The myths and realities of SI joint pain

Buttock pain, pregnancy, popping joints, and 3 easy ways to resolve SI joint pain

‘My SI joint is out of place.’ I hear that one a lot…frequently enough to address it here.

It’s common to hear people express that they have bones or joints literally out of place. That structures in their body move out of their normal alignment every few weeks without any trauma, and that those structures need to be put back into their place to get out of pain.

This has become a widely accepted idea that has created unnecessary fear and dependence on medical and other health-related workers.

I want to talk about this idea here, and we’re going to focus on the main culprit: the SI (sacroiliac) joint.

How much does the SI joint really move?

According to one research study using the most accurate measuring method, you see an average of about .5 degrees of movement at the SI joint. That’s no typo. It’s not 5 degrees, it’s .5 degrees.

In fact, it was so small that their fancy x-ray measuring technology (Roentgen Stereophotogrammetric Analysis) could barely detect the movement. I want you to keep that in mind the next time someone tells you they feel how off the movement of your SI joint is on one side compared to the other.

To snag a quote from David Poulter, attempting to assess SI joint movement with one’s fingers is like, “trying to read braille through a rump steak.”

Can someone literally put my joint back in place?

Here’s one of my favorite research articles on this topic. These researchers brought in women with posterior buttock and back pain. Each of these women tested positive for at least 11 commonly used SI joint mobility tests at the beginning of the study.

The researchers then performed a commonly used manipulation for the SI joint. This would be what some folks might claim is putting the SI joint “back in place.”

The researchers redid the mobility tests and they were all negative, so they would traditionally say that they put their SI joint back where it belongs! Awesome right?

Well, they used the same fancy x-ray machine we talked about earlier to assess the actual position of the joint. There was absolutely no change in the position of the joint before and after the manipulation.

The authors of the study concluded, “the use of the expression ‘forward and backward rotated ilia’ should be abandoned.”

Translation? The bones around your SI joint don’t rotate out of place on their own. It’s a very stiff and solid joint.

This is a really good thing. If our SI joints were so loosey goosey that they could fall out of place and then be pushed back into place, we would all be walking around like limping zombies. Not pretty.

What about the SI joint tests that were positive and then negative? It means that those tests aren’t actually good at telling us about the position and movement of the SI joint.

People who use these tests want them to be legitimate, and these tests convince patients to keep coming back to “get fixed.” But long term they’re likely not doing much to help you be rid of your actual injury and pain.

Hold on. But I feel relief when someone pops my SI joint!

Absolutely. Those tests in the last study were negative after the manipulation because things do happen when we pop a joint.

It just typically doesn’t involve real healing, just like it obviously doesn’t involve literally realigning bones either.

So what’s actually happening when you get your joints popped?

First, the popping sound (called a cavitation), likely involves changes in the pressure and gases within a joint. With a sudden movement of the joint, pressure decreases, gas bubbles move around, the joint capsule snaps, and a pop is produced.

I say “likely” there because this is still debated and multiple theories exist currently, not a firm conclusion. (Research articles for further reading if you’d like: 1, 2)

When your joints pop, you experience changes to your nervous system. It initiates a stretch reflex that alters nerve function and sensation in multiple ways, leading to the tissues around the joint to feel more relaxed. (More references for your casual reading pleasure: 1, 2,)

This feels relieving to us and we gain a little more motion temporarily. Thus we might say we feel a little more “loose” or “in alignment.”

It’s the same as when someone cracks their knuckles. You’re not realigning your finger bones, but it does feel relieving. Once started, you have to keep popping your knuckles regularly forever to keep experiencing relief.

It’s a very short term, repetitive game.

When it comes to pain, we don’t want to stay in the game forever. We need long term winning strategies to beat the game.

What’s this talk about short term games?

It has become accepted in our culture, and often in medical practice, to just do what brings the quickest relief.

Tight hamstrings? Try stretching them into oblivion for years.

Tight back muscles? Try smashing them into oblivion for years.

SI joint feels ‘out of place?’ Try popping it back into place every week…for years.

Any pain at all? Take an advil, throw some ice on it, and stop doing what hurts.

All of these things bring short term relief but you have to keep doing it over and over again without real progress. Why?

Because often times this tightness is your body’s secondary response to the real issue. That’s why it keeps coming back.

Just like the tight hamstrings and back muscles, when you feel like your SI joint is out of whack, it’s often due to a pain signal.

It would be like someone who is lost in a wilderness setting a bush on fire to ask for help. A helicopter crew comes and dumps water to put the fire out but never looks for why the fire started.

Then the cycle just continues forever. The crew puts out the fire week after week while the lost soul suffers in the wilderness becoming very proficient at starting fires.

There is a source to your tension and pain that is trying to ask for your help, and we need to find out the source and help it heal!

How do I know if my pain is coming from the SI joint?

None of what I have said is denying that pain can actually come from one’s SI joint, but it is much less common than you might think.

Often times you feel pain at a specific spot right at your SI joint, and you swear it’s your SI joint, but the pain is actually referred from a disc in your low back.

How do we know? The most obvious reason is that we treat their back and the pain gets a lot better.

So how can you tell where your pain is coming from? For starters, you are more likely to be experiencing SI joint pain if:

1. You fell hard on your bottom (which seems to happen most when you’re in important public places in front of a lot of people)
2. You took an odd step off a curb or something similar that led to a jarring upward force in one of your legs
3. You are currently pregnant or have experienced multiple pregnancies (is ‘experienced’ the proper word there?)

If you don’t fall into that shortlist, it’s far less likely you have SI joint pain, and far more likely your pain is sourced from your low back. Hurray!

Second thing is pain location. If it is coming from your SI joint, your pain will stay close to the middle of your pelvis and possibly radiate across one side of your bottom.

If the pain is traveling down your leg or is above your bottom or across your low back, it’s most definitely coming from your spine. Most definitely.

What can I do for my SI joint pain?

The SI joint is built to be stable. The most common instances when people have SI joint pain, as listed above, involve events that introduce too much movement to the joint.

A hard fall. A hard misstep. Pregnancy (shout out to all the women in the world who take on a lot of pain and problems to bring us into the world!). These all introduce excess movement to a joint that must be stable.

The easiest way to improve SI joint pain then is to stabilize it!

1. Put on an SI joint belt (if it isn’t coming from your SI joint and you do put this on, it’s probably going to make your pain worse when you have it on. Another easy way to figure out where your pain is coming from).
2. When you exercise, avoid movements that split your legs forward and back, especially if you’ll be adding weight (i.e. lunges, single-leg squats, step-ups, etc).
3. When climbing stairs, just go up one stair at a time. I know you might take pride in using your long legs to go up two stairs at a time, but your SI joint needs a breather.

Conclusion

Alright, let’s summarize what’s important to remember here.

Pain coming from the SI joint is actually quite rare, but it is more likely in certain situations (trauma, pregnancy).

If someone has convinced you that your SI joint is out of place and you have to go back to them every week or month to “put it back in place,” I’d be concerned you’re not doing much good. Especially if your pain just keeps coming back.

To add to that concern, the SI joint is made to be stable. If you are having pain from the SI joint, it usually needs increased stability, not mobility. So stabilize!

You may not have noticed, but I feel pretty passionate about this topic. It hurts me to see people feel completely helpless because they think their joints are popping out of place all around them.

So, if you have any questions about anything you just read, shoot me an email. I’ll be happy to help with any questions.

Stay stable my friends!

Originally published at https://zonaperformance.com on October 21, 2020.