Is It Really Your Low Back That Is Hurting? This Joint May Be The Culprit
By: Caitlin Scheib
Low back pain is one of the most common complaints that I receive from athletes and non-athletes alike. It can be due to tough workouts, bending over to pick up something up off of the floor, sitting at a desk working all day, or even having a job that utilizes heavy and awkward equipment such as videographers or police officers. Whatever the cause of low back pain may be, a lot of times what seems to be low back pain is actually stemming from a different location. This location is the SacroIliac joint or “SI” joint for short. Injury to this joint can very easily mimic low back or hip pain. Let me explain how and why this joint can create pain.
Sacroiliac Joint Anatomy
To start off, it is important to look at the anatomy of the sacroiliac joint. This joint is where the pelvis joins together with the spine, specifically at the sacrum which sits just below the lumbar spine (aka the common area considered as the low back). There is an SI joint on both right and left sides of the body where each hips attaches. This joint provides very limited movement, but it does allow for shock absorption to take place between the upper body and pelvis and legs. There are ligaments that attach the pelvis to the sacrum and it is those ligaments that can become injured along with cartilage that sits between the two bones as well.
Sacroiliac Joint Movement
Now that we know what the sacroiliac joint looks like, let’s talk about how it moves. The primary movements of the SI joint are anterior-posterior (forward-backward) movement and superior-inferior (upward-downward) movement. These movements can then be combined based on how the hip is needing to move. As an example, if the leg needs to be brought up toward the chest, the SI joint will then move posteriorly and inferiorly to allow for the hip movement. It is when extreme movements take place that put the SI joint in a more vulnerable position. Sports such as dance, soccer, crossfit, or volleyball in which being able to reach the end ranges of a movement are necessary is when SI joint needs to be as mobile and as stable as possible.
Many muscles help with creating stability for the SI joints which can also lead to the misleading belief of low back pain. The back muscles such as the erector spinae, multifidi, and the quadratus lumborum help support the posterior aspect of the SI joint. Along with the back musculature, the gluteus maximus, piriformis, and hamstrings help posteriorly as well. Due to this, the misdiagnosis of sciatica is seen. Hip muscles such as the iliopsoas and the gluteus medius help create stability for the SI joints from a lateral perspective. Core musculature such as the rectus abdominus and internal and external obliques helps out the anterior aspect. All in all, it is very easy to assume one of the larger muscles to be the source of pain rather than examining how someone is moving in relation to the hips and SI joints to find the source.
Sacroiliac Joint Dysfunction
Ultimately, the injuries that can occur at the SI joint are going to be related to either: too much movement or not enough movement. This is generally called SI Joint Dysfunction meaning the joint is not functioning how it should be. Hypermobility of the SI joint (too much movement) can create pain from being unstable. This causes the surrounding musculature to work harder to help create stability and therefore mimic back pain. Hypomobility of the SI joint (too little movement) can also create pain from being “stuck” for lack of a better term. Usually hypomobility will cause complaints of tightness or a “pinching” feeling in the low back. Along with the SI joint, the musculature will tend to be tighter as well trying to guard and protect the SI joint. Another term that is sometimes interchangeable with Sacroiliac Joint Dysfunction is Sacroiliitis. This term refers to a chronic inflammation that has developed over time due to the increased or decreased movement at the SI joint. This inflammation then causes pain on top of the underlying movement issues of the SI joint.
So how do you know if the pain is from the SI joint or from the low back? Great question! It takes a full functional evaluation, a thorough medical history, and maybe a little bit of luck (just kidding!) to tell where the source of pain is coming from. The evaluation should involve a thorough look at the spine, the hips, and the core and how they all are working together. It really is essential to determine if the SI joint is a factor because if only the hips and core are treated and not the SI joint, the pain will still persist. It is also important to look into everyday life factors (sleep position, sitting position while working, types of surfaces ran on, types of shoes worn, etc..)
What do I do if I have SI Joint Dysfunction?
Call me so I can help you! Other than that, here are a few good exercises to help the SI joint:
Single Knee to Chest Stretch
This exercise is great for getting more movement at the SI joint. The further the knee is brought towards the chest, the more rotation that will occur at the SI joint. Hold this stretch for at least 30 seconds per leg. Repeat 2-3 times.
This exercise is a great one to help with stability of the SI joint. Start off with bracing the core and tucking the hips under the make the back flat against the floor. Press down through the heels and lift the hips up high while squeezing the glutes. Control back down to the floor. Complete 10-15 reps for 2-3 sets.
The bird dog exercise is fantastic because it not only is helping with SI joint stability, but it is also engaging the core and hip musculature as well to create even more stability for the SI joint. Starting off on the hands and knees, make sure the brace the core and tuck the hips under. With control, lift the opposite arm and opposite leg to full extension being careful to not allow the low back to arch. Control both limbs back to the floor and repeat on the opposite side. Complete 10-15 reps of 2-3 sets.