Thursday, June 17, 2010

Sacroiliac Joint

I have written -- although not as much as I feel like it -- about my sacroiliac (SI) joint problems. They have really put a cramp in my style. I wanted to link to several of the resources I have found helpful in dealing with my SI joint issues so that other SI joint sufferers can hopefully save a little time when trying to find ways to deal with this issue. If you are a person dealing with this issue then
  1. I am really sorry to hear that; I hope you find relief soon.
  2. Please let me know if you have any additional links or resources to add; I will happily integrate any commented stuff into this post.
  3. Please know you are not alone. I absolutely know how much it sucks to deal with SI joint issues.
First of all the standard stuff -- I'm not a doctor (well not a medical one anyway), I'm not a physical therapist, I'm not an official anything having to do with SI joint issues. I am, however, a frustrated civilian tired of dealing with pain, and a relentless researcher. That having been said, you should probably consult a medical doctor for any official diagnosis or advice. Additionally, these exercises/recommendations are things that have worked for me. Your milage may vary.

So what is the SI joint? This is in your lower back/hip area, where your sacrum (the lower 5 vertabrae fused together) meet your ilium (the largest bone in your pelvis)

I have read that SI disorders are much more common in women than in men. Personally, I injured my SI joint on my first surf lesson, and I have subsequently reinjured it by attempting to run using the Couch to 5K program -- I think I have to accept that running and triathalons just aren't in my near future, sadly.

If your SI joint is misaligned, it can smash your sciatic nerve. It is incredibly painful, and the symptoms are often mistaken for sciatica. However, if the underlying issue really is the SI joint, then re-aligning the joint can cause almost instant relief.

I have found that chiropractors are, counterintuitively, not that helpful at this as it may initially sound. Yes, they can align everything and put it back into place -- but more often than not, the reason why the joint is out of place is because of muscle imbalances. For example, if your hamstrings are tighter or more stressed on one side of your body than the other, they will keep pulling the joint out of place. Until the underlying muscle imbalances are fixed or resolved, a realignment will only be temporary.

The SI joint issues often cause the hips to twist out of place. I think this site's analogy on how this works is good, but the bottom line is that these problems will often show themselves in the form of a functional leg length difference, where one leg appears longer than the other. To determine which leg is longer, it is best to have a friend help you. This video explains how to assess this.

If you don't have a friend handy, you can try the following: experiment by putting a magazine or magazines under your feet until you feel like your hips are even again. This becomes easier to tell with time, and as you get to know your own body (for example, my right leg usually appears longer than my left leg).

You can then align your hips using this method. I suggest rechecking your leg length after this alignment

Here is another trick I found on a cycling forum. This works for me sometimes, but more slowly and I find with less success than the methods described above.
  • Lie on your back, knees bent, feet flat on the bed.
  • Stick a pillow between your knees.
  • BARELY, gently, imperceptibly squeeze the pillow for 10 seconds.
  • Let off for 10 seconds
  • Do until you are bored silly. (generally you become bored when the SI's have returned and your bod is no longer excited by the gradually shifting SI's) Maybe 10 or 20 or 30 times.
To correct the underlying muscle imbalances, stretching is key. Some of the key stretches the PT told me that I should do are
  1. The piriformis stretch. This is key since many SI problems are caused by piriformis syndrome, where the muscle spasms out of control.
  2. Single knee to chest stretch.
  3. Spinal twist stretch. Note that if you're having a flare up, straightening the leg is probably a bad idea. This will make your already irritated sciatic nerve pain worse.
  4. Hamstring stretch. Any will do, but this one is super important.
If I am in reasonably good shape or just starting to feel a hint that something bad is about to happen to my SI joint, I have found Jill Miller's Hip Helpers DVD to be invaluable. In fact, this video was absolutely helping me -- so much that I took it on my last business trip. I literally forgot to do it one day, and the next day I was doubled over in pain. The fact that this video made so much difference was amazing to me. I will make myself do this 1-2 times/week once I get back to normal (during flareups, though, avoid the stretching as it will exaccerbate problems with your already tender sciatic nerve).

I hope this helps SI sufferers, and that we are able to pull together a comprehensive list of resources so that they are easy to navigate for others. Please let me know if you have other favorite resources or suggestions I have missed.


  1. Hi Sarah, thank you for this excellent blog post. Going to apply these exercises and let you know how I get on. Thanks :-)

  2. Hi, this is a very old post but you are the top google result. Have you ever tried SI belts?


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