It’s hard for the medical community to accurately determine the cause of your low back pain. This is, at least, what I keep reading in medical journals. But in this office, we are pretty confident in our diagnosis based on certain patterns that we often see. One of the most common causes of low back pain is pain that comes from your sacroilliac joint, not from your lumbar spine. We shorten the name of sacroiliac to SI. The SI joint. Of course, one of the confounding variables is that the source of the pain could be from both the lumbar spine and from the SI joints.
Sacroiliac joint showing deep muscle attachments
The SI joint is between the sacrum and the ilium. That’s where it gets its name. These bones form the pelvis, and actually form a ring of bones. And, when you distort the shape of a ring, you will get points of stress in more than one area. In the pelvis, this happens at one or both of the SI Joints. The third place it could happen is at the pubic symphysis at the pubic bone.
Close up of the back part of the SI joint. Looking straight down the left joint.
Symptoms
How do you know if the pain you are experiencing is at the SI joint? One the hallmark signs is that when you are sitting up, going from sitting to standing, you feel pain in your low back, but it’s slightly off to one side. This pain may radiate down the back of the leg, but it’s pain that is not coming from a “pinched” nerve. When you have pain in your lumbar spine, you might feel a difference in your pain when you lean forward or backward. But with SI joint pain, the pain is less affected by posture.
People with SI joint problems also tend to find relief if they are sitting with their legs crossed. This takes pressure off of one side of the pelvis, and shifts is away from the pain. This side-sitting, though, can actually make your pelvic problem worse over time.
The SI joints are very tough and fibrous. They move when you walk, but only very little. If you strain or tear the ligaments in the SI joint, it can cause a sharp pain, and you may need to brace the pelvis with an SI joint belt to get a lasting cure.
Most people, though do really well with chiropractic adjustments to correct any dysfunction that occurs in the pelvis. Usually when I evaluate my patients, I find that while one side of the pelvis does not move very well, you might feel all your pain on the side that moves too much. Adjusting one side of the pelvis will help you move more symmetrically taking pressure off of the painful side.
Looking at the front of the pelvis where you can clearly see both SI joints on both sides of the pelvis.
If you think you might have an SI joint problem, you still need a differential diagnosis from a chiropractor to determine if the SI joint is the cause of the pain, or if it is from the lumbar spine or other potential causes. After a spinal exam, at the chiropractor’s office you will usually receive treatment that will give you relief from the pain. You usually need multiple treatments to ensure that the pressure stays off the irritated joints
Todd Lloyd, DC
Chiropractic Physician in Salt Lake City
The SI joint is stabilized by the gluteus medius. In 90% of the population, people have inactive gluteus medius muscles. It’s important to take a functional approach to restoring muscle strength for joint stability and for good hip mobility.
Great information Dr. Lloyd! I see this way too many times where people think their pain is coming from the lumbar spine when it actuality it is from the pelvis and SI joints. Many times the pain isn’t coming from the point of pain but other areas that are not functioning well. Great presentation and graphics to explain to people.
Thanks Dr. Brokstein!
Anytime Dr. Lloyd, it’s so important for top quality doctors like you who are educating the public about these topics. Thanks again!
Do you ever refer patients who fail conservative therapy for the new Ifuse Technology?
If a patient of ours fails conservative therapy, I leave it up to our orthopedic or neurologic medical referrals to chose their appropriate technique.
I get these heat wraps from Allegro Medical online that seem to help me. Also the heating pad at night. I think I need to practice better posture as well!