My back hurts, is it my SIJ?

SIJ is a buzzword in the rehabilitation industry and is becoming more well known amongst clients who have seen a health professional for lower back pain. Your chiropractor may have told you that your “SIJ is out”. A physiotherapist or massage therapist may have felt that your SIJ is restricted or not moving well. I’ve definitely heard my clients use this 3-letter acronym to describe their pain. I wanted to share some of my working knowledge of back injuries to help you understand what the SIJ is and whether it is involved in your injury or not.

The Sacroiliac Joint (SIJ)

SIJ stands for sacroiliac joint. It is the juncture between your hip bone known as the ilium, and the sacrum which is your tailbone. You have a right and left sacroiliac joint, and they sit just below your spine. If you run your fingers down your back, you will notice two dimples. This is where your SIJ is located, and a common area that people report as painful.

Sacroiliac Joint Dysfunction

Sacroiliac joint dysfunction or sacroiliac joint syndrome is the name of an injury in this area. Here are some characteristics of this injury:

• A sharp or stabbing pain over the buttock or in the sacroiliac joint region

• Pain that is more commonly on one side only

• Difficulty standing for long periods

• Sitting for long periods produces pain

• Lying on the painful side is very uncomfortable

• There is tenderness to touch at the joint itself  

What can cause SIJ syndrome/dysfunction?

Previous trauma

You may have been in a motor vehicle accident which has caused some changes to occur at your pelvis. Perhaps you have slipped or had a fall, and never sought treatment afterwards. It may even be an old sports injury from your younger years, or more recently, that has caused some discomfort in the SIJ region. Either way, it would be important to talk to your physiotherapist about your past injury history so they can consider this in their assessment.  

Repetitive positions or movements

Do you favour one side versus the other when standing? When you are bending forward, is there one leg you put more weight on than the other? Do you have a job that requires you to consistently and repetitively bend forward? There is a good chance that your SIJ pain could be due to repetitive strain from adopting the same positions repeatedly.

Pregnancy

Around the first trimester, a hormone known as relaxin is produced by your body which helps your body prepare for labour. This leads to increased flexibility in ligaments, and more mobility at your pelvis. Thus, your sacroiliac joint may become more mobile, consequently leading to pain in that region. 

Idiopathic

Idiopathic is a Latin medical term for “no good reason”. The medical cause is unknown. Not the answer anyone is looking for.

What can physiotherapy do to help?

Physiotherapists can accurately diagnose the issue. You are likely reading this blog because you are looking for some answers as to why your back hurts. The internet has been a great tool to help us find resources and build understanding around injuries. However, what is challenging is finding a way to accurately diagnose the issue. Physiotherapists at Break Free have been trained to carefully assess the root cause of your pain. This includes screening other areas of your body that could potentially be contributing to the pain.

Finding the source

In the healthcare market, we find that people are looking for quick options for pain relief. That can come in many shapes or forms. Many of my clients start with some form of medication to mask the pain. Social media platforms like TikTok, YouTube, and Instagram have short videos that ask you to ‘try this stretch’ if you are experiencing pain here. There are even some healthcare practitioners that can use their hands and machines to give you temporary relief. The only issue with all of these are they don’t last.

If you are looking to find relief that lasts, the first step is understanding your injury and knowing all the different factors that could be contributing to your pain. Let’s dive into possible sources of your SIJ pain.

Lower Back

But isn’t my SIJ technically my lower back?

The SIJ is technically your pelvic region. When we talk about the lower back, we are usually talking about the lumbar spine. Your lumbar spine consists of 5 bones that stacked upon each other. There are discs that cushion the surfaces between each of these bones. Your lumbar spine houses your spinal cord which is the information highway to the brain. There are smaller information highways called peripheral nerves, that split from the spinal cord and travel from the lumbar spine to skin and muscles, giving us the ability to feel things and move our muscles in the lower half of our body.

Your lower back is a potential source of SIJ pain because a lot of nerves travel near the sacroiliac joint region. We mentioned before that people report pain around the buttock and dimple region, and many nerves that originate from the spine innervate the skin and muscles around the hip and pelvic area.

This image is a crude depiction of peripheral nerves connecting to a muscle.

Your physiotherapist at Break Free is trained to screen the lower back to find any potential sources of pain from a compressed nerve in your lower back. There are a series of tests that your physiotherapist can apply that would give more information about what level of the spine might be affected and what stretches of the lower back could help alleviate your SIJ pain. 

The Hip

Your hip could be a potential source of buttock pain! Our hip is a ball and socket joint that is surrounded by ligaments, a thick covering of tissue that surrounds the joint called the capsule, and muscles that attach to the hip, pelvis, and lower back. Your hip could be tight in one particular motion which can affect your lower back, hip, and pelvic mechanics resulting in SIJ pain. Your physiotherapist would complete a range of motion assessment to see if your hip is restricted and provide you with the right movements to try at home.

Another reason for SIJ pain is that the muscles around your hip may be weak and need strengthening. Your physiotherapist has a keen eye to see how you are walking and moving to pick up on any potential muscular imbalances. They can perform strength tests to see if there any differences side to side. After figuring our which muscles are weak, they can give you exercises to take home and work on. However, these aren’t the only muscles that could be affected.

Your core

If your core is weak, it can affect the way your spine, hips, and pelvis move. We explained that there are muscles that attach to different parts of your hips that can affect your SIJ. The same is true for the pelvis.

Core, is again, another buzzword in the fitness and rehab community. Your core is often mistaken for just your six pack or abs. This is in fact, not the case. Your core is a grouping of several muscles deep within your trunk known as stabilizers, consisting of the pelvic floor, transversus abdominis, internal obliques, multifidus, and your diaphragm. There are other global movers like your abdominal muscles and hips that also contribute to the stability of the spine by working together as a whole during functional movements.   

These groupings of core muscles are often undertrained because of the misconception on how to train them. People will often mistake crunches as a core exercise, when in fact, there is new research with safer alternatives that are more effective in improving stability of your spine and pelvis. Your physiotherapist at Break Free will be able to teach you different variations of core exercises that will properly activate the right muscles by providing cueing and coaching. By assessing your form, you can improve your spine stability to help decrease pain in your SIJ region.

A Physiotherapist performing tests to determine if the SIJ would benefit from stretching and movement.

The Sacroiliac Joint Itself

If everything else that we talked about above looks great, then we take a look at the SIJ itself. Your physiotherapist will have a cluster of tests they will use to determine whether stretches or repeated movements in this area will change your pain.  

What if physiotherapy doesn’t work?

After several sessions and thorough clearance of the lower back, hip and pelvis, it may be time to see your doctor for other options. This can include a corticosteroid injection if your pain is very high before returning to physiotherapy and continuing strengthening. Another option is making a referral to a specialist. If physiotherapy is not improving your symptoms, you may have a rheumatological condition that needs blood work and x-rays to rule this out as a possibility. If the tests are positive, your general practitioner can refer you a rheumatologist.   

I want an assessment, where do I start?

You want to ask yourself: where is there a physiotherapist close to me that can systemically rule out all potential sources of pain?

Our physiotherapists at Break Free Physiotherapy and Wellness in London, Ontario are trained in the McKenzie Method or Mechanical Diagnosis Therapy. This methodology helps us understand injuries by systematically going through all potential sources of your injury. We will repeat movements to find patterns and discern whether it is related to your SIJ pain. It will also help you understand what you can do to prevent it.

We look forward to giving you the tools to heal. Click here to book now!