Sometimes you feel invincible. Despite having had two surgeries on my spine, my body felt so great at the time, I decided to take a kickboxing class. Turns out that wasn’t such a great idea (and that I’m not invincible after all).  After a few kicks, I felt tremendous pain in my lower back and simply couldn’t go on. I knew the incident wasn’t disc-related – the pain was completely different, yet just as intense.

After a few days, the discomfort eventually dulled and subsided. I returned to my usual activities – Pilates, yoga and swimming. Weeks later, I picked up my then toddler, and felt as though the right side of my pelvis had separated from the rest of my body; it was excruciating. And then it felt better. I would bend down to pick up something, and it would return. Round and round. While the episodes became less recurrent, I knew something had shifted, but I wasn’t quite sure what. My right leg felt longer and my foot supination worsened, forward folds became uncomfortable, my pelvis started to rotate to the left, my right hip became bothersome, and I experienced the occasional creak in my neck. I stayed like this for two years, thinking I must have damaged my back or spine. Except I hadn’t. I had posteriorly rotated my sacroiliac joint.

The sacroiliac joint is where the sacrum and ilium bones meet.

The sacroiliac joint is where the sacrum and ilium bones meet.

The sacrum is a triangle-shaped bone located at the base of the spine and the sacroiliac joint (SIJ), a rail and groove joint, is the bridge between each ilium and the sacrum. In Latin, sacrum means sacred bone and for a good reason! The sacrum is the foundation of your pelvis, your center of balance and the first shock absorber on the highway of your spine.

While little movement generally happens at the SIJ, it is commonly more stable in men, who have four articulations at the joint whereas women only have three. Think of it this way: a door with less hinges is less stable than one with multiple attachment sites, as each anchor provides stability.

SIJ pain is common in the field of movement, especially in the Yoga, Pilates and dance circles, where many practitioners are hypermobile. When you consider a woman’s wider pelvis (to allow for birth), ligament laxity from hypermobility and/or pregnancy, it’s easy to see why many women are SIJ casualties, but the truth is both men and women can experience SIJ pain. This can stem from lifting heavy items without proper form and a lack of core engagement as well as repetitive movements, such as running or cycling. Repetitive Warrior Ones and twists that aren’t complemented with enough cross-training, can also create less than optimum conditions for SIJ integrity. But an SI joint injury can also be caused by something as unfortunate as missing the curb, a fall or a car accident.

How does sacroiliac joint rotation manifest itself? While it’s different for every individual, common complaints include low back, hip and knee pain. Let’s look at the mechanics for a moment. When the joint moves either posteriorly or anteriorly – even only millimetres – the surrounding tissues are forced to accommodate this new ‘normal’. They begin winding themselves up, affecting your posture from your feet to your neck.

Referred pain can be felt in the psoas (on the involved or non-involved side) as it begins to work overtime to stabilize the pelvis. Other muscles, including the tensor fascia latae, gluteus maximus, quadratus lumborum and adductors, also hop on the wagon of dysfunction in an attempt to fulfil a job description for which they are not trained, and can spasm. Common observations of SIJ dysfunction can range from a lack of internal hip rotation on the involved side, while external rotation becomes sloppy, to leg length discrepancy, or off axis forward folds due to pelvic rotation.

So what’s next? Come back on Friday to learn how I helped rehabilitate my SI joint along with the help of a manual therapist.


Enjoyed this article? Read Sitting and Other Wild and Risky Modern Habits

Emilie Mikulla

Having contracted a major case of wanderlust, Emilie has traveled the world, working as journalist, and now lives Dubai. After a second surgery on her spine, Emilie followed a lengthy Pilates rehabilitation program and, amazed by the results in her own body, became a comprehensively trained Pilates instructor in 2008. Emilie has taught in Thailand, South Africa, Dubai and in San Francisco. Emilie is an E-RYT and has completed her trainings with YogaWorks and Yoga Tree San Francisco, before earning her Yoga Tune Up® certification from Jill Miller. She has also spent hundreds of hours assisting her mentor Harvey Deutch PT at RedHawk Physical Therapy clinic in San Francisco, in teacher trainings, and on retreats at the Esalen Institute in Big Sur. She has also recently participated in a week-long cadaver dissection workshop with Gil Hedley of Integral Anatomy. Emilie is the Lifestyle Editor for Women's Health & Fitness Middle East where she contributes a variety of articles and columns ranging from fitness and wellness, inspirational stories and nutrition. Blending dynamic movement with therapeutic releases, Emilie’s classes will empower you to practice the activities you love with awareness and joy.

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Karen McGovern

Ladies, your SI joint is not as stable as men’s. What havoc the this joint can play on your body. To save the SI joint strengthen the core muscles. This helps to stabilize the SI joint. Low back , neck and even knee pain can all be contributed to an unstable SI joint. HOW KNEW?


Thank you, I’ll follow you in your next step.


Appreciate your comments here and have also had SIJ related pain and ignored it. When my neck hurts I seek to realign my SIJ – looking forward to your next piece on this topic.


Thank you for the detail info on SIJ and sharing your experience. It definitely help me to understand SIJ pain better. It leads me to think many yogis suffer as a result of overstretching. Hypermobile is definitely dangerous while lack of stability.

Muriel Metcalfe

Interesting article. Wish I had found it earlier. It’s me alright. My consulants here in Yorkshire uk diagnosed as OA (2hR’s) and also other therapists with no definite answer. Still nagging them after 17 years. And I repeatedly told them it wasn’t OA. And that discomfort was in area of SIJ.


Great, informative article. Thank you! I have clients with SI Joint complaints and this is a helpful article to share with them.

cg ovalle

oh i know this pain very well, knocked me down for a year and a half, trying to build strength bk. I am 3 yrs in and still find the discomfort less than before. i was not able to lift 3 pounds after sij shifted. took me a long time building my body back up, with the help of a great chiropractor and massage therapist, and personal trainer i am on my way on strengthening my glutes, hamstrings, and core.

Aleks Meuse

Thank you for the introduction to the SIJ. Looking to forward to the follow up and receiving more in depth information about exactly what happened, how that was resolved and integrated. Curious what the specific rotation of sacrum was, as it rotates in multiple planes.


Thanks for this article! I’ve had SIJ pain when I was heavily stretching for splits and now I know to strengthen before stretching and keeping my SI aligned while doing most movements.


I’ve had SIJ issues in the past, and after working for years to stabilize the area, it’s thankfully no longer an issue. Thank you for reminding me of all of the potential referral pains that SIJ can cause. Helpful to keep in mind.

Katrina Sukola

After reading this, I realize I have my own variation of SIJ dysfunction. I have a weakened/dysfunctional tensor fascia latae, and after years of studying ballet, lack internal hip rotation and some leg length discrepancies. It reminds me that people with excess mobility (yoga, pilates, and dance), have to balance mobility with stability and strength.


Thank you for interesting bits of info on sacrum (had no idea it’s structured differently in men). And it’s Latin name makes total sense.


I suffer from a back pain during yoga practicing, I know for some people it sounds unbelievable and some yoga teacher would tell me, “it happens, put a blanket in savasana, it helps” (and yes, it actually does), but I have been asking “why so” though and never really got the real answer yet.
I don’t think it is firm that it’s my sacroiliac joint, but this article gave me a new perspective to help me really find out the reason, thanks.

Kate Clark

I was in my 30s before I knew that nagging low-back pain I’d had on and off since my teens was in my SI joint. Like many people, I wasn’t even aware that I had a joint to hurt there before I studied anatomy. I really injured it when I was in massage therapy school, and that amazing (though uncomfortable!) learning experience has really served me in my massage work. Thank you for this article.