How To Fix Sacroiliac Joint Pain With Exercises

The sacroiliac joint is a joint in the body that is quite different to many others and when pain occurs in the vicinity of the sacroiliac joints it can be somewhat confusing as to what can be done to help it. This poor understanding of the region is fundamentally why so many people struggle to make improvements with sacroiliac joint pain. 

Let us look now at the uniqueness of the sacroiliac joint to help us appreciate what it should be doing, and from there we can start to understand how things fail.

How the sacroiliac joint works

The sacroiliac joint or SIJ is a fibrous joint that moves very little in most of us, apart from during pregnancy where laxity in the dense ligaments that support this strong joint give way for more mobility for obvious reasons. Your Sacrum, the tailbone makes up the joint with the Ilium and is supported by an array of thick and dense ligaments. The design is quite unique making up an inverted Keystone whereby the load of the spine and upper body helps wedge the sacrum between the two Ilium bones. This provides stability and helps transfer forces from the upper body into the lower body and vice versa. 

The really important thing to note here, for later, is that you cannot really move your sacroiliac joint directly, sure if you round your back completely or give your leg a swinging kicking motion, the sacroiliac joint will partake in the motion to a very small degree, but consciously, you cannot control this joint like the hip, your finger or your knee for example.

Fundamentally, when your lower back and hips curl up into “flexion” your sacroiliac joints will flare as more space is created to allow for mobility. To the contrary when you stand erect with the hips extended with good posture and the spine upright load bearing, the movement of relative extension will provide a “locking in mechanism” providing stability. With both of these movements there is always a trade off one way or another, this helps us start to appreciate when things can become more vulnerable, particularly certain positions where the body is asked to deal with load. For example, lifting something from a curled rounded position, is one in which more mobility is present and therefore less stability, perhaps giving room for vulnerabilities to be exploited.

What can affect the balance between the two sacroiliac joints?

There are two main issues that can have an impact on the balance of the sacroiliac joints as well as a third factor which is more temporary or adjustable. Firstly the position of your spine, for those with scoliosis, the symmetry with which forces travel down the spine and into the pelvic ring via the sacroiliac joints will certainly skew this one way or another. This will often have the habit of loading one side and giving rise to more mobility on the other side.

Another anatomical feature that can have a similar effect is leg length, we’re talking true bony leg length. This can be measured very accurately, but doing so with a tape measure in a clinic, whether they are a professional osteopath or chiropractor or not, is not accurate at all! Be careful if you have had comments on leg lengths after this inaccurate measuring method. 

Finally the more temporary and easily fixable interference with the balance of the sacroiliac joints is your posture. Ladies who’ve had children in particular, tend to adopt a posture favouring one side, which has the same effect as those mentioned above. This is often a well practiced posture, and will be accompanied by numerous muscular adaptations of stiffness that are asymmetrical too.

How does the sacroiliac joint become injured?

Simply put the sacroiliac joint is rarely going to be a primary problem outside the realms of pregnancy. It is so dependent on the normal and effective functioning of the hips and the lumbar spine, particularly the latter, that it is nearly always a secondary consequence of lumbar spine issues. You cannot really do exercises that innately stabilize the sacroiliac joint like you could for a hip or lower back. 

If we take a look, at a typical case of unilateral sacroiliac joint issues. It will commonly be that there is some asymmetrical force at play. Let us say perhaps there is a deviation of the spine to one side or other, not perhaps enough to call it a “scoliosis” but enough to have an effect. Perhaps this is exacerbated by the tendency to lean more on one side when sitting and standing, a habit built over many years. Two things that can exist without any particular symptoms, but that could lead to “wear and tear” on that one side more than the other over years. That’s not to say there is any pain there… Yet.

Now one morning it’s cold and you lean forwards to put that one sock on, yes another asymmetrical activity, and boom it goes!

Of course there is some issue with the sacroiliac joint as that may be one of the structures that has failed, but also the lumbar spine, that L5/S1 disc, the last one, is also subject to exactly the same forces, both asymmetrical and focused into flexion. Now we have lower back pain that is more on one side or the other and we have inflammation in the region around both the SIJ and the lumbar spine. Practically, as a patient with so much going on, referral or pain and the sheer inter-relatedness of the area, it is near impossible to fully conclude which specific small area of tissue was the “one that did it”. Even if we did know which specific bit failed at that specific moment, can we realistically do anything about it, and would that even be wise? This is a failure of many areas that has culminated in a specific tissue being strained but that tissue will immediately try to go through the usual healing process! 

So why doesn’t it get any better?

Fixing sacroiliac joint pain and injuries for good

The punchline is, because you’re not working on the right bit. Now we have tissue damage, the factors that were being held at bay for so long, the leaning on one side, the rounding of the back all day, that the body had adapted and built up a resistance to has failed. It is now MUCH WEAKER than it was, so weak in fact that the body cannot tolerate those inefficient, sub-par ways of being anymore.

People often argue that there are no ideal postures and that all postures are good if they’re your posture. The reality is that when a series of strains have been adapted to and tissues have become reinforced over years or decades, the body does a remarkable job of creating dynamic adaptation. However, when we are unlucky and those adapted tissues fail, the support that was there propping up these EXCESSIVE forces of loading or strain is now gone completely.  

The excessive load and strain however, by function of them being a feature of subconscious habits remain. They remain as significant barriers to your recovery and are why you don’t just “get better” either on their own, or with well meaning treatments. 

Even the best of treatments are like sowing seeds, they can be fantastic, but if the soil, the environment the treatment is being “sown into” is toxic and a mess, you’ll have limited luck producing a desirable outcome.

From here, it is important that you’re honest with yourself, how long have these issues been present, and ignored. How long have we been neglecting our body, not spending time regularly working out, doing stretching too? 

Properly.

Are we really moving properly? We are more vulnerable now as our body has now forced us to address the many issues that have lead to this sacroiliac joint being put in such a vulnerable position that it was inevitably irritated. Often we had a chance to fix these things before we have a significant, life disrupting event of back pain. But true to our busy selves, and much to our detriment, we ignored these problems, favouring a quick fix and carried on with life. 

Eventually your body will make you put it first, and when you do, you will begin to realise, after you put in the right amount of work, that you will be in receipt of lavish rewards, perhaps like so many, crafting a body that allows you to do more than you have in many years, restoring a zest for life that has not been present in recent memory. 

The more you do, the more you can do.

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Comment Of The Week: Annie

A fantastic achievement from Annie this last month or so – Thanks for sharing it with us, full post in the group!

“We started walking from France on 21st September and arrived in Santiago de Compostela in Spain on 21st October (31 days walking). It was about 800km (500 miles) which is about 1 million steps.”

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4 Steps to Fix Your Sacroiliac Joint Pain

• Learn to control your neutral spine

Most people with sacroiliac joint pain have an inability to do this, more often than not they favour rounding the lower back, subconsciously or because they were erroneously taught to have an almost permanent pelvic tuck.

• Practice asymmetrical stabilisation safely

Learning to stabilise the trunk as one leg is being moved helps you focus movement to the hip so the sacroiliac remains stable and isn’t as easily pulled one way or another. For example, a dead bug is an exercise that can allow the sacroiliac to pull in both directions at each end of the movement. If you do not control the spine as the hip flexors, the sacroiliac will pull round and open out, and as the leg goes out and load increases, without control the sacroiliac can be jammed in. Both creating opposing strains, both being incorrect!

• Apply this to load bearing and continue to progress

Taking these asymmetrical exercises to a load bearing environment and later with resistance, you will challenge the ability to stabilise further, building resilience effectively over the long term.

• Be more conscientious on a day to day basis about how you use your body

Granted many activities of life are dynamic, on one side or the other in an unbalanced way, hence the exercise points above. There are however many activities that are sedentary and repetitive, these activities when done asymmetrically, can strain ligaments, much like we’ve mentioned at other times, flattening the lumbar lordosis. Learning to sit square in particular, will help reduce the focussed repetitive stretch creating pockets of ligamentous change.