The lower back pain secret: Sacroiliac Joint Instability
One Sunday morning, I got up out of bed and felt a groaning ache radiating from my lumbar region, around the hips and down the outside of my left thigh. Fast forward to ten days later, and I am now an ecstatic 90% better! I’m writing this blog post to let you know how I self-diagnosed my problem and learned to heal in only 10 days.
Youtube is an amazing resource for back problems. A heartfelt thank you goes to Dr. Brant Peterson, a sports chiropractor at Positive Motion Chiropratric, for sharing the information that helped me the most to get through this. The bonus was that I was able to help to pass his advice on to my friend Steven who had, coincidentally, been suffering from the same debilitating condition for several months. Months?? I could barely handle a week! But I’m a wimp when it comes to pain and being a bit of a yoga geek, I also love to research problems.
SO WHAT WAS THE PROBLEM?
Turns out I was suffering from an often-undiagnosed condition called SACROILIAC JOINT (SIJ) INSTABILITY. SIJ issues are tricky to diagnose. The problem is often missed on an x-ray, CT scan or MRI even though SIJ issues cause up to 15% of lower back problems. And it is not something that can be fixed with an ‘adjustment’, which will offer temporary relief at best and might well make the condition worse. This is because the problem is not that the joint is too fixed or rigid but that it is TOO UNSTABLE.
There is a (controversial) process of diagnosis that involves injecting an anesthetic into the joint but you obviously need a medical professional for that. Also, there are many other conditions that can mimic the symptoms of SIJ problems such as a herniated disc, spinal stenosis, osteoarthritis or bursitis of the hip. The good news is that this problem responds very quickly to some very simple interventions.
SO WHAT IS THE SACROILIAC JOINT?
I always started to nod off in anatomy class. Nothing like a personal injury to get you fascinated by the subject! The SI joints lie between the sacrum and the ilia (singular: ilium) bones of the pelvis — hence the name sacroiliac joint.
The ilea are basically the hip bones, the large ones that look like the ears of an elephant. The joint we’re talking about connects the elephant ears of the hip bones to the sacrum at the base of the spine. The sacrum is a bony structure that looks like a shield from Game of Thrones. It’s located just above the tail bone at the base of the lumbar vertebrae, which itself is connected to the pelvis. Remember, everything is connected.
These joints carry the entire weight of the body, so the ligaments that connect need to be super strong and stable. In fact, they are the strongest ligaments in the whole body. The joints they attach to act as SHOCK ABSORBERS, protecting from stress on the pelvis and spine, and they are key to LOAD TRANSFER from the upper to lower body when upright.
WHAT IS SACROILIAC JOINT INSTABILITY?
SIJ instability occurs when the ligaments that connect these joints get stretched from overuse or trauma. Dr. Dan Tuttle explains: The joint becomes hyper-mobile. In an attempt to stabilize the joint, the body will activate a multitude of muscles and people will experience this as a multitude of symptoms. Since the SI joints are so key to stabilizing the body, when they are not working properly, the whole system can get out of whack.
WHAT DOES SIJ INSTABILITY FEEL LIKE?
For me it felt like my body was being slowly crushed from both ends. It was a dull, grinding kind of pain. But it’s not always just around lower back. The pain can be felt in the hips, the buttocks, where the hips and thighs meet at the front of the body, down the side of the thighs, even around the shoulders and neck. If left untreated, it can even lead to sciatica. Since there are so many muscles from the rest of the body that attach to the pelvis (being able to run away is of paramount importance to survival) SIJ PAIN CAN TRANSFER ALMOST ANYWHERE, including the neck and shoulders. It can even cause headaches, which it did for me.
Some people can pin-point a very specific area as the central point of the pain region. This is classically on one side of the rear-most point of the pelvic bone above the buttock, a couple of inches to the side of the centre line of the upper sacrum. It can be felt as a small bony protrusion.
Pain sucks our milkshake dry. Leaving us tired, grumpy, restricted, and vulnerable to more injury. The pain of SIJ instability can be dull and throbbing, but it can also be sharp and stabbing. The back can feel tight or stiff. The pain can come on suddenly or creep up over time. Mine was always worse in the mornings and improved throughout the day and then got worse again in the evening.
WHAT CAUSES SIJ INSTABILITY?
Trauma to the area can be caused in several ways, often from a simple motion that combines bending forward, tilting the pelvis and twisting the torso. Steven knows exactly when his trauma occurred. He was on a ladder fixing a roof and he twisted around while carrying some tiles, combing classic SIJ damaging moves.
One common trigger is misjudging a step down and banging the heel heavily causing a sudden, hard impact. Activities where this impact is repetitive, such as tobogganing can also be culprits. SIJ problems can affect women in late-stage pregnancy, where the weight is being carried forward, and people like myself who have one leg a different length to the other are more prone to this problem. (It was due to a motorcycle accident in my more exciting youth). And, like everything, you need to take care of this area more as you get older. I’ve always had a really strong back, but at 58, this was a wake up call to pay more attention.
In my case, I’m pretty sure that I destabilized my SIJ while leaning forward while pouring large plastic bottles of kerosene into my kerosene heater container. I could tell at the time this was not a very smart position and a couple of times my back felt tweaked afterwards, but I didn’t think much of it because the pain didn’t last very long. But this winter, when I was filling my kerosene heater almost every day, it was a step too far. Needless to say, I now use the hand pump when filling the bottles. Takes twice as long, but it’s well worth the wait!
WHAT MAKE SIJ ISSUES WORSE?
Some activities that can feel really bad when you have this condition are: prolonged sitting or standing, walking upstairs, turning in bed, leaning forward, twisting.
YOGA POSES to avoid with SIJ ISSUES
Here’s a red list of yoga poses for SIJ issues. All forward bends, especially asymmetric bends and/or those where the legs are wide like Upavistha Konasana; all side bends. Also problematic: Extended Triangle Pose (Utthita Trikonasana); Extended Side Angle Pose (Utthita Parsvakonasana); all postures that spread the thighs wide apart (abducted poses) such as Warrior II (Virabhadrasana II) and Baddha Konasana; and spinal twists such as Marichyasana III as well as any side bends. Janu Sirasana is one of the worst since it combines all the moves known to aggravate this condition: twisting, abduction, and forward bending. There’s a very informative article in the Yoga Journal that goes into all of this and more.
Many of these red list poses were included in my daily practice. I was doing warrior like it was going out of style as well as lots of forward bends and extended side bends. Looks like I’ll have to create another practice sequence for a while. A good opportunity to change the routine.
YOGA POSES THAT HELP
Many sites that claim to show helpful poses for this condition include poses that actually AGGRAVATED my SIJ instability. The two poses that I CAN recommend without hesitation are: Boat Pose (Navasana) and Bridge Pose (Setu Bandha Sarvangasana). I’d love to hear from anyone who has helpful suggestions based on experience rather than speculation. However, there are a LOT of EXERCISES that CAN help, as you’ll see.
WHAT ARE THE BEST INTERVENTIONS FOR SIJ ISSUES?
There are 4 main interventions that worked like a charm for me.
I also took 400 mg of ibuprofen once a day for the first 3 days. It seemed to help the muscles to relax and be more responsive to the exercises.
REST REST REST
As Dr. Dan Tuttle points out, physical therapists tend to think in terms of mobilization for resolving joint and muscle issues, when actually what this joint needs is to be STABILIZED-in other words held together better. This is why REST can be so important. I don’t mean bed rest. But actually, stopping your daily routine for a while — and certainly stopping the movements that could have caused or exacerbated the condition like lifting weight, especially while turning, twisting, bending forward, etc. Rest can be one of the toughest things for bodywork enthusiasts to do, but you need to take time to reset, figure out what you’ve been doing that has caused this problem to arise, and give your body a break from all unnecessary stress. I stopped all yoga and my 1 hour daily walks for a week. Walking on flat ground for up to 15 minutes is fine though. You can start the suggested exercises right away, since they address the problem instead of exacerbating it.
SIJ SPECIFIC EXERCISES
Most importantly of all DON’T’ STRETCH! I know it feels like this is what you need, but it’s not. My friend who didn’t know that he had SIJ instability, kept coming to me for private yoga lessons for his back pain. Sometimes he would get temporary relief, but that was the rub. It was always only temporary. There are specific exercises that can radically improve your SI joint stability, but they do NOT involve stretching. They involve horizontal hip-stacked leg lifts, clamshell exercises, core work and isometrics.
Dr. Brant Pederson of Positive Motion Chiropractic has some very helpful exercises here. Dr. Joe DeMarco of OcraMed Health has some cool core-building exercises designed especially for people with SI joint issues here.
My SI joint healing routine (morning and evening) involved 3 rounds of 10 the horizontal leg lifts, 20 or so clamshells each side, and a couple of isometric exercises. The key to the horizontal leg lifts is to STACK THE HIPS and even to roll the top hip slightly forward. If it’s hard, you’re probably doing it right. Later, I included Dr. Joe DeMarco’s knee-raised crawl which was fun as well as stabilizing. How I love that word — stabilizing.
TARGETED COLD WATER THERAPY
Cold water is a natural pain reliever. Cold water causes the blood vessels to restrict, reducing blood flow and so bringing down swelling and inflammation.
Since cold therapy has several other benefits, I normally take a 3–4 minute cold rinse after my hot shower every morning, so staying in a bit longer to target my SI joints wasn’t a big deal for me. I know that many people have a huge aversion to cold water (as did I before I got used to it) but it has an amazing effect on pain. After my hot shower, I use the spray nozzle for 1 minute I on my front pelvic region, 1 minute each on my hips and 1 minute on my lower back. It is simply AMAZING how good this feels afterwards.
SACROILIAC BELT — MY NEW BEST FRIEND
When I put on my sacroiliac belt my first feeling was — gratitude and relief. It just feels so, so good, like this is EXACTLY what my body needed. “I can finally start to heal” Steven texted after the first day of trying it out. The belt costs about 30 USD. You can run a test by tying a scarf or any long narrow material around your hips. If this feels good, then a sacroiliac belt might be what you need. You can hide the belt under clothes but I tend to wear mine on top. It feels a bit action hero, like it should be hung with high tech weaponry. I might never take it off.
Here’s a video from the wonderful Dr. Brant Pederson on how to wear it, because it’s a bit tricky. It needs to be below worn on the hip to be effective.
OTHER SIJ INTERVENTIONS
There are more extreme interventions such as SI joint fusion — a surgical procedure that involves placing a bone graft over the joint with screws and rods to keep it in place as it grows. There’s only about a 50% success rate though and spinal surgery seems an extreme and risky option.
There are also SUPPLEMENTS that help some people. Dr. Pederson recommends a product called Ligaplex 1. Glucosamine and Chondroitin formulas are also said to help, especially if your SIJ problem is linked to other underlying issues. I encourage you to work with your own chiropractor or health professional for proper diagnosis and resolution.
I hope that you found this helpful and that you are soon pain free and back to your best self once again.
And as always, respect yourself, explore yourself.
Originally published at http://lavieenyoga.blog on March 4, 2022.