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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Wendy Hensley

I’ve read a couple articles lately about the SIJ. A few years ago I suffered a miss alignment of my left SIJ due to repetious movement getting in and out of a low car seat dozens of times each day. The same abduction and eternal rotation move repeated over and over added with bearing weight on that leg to get in and out was the problem. For over three years I complained of a dull uncomfortable low back pain and never got relief from chiropractic adjustments. Relief finally came from resistance stretching from a Ki Hara personal trainer quite by… Read more »

Sonya Brar

Thanks for the thorough break down of the SIJ and providing the understanding of how important strength and stability is in the pelvis. I didn’t understand previously how such a small joint could refer pain to so many parts of the body but know Im better understanding everything being connected and the slightest imbalance creates the wind up that moves through the body.

Ting

I have hyperextension knees and elbows.
The Standing Head to Knee Pose is one of a hard posture to my practice.
Working so hard on my strength! Especially, micro-bend my standing leg. I know some postures will hurt my knees and I am trying so hard correct myself. This is a really helpful post. Commons are helpful as well. thanks.

Ernie

Took me a couple years too to figure out it was my SI that was causing a plethora of seemingly unrelated symptoms which you have totally hit on in this article. The worst is not being able to sit for any length of time at all without pain. Very interested to read your next instalment to see how you worked towards feeling better.

Harriet

Great post! I always appreciate a reminder as to the importance of cross training to uncover blind spots and compensation patterns. I see too many hyper-flexible yogis lacking the strength to safely perform in their end ranges. Yoga is wonderful, but can be quite harmful if it’s the only movement modality you habitually use, especially if you’re repeating the same asanas again and again. Cultivating a more consistent and dedicated weight training practice is one of my biggest goals toward living in a more balanced and functional body. Congratulations on your profound rehabilitation!

Jess

I’m just now learning (more so learning to care) about anatomy, and wish I would have known about the ISJ a few years ago. I started practicing Tae Kwon Do and within a few months, had a deep pain in my lower back and hip area. I thought I had pulled a quad or ham muscle and it radiated to my hips, but looking back I am sure my inexperienced kicks and improper stretching led to an injury in my ISJ.

Barbara

Two years of misery! That must have been dreadful. I had first pulled my SI out of alignment about six years ago when weeding. The chain reaction in my body was very much as you describe — everything began to compensate. I developed knee pain, foot pain, neck pain, and who knows what else, culminating in sciatica — fun! No matter how hard I tried fixing myself with yoga and Pilates practice, the problem only grew worse. I finally got rescued by a chiropractor, who popped my SI back into place in a few smooth moves. What a relief. It’s… Read more »

Kirsten

Many years ago my yoga teacher saw me bending forward fully out off line. Back then, I had no idea where this ‘off axis bending’ could lead to…. Practicing yoga helped a lot, I felt more flexible and there was a lot less tension in my body. By becoming more and more flexible the pain grew. No therapist or teacher knew what is was; according to them it was just lower back pain. After reading your article I know where my pain comes from and how I can heal myself. Its also feels “good” that I am not the only… Read more »

Nina

Yes, this is so true! I myself have hypermobility on the right side of my SI joint and all the other muscle take up the slack. In my comment on your other post I mentioned about working on what needs to strengthen and what needs to release is important for me. Like you mentioned in your article to be aware of pelvis position in yoga poses, like Vir 1! I usually recommend to alter the foot position.

Tatjana Brandl

Sometimes it confuses me, where I should start working on my body. And when I finally decided myself working on of many dysfunction, I already can feel the next trigger point on a complete different muscle. So it was a very hard reality shock, when I realized, that there will always be trigger points in my body caused by my daily life. But: “I love my imperfection”. 🙂

Isabelle P

I can’t wait to read how you fix it and learn safe ways to prevent it.

Josh

I’ve found the SI joint to be the most common area for back pain, even moreso than the lumbar spine itself. The SI joint is most affected by rotation, or a lack thereof, particularly through the thoracic spine, pelvis, and hips.

I’ve found one of the best ways to relieve the SI joint of chronic pain is improve the functionality the posterior oblique sling and the connection between the contralateral glutes and lats. As well, immobility of the hip, particularly of the posterior capsule can result in instability and gapping of the SI joint.

Steven Adams

My hips and lower back locked up ferociously back in 2012. I soon learned that the issue was a combination of L5-S1 disc herniation and SIJ misalignment. The discs are much better after a combination of regular chiropractic adjustment, tractioning and stretching, but the the SIJ still flares up–I can feel it now, more on the right side. RICE helps a lot as treatment. Gotta be very precise about my lower body lifting form in all patterns to prevent flare-ups, as well as lots of hip mobility and flexibility training.

Emily

I wonder how many of my students who complain about back, hip or knee pain are actually experiencing SIJ dysfunction. It sounds like its difficult to tweeze apart causation. Thank you for the last paragraph to assist in maybe being able so spot this possibility as a teacher “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.”

Helen

I’ve had issues with SI instability since I was a teenager, and I suffered for years, trying “lower back” exercises before a physical therapist told me my SI was rotated. It was a huge revelation to me and I learned how to make my pain go away…until I got hit hard while in a rotated position playing lacrosse in college. I knew it was my SI and requested physical therapy, but the doctor they sent me to “didn’t believe in” SI dysfunction – he told me my L5-S1 was compacted, and prescribed a girdle and muscle relaxers, saying that would… Read more »

Julie

Very informative article. I really like how you described different ways that the sacroiliac joint dysfunction can manifest itself, and how it is different for each individual case. “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.” This really hits home with me. I never realized how even the neck could be affected with sacroiliac joint dysfunction-but it definitely makes sense why after reading this.

sabrina

As someone who is hypermobile I have struggled for years with SI joint pain, sciatica & low back tenderness. Building stability is always so challenging but gains are exciting! It’s definitely not a linear journey to comfort & stability within my body. And is certainly a practice of patience!

Brittany Brie

I didn’t know that the SI Joint was “two”, I thought it was one joint that helped hold the pelvis together. After reading this article I imagine the pelvis to represent the stories of a house foundation- The sacrum (being the basement foundation) which supports the spine all the way up the body, and the illium on either side (acting as the dry wall) holding the pelvis together, supporting the basement.

Marie-Pierre Gauthier

Merci pour cet article sur SI joint,
Je comprends beaucoup mieux l’impact que peu avoir
un bassin instable sur les muscles du corps. Certains doivent travailler
beaucoup plus forts (et ce n’est pas leurs rôles premier) pour compenser cet instabilité.

Ella

Very informative article! It seems like stability and strength help the SI joint get along with its surrounding friends. I know that external rotators of the hip if not strong but very open, can cause instability in this area causing pain around the lower back area. Keeping the pelvis stable and the glutes and external rotators strong will help as well. Thank you for sharing such an insightful article!

Dianne

I’m glad to have found your article Emilie and will search to find the second installment describing what techniques, poses, YTU’s you used to strengthen this area. I have seen a P.T., use a SacroWedgy to help re-align and need to be a further student of my own body to know the entire picture of what poses/movements to eliminate from my practice and which to include. I have been seriously considering giving up teaching yoga because the SIJ keeps de-stabilizing! Then I found YogaTuneUp and I know I am onto something very good here! I need to connect all the… Read more »

Lyson

C’est toujours impressionnant de constater à quel point le mauvais alignement d’une articulation peut avoir un si grand impact sur l’ensemble du corps. Il faut rester à l’écoute des changements qui se produisent dans notre corps pour corriger le problème avant qu’il ne se propage et cause encore plus de dommage. merci pour l’information.

Jennifer Strumfeld

Wow! This is helpful in all aspects: understanding the anatomy piece of the SIJ, where the pain manifests and then referred pain…I have had tightness in my SIJ, hip, and knee…hmmm…I need to do some more exploration. My naturopath has done some adjustments on a subluxed SIJ. Maybe it is time to go back to her, or read more about how to rehabilitate my SIJ in your next article.

maryday

Thanks for a great information! I also suffer from SIJ pain that comes and goes. I would consider myself hypermobile and its challenging to create strength in muscles I am suppose to be using. Its definitely an ongoing practice.

Laura Cornish

I knew SIJ pain was more common in women than men but I didn’t know why! Thanks for such a comprehensive explanation and I’m interested to see how you treated it.

Christy

The breakdown of differences in men and women and the SIJ is fascinating. As someone who only has moderate mobility I sometimes forget that there are pros and cons to either end of the mobility spectrum.

Miao Zhang

This post actually helps me understand why and how I’m having SIJ pain and why and how my right psoas gave me trouble for months! They are totally related now I look at it because the right psoas is compensating and is doing the work to stabilize the pelvis so it was in constant tension. I actually have developed more tension on the right side of my body beyond the hips. My right shoulder tensed up, my mid back muscles close to my lower right ribs are in constant soreness, and even my transverse abdominis on the right side feels… Read more »

Cintia Hongay

For women, this joint becomes very loose/elastic during pregnancy in preparation for the passage of the baby body through the birth canal and, after delivering the baby, it slowly gets back to “normal/non pregnant” elasticity, so if we’re not taking care of our posture and pelvic/SI joints, they could get crooked during the rebound.

Heather Longoria

Thank you very much for this description of the SI joint. Until reading your article, I never really understood that the SI joint is a rail and grove joint that COULD slip out of alignment. I mistakenly thought they were essentially “glued” together. Now “SI Joint pain” makes SO much more sense. I recently read the description of nutation and counternutation and was so confused about how that could happen. Thanks for the clarification!

Lisa Federico

Thank you for validating so many of my symptoms over the past many years! Did not realize women vs men articulating points…quite interesting. I currently am dealing with some discomfort and am grateful for the reminder that my SIJ may be the culprit…not my back, hip and knee!

Julia Sims Haas

I’ve been trying to figure out if I have injured my low back or twisted my SI joint for years. The way you describe the pain and the positioning of the SIJ I have some new things to explore to help find the answer!

Chelsea Fuller

Hi Emilie,

The following quote stuck out to me: “Repetitive Warrior Ones and twists that aren’t complemented with enough cross-training, can also create less than optimum conditions for SIJ integrity.” This quote stuck out because I have often wondered how one can cross-train for various poses. I have also been told be teachers that yoga is good for everything, but nothing is good for improving your practice. What specifically do you mean by cross-training? In addition, to what extent do you think other forms of exercise can help your yoga practice?

Simran Khalsa

Sorry for your pain, sounds awful. Grateful for this informative article about the sacroiliac joint. There is so much to learn about the body and the different ways it tries to compensate to keep us upright when something is out of place. thank you

Austin Way

Wow! this post really resinated with me & just like previous comments stated….Super looking forward to reading the next installment!reading this and have been similarly interested in strategies for pelvic rebalancing. Cool fact about men had an extra attachment.

Gloria LoCurto

Thanks for such an informative article, Emilie. My mom suffers from SI joint pain so I’m always looking for more information on this (in addition to encouraging her to roll on her YTU ® Therapy Balls. I had no idea that the SI joint had connection with the neck – that’s interesting. I did notice that both my mom and even myself for a time, at an external rotation of the affected hip when we walked. I was able to correct mine and now I’m on a crusade to help her. Also that tidbit about women only having 3 articulation… Read more »

Emma

This is a fascinating article! Being an ex-dancer and quite mobile, I wonder if my QL and psoas issues that occasionally bother me are actually due to an SIJ displacement. It’s so frustrating not to know, and worse, to not have motor control over the joints in the pelvis, so the trial-and-error will just continue. I am looking forward to reading the next article to learn how you rehabilitated your SIJ!

Keisha F.

The anatomy breakdown of the S.I., indicating the difference in men and women was very useful. I think because yoga is populated with mostly women, it’s to no think about how the male physiology sometimes differs from the female. Your plan of attack for dealing with the issue is also extremely useful as a have a hyper mobile S.I. that tends to compress on my sciatic nerve after certain poses. My therapist showed me how to click it back into place, but developing more balance is something I really need and this opens a pathway to accomplish this. Thank you!

Bonnie Chiong

It’s amazing how SIJ issues can translate into a plethora of problems that can mask the root cause. Definitely including more SIJ assessments in standard examinations! Thanks for calling this to my attention!

Chris Greene

Excercise will decreased activity level in people with rheumatoid arthritis actually results in reduced muscle strength and ultimately can lead to increased arthritis pain and disability.

Nicole

I had this same rotation in my SIJ happen a few weeks knee post-op while I was using crutches, and braced up. No one seemed to noticed it until I lost the crutches, and I just couldn’t figure out WHY I couldn’t get my rib to sit properly over my hips while standing… luckily I know a good chiropractor. 😉 after a few weeks we go the adjustment to hold steady – thank goodness!

Monica

I’ve been reading a lot about SIJ pain and dysfunction. Both for my own injury as well as for students who present themselves with SIJ injuries in class. It’s so interesting how pain can present in other areas of the body bc other muscles are turning on and attempting to do the work of another. Not sure I’ve heard it explained like that before but it makes sense while it confuses most people into thinking something else is going on in the body. Great information, will add it to my understanding of the SIJ.

Lulu Goodman

Hmmm…. This is definitely getting me to rethink the nagging soreness that creeps in and out of my low back. During my YTU training, I became keenly aware of instability in my SIJ and actually felt improvement by the end if the training. I think Tubular Core was crucial and of course, body awareness. I’ll be anxious to read part 2!

Martine Kerr

It never ceases to surprise me when students arrive with physical complaints but don’t understand that the location of that pain or discomfort is rarely the guilty party. This is why we ask for a detailed history of past injuries. I’m not a medical practitioner nor do I play one on TV, so I am rather adamant that students get appropriately assessed so that I can work with their therapist on the best plan of action. FMS screening and a history are two key tools in helping someone take responsibility for their health and fitness…I need to be confident that… Read more »

eneida cardona

Wow this blog post was an eye opener. make me wonder which of my discomforts may be related to this joint.
Food for thought.

megan mcdonald

This is a really awesome post. I have scoliosis, and I was told by a rolfer that it was stemming from my sacrum. I have other symptoms as well…I have major sloppier external rotation through one leg, which is longer than the other, according to the man who fit me for a scoliotic brace as a kid. I’ve got pain in one psoas, and it’s locked long due to my spine. Or maybe it’s due to my SIJ!!! Also, when I started practicing yoga, I would stand up out of forward folds, and notice that my hips would wobble. Holy… Read more »

Mary Aranas

In reading research completing some anatomy homework, I remember reading that the SI joint has the strongest ligaments in the human body. That is a relief to know, even though humbling to think that we can still stress it enough to cause imbalance! At least we know the body is a determined partner and co-operator in re-aligning and restoring!

Patti

Can’t wait for the next installment! I’ve been suffering with Sijd including sciatica for 5 years. You’ve really peaked my interest!

katie

Just curious as to what does an extra articulation in men mean? Is this an extra ligament? I have a very hyper mobile SI joint on the left due to lax ligaments from injuries. The title of your article and descriptions are spot on. Lookiing forward to your next post.

Michelle Officer

Wow! Really enjoyed reading this and have been similarly interested in strategies for pelvic rebalancing. also never knew men had an extra attachment. Looking forward to reading the next installment!

Alys

I’m always interested in knowing what strategies people find most helpful in remedying a structural imbalance across the pelvis. I’ll be anxiously awaiting part 2!