The sacroiliac (SI) joint, a pivotal connection between the spine and pelvis, plays a crucial role in how the body distributes load and maintains spinal stability. When this joint is compromised, it can lead to significant pain and discomfort, making everyday activities challenging. This article delves into the intricacies of SI joint pain, exploring its anatomy, biomechanics, symptoms, diagnostic methods, and effective treatment options.
Achieving Over 90% Success in Pain Relief
Our approach achieves an impressive success rate of over 90% in reducing or eliminating pain and improving function. This success stems from our multimodal, interdisciplinary method integrating osseous (joint) and myofascial (soft tissue) procedures with tailored functional exercise programs. By combining the best elements of various treatment systems, we provide individualized care that delivers lasting results.
Article Index
Signs and Symptoms
The clinical presentation of SI joint pain and dysfunction is often complex, with patients experiencing a variety of symptoms. Commonly reported symptoms include:
Lower back pain
Hip pain
Buttock pain
Pain radiating down the leg, potentially due to nearby neural structures or referred pain patterns
SI joint dysfunction pain may present as:
Sharp sensations, often triggered by specific movements or positions due to mechanical dysfunction
Dull or achy sensations, typically from inflammatory processes or chronic dysfunction
Symptoms can be aggravated by activities that load or stress the SI joint, such as:
Sitting
Standing
Walking
Lying down in certain positions
These activities increase the biomechanical demands on the joint and surrounding structures, exacerbating pain and discomfort. SI joint dysfunction can significantly impact an individual's quality of life and functional capacity, necessitating thorough evaluation and management.
Anatomy and Biomechanics of the SI Joint
The sacroiliac (SI) joint, where your spine meets your pelvis, is a crucial hub for stabilizing your body and transmitting forces between your upper body and legs. This joint, which connects the sacrum (the triangular bone at the base of your spine) to the ilium (the large pelvic bone), is both strong and uniquely complex, combining synovial (fluid-filled) and fibrous elements.
The SI joint's stability comes from a network of ligaments, including the anterior and posterior sacroiliac ligaments, interosseous sacroiliac ligaments, and the sacrotuberous and sacrospinous ligaments. These ligaments work together to keep the joint stable and prevent excessive movement. Surrounding muscles like the gluteals, piriformis, and erector spinae also play a vital role in maintaining SI joint function.
When the SI joint becomes restricted or is affected by abnormal biomechanics or pathology, it can disrupt how forces are transmitted through your body. This can lead to pain and discomfort, often stemming from altered movement patterns or undue stress on the joint.
Kinetic Chains and Fascia: The Interconnected Network
Kinetic Chains and Fascia: The Body's Interconnected Network
The sacroiliac (SI) joint doesn't work in isolation—it's part of a complex, interconnected system of muscles, ligaments, and fascia that helps stabilize your body and distribute forces efficiently. This system, known as the kinetic chain, is vital in maintaining proper movement and balance throughout the body.
The Kinetic Chain and Its Components:
The kinetic chain includes the pelvis, lower extremities, and spine, with the pelvis serving as a central hub—the SI joint acts as a crucial link, transferring forces between these areas. Key muscles like the gluteals, piriformis, iliopsoas, and erector spinae work together to provide stability and movement support for the SI joint.
Fascial Support:
Fascia, a continuous web of connective tissue, is integral to the function of the kinetic chain. In the lumbopelvic region, fascial structures like the thoracolumbar fascia and iliolumbar ligament help support and stabilize the SI joint. These connections ensure that forces are evenly distributed, reducing stress and helping maintain overall biomechanical balance.
Comprehensive Treatment:
Effectively managing SI joint pain means understanding and addressing the entire kinetic chain. Manual therapy and targeted exercises can restore SI joint function and relieve pain by resolving restrictions and imbalances within this interconnected network. A holistic approach considers not just the SI joint but its relationships with surrounding structures for lasting relief.
Diagnosis
Diagnosing SI joint pain can be complex, requiring a thorough assessment of the patient’s history, symptoms, and a series of detailed examinations. This process often involves orthopedic, neurological, and vascular tests to accurately identify the source of pain and dysfunction.
Below, you’ll find demonstration videos showcasing the orthopedic, neurological, and vascular assessments we commonly use to evaluate SI joint dysfunction.
Low Back Examination
This educational YouTube video is a valuable resource for healthcare practitioners, students, and anyone interested in understanding the relationship between SI joint dysfunction and low back pain. It provides insights into common causes of pain in this area. It demonstrates orthopedic examination procedures used to diagnose and differentiate SI joint-related issues from other potential causes of low back pain.
Lower Limb Neuro Examination
The lower limb neurological examination is essential to assessing SI joint dysfunction, focusing on the motor and sensory neurons that supply the lower limbs. This examination helps detect any neurological impairments that may be related to SI joint issues, serving as both a screening and diagnostic tool to identify nerve-related complications stemming from SI joint dysfunction.
Peripheral Vascular Examination
A peripheral vascular examination is crucial in assessing SI joint dysfunction, as it helps rule out vascular-related pathologies that could mimic or exacerbate SI joint pain. By identifying and addressing any vascular issues, we can better understand the true source of discomfort and ensure a comprehensive approach to managing SI joint dysfunction. This video demonstrates common procedures we use in daily clinical practice to evaluate peripheral vascular health in the context of SI joint assessment.
Imaging of the SI Joint
Each imaging modality offers unique advantages in the evaluation of SI joint pain and dysfunction, allowing for a more comprehensive understanding of the underlying pathology:
X-rays:
First-line imaging modality for assessing the lumbopelvic region
Provides a two-dimensional view of the bony anatomy
Identifies degenerative changes, fractures, or joint malalignment
Assists in ruling out other structural abnormalities in the lumbar spine and pelvis[4]
Magnetic Resonance Imaging (MRI):
Non-invasive imaging technique with detailed visualization of soft tissues and bony structures
Detects inflammatory changes, joint effusion, or bone marrow edema in the SI joint
Identifies lumbar disc herniations, facet joint arthritis, and nerve root compression that may contribute to symptoms[4]
Computed Tomography (CT) scans:
Offers higher resolution images of bony anatomy compared to X-rays
Reveals subtle fractures, joint space abnormalities, or bony erosions
Contributes valuable information about the structural integrity of the SI joint and surrounding osseous structures[4]
It helps rule out other potential sources of pain, such as the lumbar spine or hip joint pathology
Differential Diagnosis
Due to the complexity of pain in the lumbopelvic region, accurately diagnosing SI joint dysfunction requires considering other conditions with similar symptoms. A few key conditions to differentiate include:
Lumbar Disc Herniation: This condition involves the displacement of the disc material, potentially compressing nerve roots and causing pain in the lower back and legs that can mimic SI joint issues.
Facet Joint Pain: Inflammation or arthritis in the facet joints, which connect vertebrae, can produce pain similar to SI joint dysfunction. Distinguishing between these two is vital for targeted treatment.
Hip Joint Pathology: Conditions like hip osteoarthritis, labral tears, or femoroacetabular impingement can cause hip or groin pain, sometimes confused with SI joint pain. A thorough hip examination is necessary to rule out these possibilities.
Piriformis Syndrome: Compression of the sciatic nerve by the piriformis muscle in the buttock can cause pain similar to SI joint dysfunction, particularly in the buttocks and legs.
Myofascial Pain Syndrome: Trigger points in muscles like the gluteals or erector spinae can refer pain to the SI joint area, making it important to identify whether the pain stems from muscles or the joint.
Sacral Stress Fractures: Though uncommon, stress fractures in the sacrum can present similarly to SI joint pain. Imaging techniques such as MRI or CT scans can help distinguish between the two.
SI Joint Treatment
Once SI joint dysfunction is confirmed, our treatment plan focuses on a comprehensive approach with over a 90% success rate in reducing pain and improving function. Key elements include:
Manual Therapy: Techniques like Motion Specific Release (MSR) target soft tissue and joint restrictions, enhancing SI joint mobility and function. MSR also addresses the joint's connection within the broader kinetic chain, promoting overall stability.
Targeted Exercises: Complementary exercises are designed to strengthen the muscles supporting the SI joint, further improving stability and function.
This integrated approach alleviates pain and ensures long-term improvement in joint health and mobility.
Treatment Demonstration Videos
SI Joint Pain - Unravelling the Mystery
The sacroiliac (SI) joint, a crucial connection between the spine and pelvis, plays a vital role in load distribution and maintaining spinal stability. In this video, Dr. Abelson, DC, and Miki Burton, RMT/Instructor, demonstrate effective treatment strategies and essential functional exercises to address SI joint pain and dysfunction.
Chiropractic Adjustments
Chiropractic adjustments are critical in treating SI joint dysfunction by restoring proper joint mobility. When the SI joint or surrounding vertebrae are restricted due to poor posture, muscle imbalances, or trauma, it disrupts the spine's ability to distribute forces and absorb shock efficiently. By improving joint mobility, chiropractic adjustments help alleviate pain, enhance posture, and restore the SI joint's capacity for optimal function.
Fascial Expansion: MSR Low Back Pain Protocol
Fascial expansions offer a highly effective approach to managing SI joint pain by integrating modern fascia research, kinetic chain dynamics, and principles from acupuncture and traditional Chinese medicine. In this video, Dr. Abelson, the Motion Specific Release (MSR) developer, demonstrates how fascial expansions are used to alleviate SI joint pain. This technique addresses restrictions in the fascia that can contribute to pain and dysfunction, helping to restore balance and improve overall joint function.
Treatment Frequency for SI Joint Pain
Tailored Approach: Treatment frequency is customized based on the severity of SI joint pain, functional capabilities, and how well the patient responds to therapy. Patients can opt for two 15-minute sessions per week or one 30-minute session, depending on their availability and needs.
Acute SI Joint Pain (2 to 4 weeks):
Frequency: 2 sessions per week.
Focus: Alleviating pain, reducing inflammation, and preventing the condition from becoming chronic.
Note: In severe cases, collaboration with a healthcare provider may be necessary to prescribe medications or injections. This can help patients manage pain, tolerate therapy, and perform prescribed exercises effectively.
Sub-Acute SI Joint Pain (3 to 8 weeks):
Frequency: 1 session per week or bi-weekly.
Focus: Promoting healing, restoring function, and preventing the progression to chronic pain.
Maintenance care:
Frequency: 1 session every 2-4 weeks or as needed.
Focus: Maintenance care, symptom management, and enhancing self-care strategies.
Important Note: Combining manual therapy with a functional exercise program is far more effective than relying on either approach alone. Medications or injections should only be used as adjuncts and not as primary treatments, as they offer limited long-term benefits compared to a comprehensive, non-invasive strategy.
Exercise
Functional exercise programs aim to strengthen and stabilize the muscles surrounding the SI joint, helping to alleviate pain and improve overall function. These programs typically include the following elements:
Mobility exercises: Designed to improve joint range of motion and flexibility, specific exercises may include:
Piriformis stretch: To target the hip rotator muscles
Posterior hip stretch: To address the gluteal and deep hip external rotator muscles
Lumbar spine rotation stretch: To enhance spinal mobility and flexibility
Strengthening exercises: Focused on engaging core, hip, and pelvic muscles, examples of targeted exercises include:
Supine bridge: To activate gluteal and hamstring muscles
Plank variations: To strengthen the core and stabilize the lumbar-pelvic region
Clamshells: To engage the hip abductor and external rotator muscles
Balance and proprioception training: Aimed at improving neuromuscular control and joint stability, these exercises may involve:
Single-leg stance: To challenge balance and stability while engaging hip and core muscles
Bosu ball squats: To develop proprioceptive awareness and lower body strength
Dynamic balance exercises, such as tandem walking or lateral shuffling, to enhance coordination and stability
Exercise Demonstration Video
SI Joint Pain - Unravelling the Mystery
In the later part of this video, Miki Burton, RMT/Instructor, demonstrates effective exercises and some key functional exercises. The time stamp for these exercises is 09:40.
Why Choose Our Approach for SI Joint Pain Treatment
Our comprehensive approach to treating SI Joint Pain consistently achieves over a 90% success rate in reducing pain and restoring function. Here's why our method stands out:
Proven Expertise: Developed by Dr. Brian Abelson, our methodology is backed by over 30 years of clinical experience and the successful treatment of more than 25,000 patients. You can trust that you'll receive the highest quality of care tailored to your needs.
Thorough Assessments: We conduct detailed evaluations to identify all contributing factors, including potential muscle imbalances, ligamentous support issues, or kinetic chain disruptions. This comprehensive approach allows us to address the root causes of your SI joint pain.
Advanced MSR Procedures: Our Motion-Specific Release (MSR) methodology precisely targets myofascial restrictions, joint dysfunctions, and related soft tissue issues, providing effective and lasting relief specific to the SI joint and its surrounding structures.
Customized Exercise Programs: We create individualized exercise plans that enhance mobility, strengthen the muscles around the SI joint, and restore function, helping you recover faster and more completely.
Logical, Evidence-Based Approach: Our treatment protocols integrate manual therapy, targeted exercises, and supportive strategies to ensure a comprehensive and lasting solution to your SI joint pain.
Choose our proven, patient-centred approach for effective, long-term relief from SI Joint Pain. Take the first step toward your recovery with confidence.
References
Vleeming, A., Schuenke, M. D., Masi, A. T., Carreiro, J. E., Danneels, L., & Willard, F. H. (2012). The sacroiliac joint: an overview of its anatomy, function, and potential clinical implications. Journal of Anatomy, 221(6), 537-567.
Cohen, S. P. (2005). Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment. Anesthesia & Analgesia, 101(5), 1440-1453.
Laslett, M. (2008). Evidence-based diagnosis and treatment of the painful sacroiliac joint. Journal of Manual & Manipulative Therapy, 16(3), 142-152.
Slipman, C. W., Jackson, H. B., Lipetz, J. S., Chan, K. T., & Lenrow, D. A. (2000). Sacroiliac joint pain referral zones. Archives of Physical Medicine and Rehabilitation, 81(3), 334-338.
Hansen, H., Manchikanti, L., Simopoulos, T. T., Christo, P. J., Gupta, S., Smith, H. S., ... & Hameed, H. (2012). A systematic evaluation of the therapeutic effectiveness of sacroiliac joint interventions. Pain Physician, 15(3), E247-E278.
Abbey, B., & Abbey, M. (2021). Motion Specific Release: A Comprehensive Manual Therapy Approach. Kinetic Health.
Cher, D. J., & Polly, D. W. (2016). Re: Cher DJ, Reckling WC, Capobianco RA, et al. Implant survivorship analysis after minimally invasive sacroiliac joint fusion using the iFuse Implant System. Medical Devices: Evidence and Research. 2015;8: 485–492. Medical Devices: Evidence and Research, 9, 79-80.
Sembrano, J. N., & Polly, D. W. (2009). How often is low back pain not coming from the back? Spine, 34(1), E27-E32.
Fortin, J. D., & Falco, F. J. (1997). The Fortin finger test: an indicator of sacroiliac pain. American Journal of Orthopedics, 26(7), 477-480.
Szadek, K. M., van der Wurff, P., van Tulder, M. W., Zuurmond, W. W., & Perez, R. S. (2009). Diagnostic validity of criteria for sacroiliac joint pain: a systematic review. The Journal of Pain, 10(4), 354-368.
Kurosawa, D., Murakami, E., & Aizawa, T. (2015). Sensory nerve fibres from lumbar intervertebral discs pass through rami communicantes: a possible pathway for discogenic low back pain. Journal of Bone and Joint Surgery. British Volume, 87(10), 1391-1394.
Maigne, J. Y., Aivaliklis, A., & Pfefer, F. (1996). Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain. Spine, 21(16), 1889-1892.
Yoo, W. G. (2014). Effect of the single-leg, lateral oblique, decline squat exercise on sacroiliac joint pain with knee pain. Journal of Physical Therapy Science, 26(9), 1377-1378.
O'Sullivan, P. B., Phyty, G. D., Twomey, L. T., & Allison, G. T. (1997). Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine, 22(24), 2959-2967.
Shum, G. L., Crosbie, J., & Lee, R. Y. (2005). Symptomatic and asymptomatic movement coordination of the lumbar spine and hip during an everyday activity. Spine, 30(23), E697-E702.
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DR. BRIAN ABELSON, DC. - The Author
With over 30 years of clinical practice and experience in treating over 25,000 patients with a success rate of over 90%, Dr. Abelson created the powerful and effective Motion Specific Release (MSR) Treatment Systems.
As an internationally best-selling author, he aims to educate and share techniques to benefit the broader healthcare community.
A perpetual student himself, Dr. Abelson continually integrates leading-edge techniques into the MSR programs, with a strong emphasis on multidisciplinary care. His work constantly emphasizes patient-centred care and advancing treatment methods. His practice, Kinetic Health, is located in Calgary, Alberta, Canada.
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