You know that low back pain you've been living with...?

Posted by Liz Sims, PT, DPT - Redpoint Physical Therapy, Plymouth, Massachusetts

So, your back hurts. Maybe it's your hip. Or maybe it's sciatica. Or is it?

Does this look familiar?  Pain in this location is usually an indicator of sacroiliac joint (SIJ) dysfunction which can refer to your back, pelvis, hip, and into your leg.

If you have back pain, I’m not surprised.  Low back pain (LBP) is a common complaint among the human race, affecting nearly 80% of us.  Nearly 50% of my caseload at any given time will be due to low back pain - of that 50%, I will be able to attribute roughly half to sacroiliac joint (SIJ) dysfunction.  What surprises me is that all the research on the topic suggests SIJ dysfunction is to blame for merely 10-27% of all LBP cases (and here).  This low number of reported cases may be partly due to the fact that the SIJ is often ignored when treating LBP.  Or, perhaps my inflated estimation is partly due to my patients being “unique”.... ;)

Either way, whether it is 7% or 75%, it still merits a quick explanation and some helpful tips. After all, if you’ve ever had SIJ dysfunction, you probably didn’t care about statistics at the time - symptoms range from mild to debilitating and can stick around if untreated.

The Anatomy (What the heck is my SI joint, anyway??):

The quality picture on the right is from my anatomy notebook (I know, if PT doesn’t work out, right…?).  The SIJ (which is clearly labeled) is where your tailbone (the triangle shaped bone) meets the ilium (ear-shaped bones) on either side.  That’s right, there are 2 of them! And each joint has a front side and a back side.  Now we’re getting complicated.  There are a TON of important muscles that connect here!  Anatomy lesson over.

The Function:

Long story, short: what little motion occurs at this joint is essential in normalizing walking patterns, trunk flexion and rotation.  I could talk for ages about what this joint does, so if you’re really interested, come in to my office and ask me to get my spine out (it’s a model, don’t worry). 

Your SIJ can cause issues on one or both sides, either because they muscle moves too much or too little.  Because of all the muscles that attach here, you could experience pain because of muscle imbalance or spasm, stress, etc.

You can experience an acute injury - falls are great for throwing off pelvic alignment.  If you land just right, you can get a pelvic upslip (where one side of your pelvis is higher than the other) or torsion (where one side is rotated compared to the other).  

You can experience chronic issues if you spend a lot of time sitting or standing, or if you are strongly dominant on one side.

Symptoms vary from annoying to severe, and can be localized to the low back or can refer sciatic-like symptoms into your legs.  While often missed by other medical professionals, it is a very easy problem to diagnose, and usually very easy to treat with physical therapy.

What You should do:

STOP living with back pain!  If you can’t alleviate your pain by stretching and exercise (or stressing less), get yourself evaluated.  You might have a pelvic misalignment that is often a quick fix by skilled therapists!

Here are some of my FAVORITE exercises to help treat SIJ dysfunction:

The Cat/Cow exercise:

On your hands and knees, allow your low back to arch, dropping your belly button and chest towards the floor (keep your arms straight - think about sticking your chest out) and lifting your head up (only do the last part if pain free!).  

Then, reverse your position by tucking your tailbone under as far as you can, pushing your back and shoulders up toward the ceiling and dropping your head.

Repeat 5-10 times.

This exercise is an excellent way to keep your low back loose.

The child's pose... just as it looks.  Relax!  

This position is great to open up the SI joints and relax the muscles in your low back.

Trunk rotation on ball:

With your legs on a ball, gently rock side to side as far as you can comfortably.

Repeat 20-30 times.

Check out the cool website I borrowed this image from: exercise_ball_exercises.com is a site dedicated to ball workouts, created by a physical therapist.  There are some creative and fun exercises listed here!

As always, if you are unable to manage your symptoms with home exercise, please contact me or another trusted physical therapist.

Do you have a favorite low back exercise not listed here?  Feel free to share in the comments.  If you come up with something cool I've never seen, you can score some free Redpoint PT gear!