and breathing all the way down to the base of the pelvis. This will assist us to get the proper relaxation of the pelvic floor. As we exhale, we get the proper contraction of the transverse abdominus, our natural weight belt. Our abdominal muscles contract, returning the diaphragm back to its resting position. This will allow for proper sequencing, timing, and coordination of the deep stabilizers of our core. If we’re breathing from the neck, that will not happen. 

2) Pelvic Mobility

As I mentioned, the pelvis needs to be able to move freely in our gait cycle. We have to integrate the breath with this and coordinate into pelvic patterns. We want to be able to forward bend, backward bend, rotate, and side bend the pelvis. Evaluating those movements lying down and standing will be very valuable. Notice where the restrictions are and notice if that reproduces the pain. Remember if the pelvis isn’t moving properly as we are walking, then we are not transferring force efficiently. That is exactly what can contribute to SI joint pain.  

3) Rotational Stability

This can take on lots of different forms, although the bird dog is a great exercise to develop tensioning and coordination in a rotational pattern. This dials into a lot of other fascial lines and connections that all pass through the SI joint. It is important to stabilize basic patterns and then progress them to higher-level patterns.

4.1) Foot to Core Sequencing

Use dynamic patterns such as forward lunging, reverse lunging, side lunging, and rotational lunging. The goal is to perform all of these with proper alignment and connecting the foot to the core with intention. So, you’ll want to use a short foot, rooting the toes into the ground and connecting it to your breath, to be able to maximize how you’re sequencing from the ground up.

4.2) Foot Type

Different foot types will contribute to how we are loading and unloading force. If we have a more everted foot type for example, where the arch is flattened, this can contribute to the stability in our foot and how we transfer energy towards our pelvis. Conversely, if we have a more inverted foot type, which means we are a little higher arched, that can put a lot of stress and force on the SI joint as well. Our goal is to bring our foot back into neutral. Whether we are strengthening the feet and connecting them to our core or creating more mobility in the foot, calf, and lower leg to bring our foot back into neutral, how we load and unload the ground is going to directly impact the SI joint. 

5) Total Rotation

Lastly is addressing your total rotation. If we are in a standing position doing a full rotation, are there asymmetries side to side? Can you focus on specific thoracic spine mobility to create and emphasize more rotation in your gait? Ultimately, we need optimal rotation in our pelvis and thoracic spine for efficient gait. We walk on average 6000 to 8000 steps a day and that is our best assessment of movement efficiency. 

There you have it, a new way to look at your SI joint, and perhaps not seek out muscle energy techniques and ‘put it back into place.’ The SI joint only moves about four degrees so it is likely not out of place. You might have pain and dysfunction, but looking at why that’s happening, looking at it from an integrated perspective of how we are interacting with the ground, and get to the root of the issue is key. 

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8 causes of LOW BACK PAIN that isn’t a weak core

Do you have low back pain, and you’ve been told that it’s from a weak core? Here are eight reasons why it may not be coming from your core.

One in four people experience low back pain in their lifetime, and it is also one of the number one causes of the opioid epidemic. Most people that are seeking pain medication are coming in initially for low back pain.

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One of the things that is important to recognize with acute low back pain is that it can be treated very easily. However, because of the nature of our medical system, we tend to go to our primary care, get a muscle relaxer and pain medication, and get referred potentially for an X-ray. The X-ray doesn’t show anything, but you still continue to have low back pain. Now you are referred for an MRI but still don’t show anything except for some degeneration, which everyone after the age of 35 is going to have. You still don’t have any answers, so you get an injection. Then three months after this acute low back pain episode, you’re still having pain. Now you are in a chronic pain state. 

Chronic pain is much different than acute pain. It is defined by having pain greater than three months and is referred to as central sensitization. Our nervous system becomes sensitized. We have no tissue damage, however, the brain is still interpreting that there is pain in, let’s say, for example, the low back.

Here are eight root causes of your low back pain, that isn’t simply a weak core. All these can also contribute to acute and/or chronic low back pain.

1) Poor Breathing

Our breath should be a diaphragmatic breath. We breathe 20 to 25,000 times a day. If we are not breathing from our diaphragm, then that means that the sequencing of our entire abdomen is affected. It also creates a stress response.  

2) Movement Compensations

When we think of how pain or injury ultimately happens, think it’s when anatomy meets opportunity. If you have an ankle sprain, let’s say three months ago, and although it’s getting better, there’s still some stiffness in the ankle. Now every time you are walking and striking the ground in dynamic movement, there is asymmetry. You have different forces that are being transferred up through your body.  That means that now you’re going to begin to compensate. You’ll change how my foot strikes the ground; how your pelvis is moving. This can be an example of how any movement-compensation, especially over a period of time, can ultimately lead to pain and or injury.

3) Stress

This can not be emphasized enough and how it’s one of the biggest factors in low back pain. Not only can we hold tension in our abdomen and our pelvic floor, but it also shifts our breathing to an upper chest breathing pattern. Additionally, stress is linked to inflammation. Without a doubt, I’ve seen in my clinical practice that this is one of the biggest driving factors of low back pain, especially chronic low back pain.

4) Poor Sleep

Inadequate or interrupted sleep is actually one of the biggest drivers of low back pain. Poor sleep also shuts down the release of our growth hormone, which is needed for repair and healing.

5) Chronic Inflammation

Ninety percent of all health conditions are linked to excessive or persistent inflammation; from eczema to anxiety, depression, and even Alzheimer’s. Now, when we think about inflammation as it relates to our musculoskeletal system or nervous system, inflammation will contribute to pain, joint stiffness, joint inflammation, osteoarthritis, and more. This can also consistent with chronic low back pain.

6) Sedentary Lifestyles

This can be one of the biggest drivers of recurring low back pain, per some of the research. We are meant to move; our bodies crave movement. We do not want to be in one position all day long. As you’re thinking about your day, think of it from a ‘movement mindset’. It doesn’t have to be exercising 30 to 60 minutes; you need to be moving all day long.

7) Poor Gut Health

Your gut is your second brain, and we have an entire nervous system located right there. If there are gut issues, that means there are inflammatory issues. Without a doubt, because we have 70 percent of our immune system in our gut, and we have this nervous system, when we are having visceral pain, this will influence the sequencing, timing, and coordination of all of our muscles and our abdomen and pelvis. It is definitely something that can contribute to low back pain, especially in the case of bloating and constipation. 

8) Lack of Movement Variability

As I mentioned earlier, our bodies crave movement. When we are in sustained postures all day long like sitting at a desk or crossing our legs in one direction, not changing positions consistently throughout the day, then our fascial tissue, our three-dimensional network, or ectoskeleton can get sticky. It is meant to be elastic, create tension, and transfer force efficiently. If we are sitting in sustained postures throughout the day and not changing positions, like getting down to the floor and getting back up, this can, unfortunately, contribute to low back pain.

There you have it; eight different root causes of why you might have low back pain. There are, of course, other things like pelvic pain and other medical conditions, but hopefully, you can appreciate that it is not necessarily because you have a weak core that you are having low back pain, and if you strengthen your core it’s going to get better. You want to look well beyond that. 

Reach out for a 15-minute FREE discovery session to see how we can help you on your journey.

For more content, make sure to subscribe to our YouTube channel here.

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