si joint pain Archives - The Movement Paradigm

Struggling with SI joint pain even after physical therapy? You’re not alone. This pain can be frustrating, but the good news is there are often solutions. In this blog, we’ll explore six common causes of SI joint pain and offer targeted strategies to get you back on track. We’ll go beyond generic exercises and delve into specific approaches to address the root of your discomfort. Here’s how to improve SI joint pain.

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What is the SI Joint?

When looking at the pelvis from the back, consider the bones: the sacrum, a triangular bone, and the ilium on each side. These pelvic bones are connected by various ligaments, including the sacrotuberous and sacrospinous ligaments, creating force and forming closure on the SI joint. Pain typically occurs in the lower back region, often near the bony bumps, but it can also present in different areas around the pelvis.

The SI joint is very stable due to its self-locking mechanism, known as form-force closure. This stability depends on the forces entering the joint. For example, a vertical load creates stability through form, while different forces transmitted through the joint also contribute to stability.

Six Causes of SI Joint Pain and How to Improve Them

1. Asymmetry

Most people with SI joint pain experience it on one side. Our bodies are asymmetrical due to the placement of organs like the liver, pancreas, and spleen. Daily activities, such as writing with one hand, driving, and crossing legs, can exacerbate these asymmetries. This can lead to changes in the diaphragm and respiration, affecting the stability of the entire integrated unit. For instance, a pattern of crossing the right leg may lead to internal hip rotation and weaker external rotation, contributing to pain.

2. Force Transfer

Asymmetries affect how we transfer force through our bodies. Our fascial tissue, a 3D network, plays a crucial role in this process. The deep longitudinal line, which includes the lower leg, hamstrings, hip rotators, and low back muscles, is essential for force transmission. Compensations and imbalances, such as flat feet or tight lower leg muscles, can impact this line and contribute to SI joint pain.

Optimal stability and reflexive stabilization from the deep front fascial line, which includes the foot, inner thighs, pelvic floor, diaphragm, and even the tongue, are critical for SI joint mobility and stability. Ensuring all the surrounding musculature is stable is essential for effective force transfer.

3. Foot Position

Foot position can influence SI joint pain. Overly everted (turned in) or inverted (high-arched) feet can stress the SI joint. A rotated-in, flatter foot may lack deep stability for proper force generation, while an externally rotated foot can stress the SI joint ligaments. Achieving a neutral foot position through mobility and stability exercises can help balance the lower leg and reduce stress on the pelvis.

4. Breathing

Proper breathing involves positioning the diaphragm correctly, with the rib cage over the pelvis in a stacked position. This allows the diaphragm to communicate efficiently with the pelvic floor. An open scissors posture, where the pelvis is tipped down and the rib cage up, can cause compression on the SI joint. To improve breathing, keep the tongue on the roof of your mouth, breathe through your nose, and focus on a 360-degree breath. Exhale with the abdomen contracting while maintaining a stacked position.

5. Pelvic Mobility

While stability is crucial, pelvic mobility is equally important, especially during gait. SI joint issues often involve mobility problems. The pelvis should move forward, backward, rotate, and side bend for optimal movement. Practicing pelvic movements while lying down and coordinating with your breath can restore natural fluid movement in the pelvis.

6. Integration

To bring it all together, stability, sequencing, timing, coordination with breath, foot position, and addressing asymmetries are essential. An effective exercise to integrate these elements is the short foot exercise.

How to do the Short Foot Exercise:

Step with one foot forward and the other foot slightly back, creating a small kickstand.
Hinge at the hip.
Breathe in through your nose, exhale, and gently root the tips of your toes into the ground.
Breathe in with the tongue at the roof of your mouth, exhale, and root the tips of your toes into the ground.
If this feels easy, progress to a single-leg stance.

This exercise promotes reflexive stabilization from the foot, enhances breath control, and engages deep stabilizers. It helps integrate stability and mobility for optimal pelvic movement and efficiency.

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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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How to Improve SI Joint Pain: 6 Causes & Solutions