The Joint Everyone Forgets About
If you have chronic low back pain that has not responded to treatment, there is a reasonable chance the problem is not actually in your back at all. It is in your sacroiliac joint -- the SI joint -- and it is one of the most commonly overlooked and misdiagnosed causes of low back and pelvic pain.
Research confirms that approximately 13% of patients with persistent low back pain have the origin of their pain traced to the SI joint. That might not sound like a huge number, but when you consider how many people have chronic low back pain, we are talking about millions of people who may be getting the wrong treatment for the wrong structure.
What Is the SI Joint?
The sacroiliac joint is where your spine meets your pelvis. Specifically, it is where the sacrum -- that large triangular bone at the base of your spine -- connects to the two ilium bones of your pelvis. You have two SI joints, one on each side.
The SI joint serves as a central intersection point. Forces from your upper body travel down through the spine and are transmitted through the SI joints to the pelvis and into the legs. Forces from the ground travel up through the legs and are transmitted through the SI joints to the spine. It is a biomechanical crossroads, and when it does not function properly, the effects can be felt everywhere.
Interestingly, the sacrum has a rich history. During the Middle Ages, it was noticed that this bone survived the burning process, and it was deemed a sacred bone -- which is how the sacrum got its name.
Why the SI Joint Is So Hard to Diagnose
The SI joint is the least understood and most controversial joint in the spine. Determining a diagnosis here is complicated by the joint's complex biomechanics and its relationships with surrounding structures, including the hip, pubic symphysis, and lumbar spine.
SI joint pain can mimic lumbar disc problems, hip arthritis, sciatica, and even piriformis syndrome. The pain is typically felt in the low back, buttock, and sometimes the back of the thigh. It often worsens with prolonged standing or sitting, and transitional movements like getting out of a car or rolling over in bed can be particularly painful.
At MoloTherapy in Columbia, MO, we use a combination of specific provocation tests to identify SI joint dysfunction. No single test is definitive, but when multiple tests are positive, the confidence level rises significantly.
The SI joint has been blamed for almost all low back pain at some points in medical history, and almost none of it at other points. The truth is somewhere in the middle -- and finding it requires a thorough evaluation.
What Causes SI Joint Pain?
Common causes include:
- Pregnancy and postpartum changes -- hormonal changes that loosen ligaments, combined with altered biomechanics from carrying a baby, make the SI joint particularly vulnerable in women during and after pregnancy.
- Asymmetric loading -- leg length discrepancies, unilateral sports, or habitual postures that load one side more than the other can create SI joint dysfunction over time.
- Trauma -- falls, car accidents, or any impact that forces the pelvis into an asymmetric position can sprain the SI joint ligaments.
- Degeneration -- like any joint, the SI joint undergoes age-related changes. The joint surfaces become rougher and more irregular with time, and the range of available motion decreases.
- Lumbar fusion surgery -- when lumbar vertebrae are surgically fused, the forces that those segments used to absorb are transferred to the SI joint, often leading to dysfunction below the fusion.
How We Treat SI Joint Pain at SoftWave By MoloTherapy
Treatment begins with confirming that the SI joint is actually the source. Once we are confident in the diagnosis, we use manual therapy techniques to restore normal joint mechanics, SoftWave therapy to reduce inflammation in the joint capsule and surrounding ligaments, and targeted exercises to stabilize the pelvic ring.
For Columbia, MO clients who have been chasing low back pain treatment without results, the SI joint is always on our radar. Sometimes the most effective treatment is simply finding the right target.
If your low back pain has not responded to lumbar treatment, the SI joint might be the answer. At MoloTherapy in Columbia, MO, we look at the whole picture -- pelvis, spine, hips, and everything that connects them.