SI Joint Pain
Welcome back to the Total Performance Newsletter! If you are a new subscriber and did not receive previous editions, let me know and I will send them over right away! This month, we will continue to take a look at some specific movement and injury-related issues that commonly arise and how to deal with them.
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Getting back to today's newsletter, I have recently received a lot of questions about SI joint pain, so I figured it would be worthwhile to give some detailed info on it. Let's dive in.
What is the SI joint?
The SI (sacroiliac) joint is where your sacrum and pelvis (ilium) meet. Its main function is shock absorption and helping to transmit forces between the upper and lower body. Here is a picture:
There are 5 very strong ligaments that hold these bones together. Interestingly, there are no muscles that attach directly to the SI joint, and there aren't any muscles whose job it is specifically move the SI joint. However, there are 40 muscles that surround it and attach nearby and move all of the other joints in the area. In fact, it is widely agreed upon that the SI joint only moves between 0.8 and 3 degrees, depending on which movement is measured-this amount of movement is barely even noticeable. So, if it barely moves, no muscles attach there, and has very strong ligaments, why is SI pain so common and debilitating?
Why does it hurt?
For the sake of this newsletter, we're going to focus on why SI pain occurs in the absence of an obvious or traumatic injury. The overarching reason for this type of pain is what I call a "force distribution" issue. I wrote a previous newsletter on this, but a general summary is this:
Every time we move, our body absorbs and produces force. In a perfect world, we distribute this force evenly throughout our body and all of our muscles, bones, ligaments, tendons, joints, and other structures do their fair share. However, often times, different areas of our body lose range of motion. When we lose range of motion in one area, our body will compensate to perform the tasks/movements we want to do. When we compensate, this places extra force on certain areas of the body, and over time, this extra force can cause pain.
Since the SI joint does not move all that much, it is not one of the areas that loses range of motion. Instead, since its function is primarily to absorb and transmit force throughout the body, it is commonly one of the areas that takes the extra force if range of motion is missing somewhere else. In other words, the SI joint "picks up the slack", and it picks up too much slack for too long a period of time, it will start to tell you so with pain.
What do to about it?
The first step in dealing with SI joint pain is figuring out what ranges of motion are missing. There are several possibilities here, and it is always best to get a thorough evaluation from a qualified professional, but the most common motion that is missing with SI joint pain is hip internal rotation. If we are missing hip internal rotation, it usually indicates that our glutes and low back are tight and compressed. If you look at the picture of the SI joint above, the glute and low back muscles are the main muscles covering the bones in the picture. So, you can imagine that if these muscles are tight/compressed, it would place extra pressure on the SI joint. Click here for a video that may help visualize this.
Assuming that missing hip internal is the culprit, we need to find ways to gain back that motion and decrease the compression in the glutes/low back. We do this by doing things that stretch/lengthen/create expansion through the glute and low back area. Here's a sequence I frequently use:
Foam Roller Walkover; 1-2 sets of 10 reps per side
put roller in the middle of your hip-above the "ball" of your hip but below the top part; keep the bottom foot parallel to the ground as your walkover-do not let the heel roll up towards the ceiling
Hands Supported Offset Posterior Hip Capsule Stretch; 2-3 sets of 5 breaths per side
more weight on back foot compared to front foot (we are stretching glute on the leg that is back); soft knees, push hips back until you feel a stretch in the glutes; keep weight on back heel will help; slow inhales through the nose, slow exhales through the mouth
Feet on Wall/Box Hip Bridge; 2-3 sets of 8-10 reps per set
drag heels down the wall to lift hips, brief pause, return back to bottom slowly; only go as high as you feel hamstrings but NOT low back; key is to feel hamstrings working, NOT your glutes or low back
Reverse Kickstand RDL; 2-3 sets 8-10 reps per side, per set
same concept as Posterior Hip Capsule Stretch above, but now we are moving through a range of motion; should feel glute on same side as back leg working
Lateral Squat; 2-3 sets of 6-8 reps per side, per set
wide but comfortable stance, keep toes pointed straight; let hips/knees help out as you sit and keep opposite leg straight; should feel glute/quad on side you are sitting towards and inner thigh stretch on side you are sitting away from
As I said above, there can be several reasons for SI joint pain and different exercises work for different people, but this list is usually a good place to start and covers a lot of bases.
Stay tuned for next month’s newsletter, where will we continue to look into some common issues that arise and practical solutions to deal with them! Also, if you have any topics that you want to see covered in a future newsletter, please let me know!
Brett
