The Sacroiliac Joint (SI) and LOWER BACK pain

Lower back pain is one of the most common conditions for people with a regular training habit and also those who are inactive. There are many different types of conditions but a particularly common one is SI joint pain/dysfunction especially for those getting started with an exercise routine.

Anatomy & role

The SI joints are located between the iliac bones (hip bones) and sacrum, connecting the spine to the hips.  These 2 joints at either side of the base of the spine. If you look at someone from behind, those two little dimples are where the SI joints are located provide support and stability, they also play a big role in absorbing impact (think jumping, running, lifting etc).

Causes of pain

There are many strong ligaments and small strong muscles that support the SI joints. It’s important to note that these joints have a small range of movement and over time as we age our bones can become arthritic and or ligaments become stiffer. This reduced range of motion can result in dull lower back pain or can become more acute as cartilages wear down due to the joint not moving properly. Other causes of dysfunction can be the 2 joints having uneven strength and range of motion or if there is too much flexibility in the joint (this is common post child birth in women).

Treatment

As always with any injury its best practice to seek professional medical advice first before treatment and then work with your trainer on the specific rehabilitation protocol.

General sound protocol to move away from pain and back to sound function:

1. Unload the area: Discontinue movements that aggravate the joints. Stop anything high impact (running/jumping/skipping) and any heavy loaded hip hinge movements (think heavy deadlifts, hip thrusts etc)
2. Keep Moving! Unloading away from aggravating movements doesn’t mean it’s wise to stop moving. The reciprocal is actually true. Keep your body moving using low impact movements (walking, cross-trainer, swimming) taking care to main good posture whilst training.
3. Mobilize the area daily. A combination of remedial massage, self-massage and hip/lower back mobility drills (stretching) will get the joints moving again. Hip flexor stretches, Glute stretches (like the yoga pigeon pose) and lower back stretches are the big ones to incorporate.
4. Start to re strengthen the muscles around the SI joint. Most important here is your technique, it has to be perfect. Some simple strength movements to start with are: Glute bridging from the floor (double leg, then banded then single leg), and banded Squats (body weight or goblet).
5. Move back to high impact exercises slowly with a small amount of volume at first. For example, if you are a runner try short low, intensity hill efforts and walk down the hill on return (don’t run). Start slowly into the bigger hip hinge movements i.e., for deadlifts start with light dumbbell Romanian DLs.
6. Over time build back into your full exercise routine remembering to keep all the mobility protocols apart of your ongoing program.

Happy training pain free!