Sacroiliac Joint Dysfunction: A common source of low back pain

Sacroiliac (SI) Joint Dysfunction is a common source of low back pain. One of the first steps to managing low back pain is understanding it. It also helps to have a look at the big picture. In this post I would like to explain what SI joint dysfunction is, why it is so important, and how it can lead to low back pain as well as pain and dysfunction in other areas of our body. This is a great example of how our body will compensate in response to an issue.

The pelvis is our ‘structural core’ providing a solid base for everything above and below it. It is supported by important core muscles including the glutes, low back stabilizers, hip flexors, pelvic floor and abdominals. 

The pelvis is made of two large hip bones that come together to form a ring (red in the photo below). This ring is formed by a connection in the front at the pubic symphysis, and in the back through strong ligaments at the sacrum (the lowest section of our spine). The spots where the sacrum connects with the hip bones are called the sacroiliac joints or SI joints for short.

The SI joints are strong joints that transfer weight from the upper to the lower extremity. They also initiate and govern motion that occurs down through the legs while walking,  running etc.  Joint dysfunction basically means what it sounds like – a joint that is not functioning properly. The joint is either stuck, moving more than it should, and/or is out of proper alignment.

A classic presentation of low back pain from SI joint dysfunction looks something like this:

A patient describes low back pain that is more one sided (they point directly to their SI joint with one finger). The pain may have come on gradually without an identifiable cause or there may have been an injury such as a fall. The low back pain may radiate into the glute region on that side or even down the leg as far as the knee.

If left untreated, dysfunction in your SI joints (and therefore asymmetry in your pelvis or structural core) can cause a lot of muscle imbalances and extra stress on one side of your body. Eventually the low back/SI joint pain goes away but because it remains dysfunctional, you start to notice pain in other areas of your body – the areas that have to compensate for this dysfunction.

Here you can see how in the ‘imbalanced’ image, the pelvis appears tipped to the patient’s left side rather than being level. As a result the left leg is functionally shorter which causes more stress through the left leg with every step. The left knee collapses inwards (valgus collapse) and the left arch also collapses (excessive pronation). In an attempt to have you stand up straighter, the low back has to bend to the right. The left shoulder compensates by creating extra muscle tension, which can lead to neck, upper back and shoulder pain.

Note: our body will do whatever it takes to keep our eyes level with the horizon. Keeping our eyes level, keeps our brain happy!

Here are a few common presentations of chronic SI joint dysfunction that has been left untreated. (Patients can report just one or all of the following)

1. Knee pain, usually worse on one side but without any direct injuries or trauma to the knee. The knee pain is worse with activity, especially running. There may also be foot pain and excessive pronation on that side.
2. Chronic pain and tightness most prominent on one side of the neck and shoulder area. Most commonly, there is also pain between the shoulder blades.
3. Low back pain and more difficulty bending to one side than the other.
4. Feeling like you are walking crooked or ‘tipped to one side.’ More tightness and/or weakness on one side of the body that is noticeable during yoga or other activities like weightlifting.

So what’s with the tightness and weakness on one side?

When a joint is stuck, the surrounding muscles become tight and weak. This is a built in protective mechanism. It is an attempt to tell us that there is something wrong and slow us down to prevent further injury! Unfortunately many people tend to ignore this warning sign instead of seeking treatment. This can lead to further injury.

SI joint dysfunction is quite a big topic, but I hope this article gave you a better understanding of the big picture of how our body functions as a unit and how dysfunction in one area can lead to a host of problems in other areas.

If you are noticing pain, tightness or a decrease in mobility in your neck, low back or extremities I would be happy to work with you!