What is Sacroiliac Joint Pain

Sacroiliac pain is often described as pain that is focused in the lower portion of the
back and the buttocks. It may radiate out to one hip. In some cases it may travel
around to the front on one side, in the groin area. Some males may feel pain in the
testicles as well. Pain may radiate down the back of one leg, to either the knee or the
ankle, but will rarely be felt in the foot. The pain may be similar to sciatica. The pain
may increase by walking or weight bearing on the affected side. Sneezing, coughing,
rolling over in bed and bending may increase the pain. Stiffness in the lower back
may be experienced as well.
The sacroiliac joint can become strained and inflamed, with or without a subluxation
(this is a partial dislocation). The bones are slightly displaced, which stretches the
ligaments that hold it together and causes them to become inflamed. Subluxation of
an SI joint may be caused by bending and lifting to one side, or landing heavily on
one leg. Pain can come from the joint surfaces or from the synovial membrane or
fibrous capsule of the joint or from the ligaments that hold the joint together. These
are rich in nerve endings, and therefore any inflammation or injury to this area
results in pain. A subluxed SI joint may give the appearance of a short or long leg on
that side, depending on the direction that the SI joint is subluxed. The resultant tilt of
the base of the sacrum them puts a twist and side-bending into the lower lumbar
spine, and can cause dysfunction and symptoms in this region and sometimes above.


A feeling that the leg, or hip, is rotated may accompany this condition, and the toes
of one foot may turn out more than the other. One hip bone may appear higher than
the other, and there may be asymmetry in the waist.

SI joint sprain may be accompanied by piriformis
syndrome (see free PDF download on ‘Piriformis Syndrome’), though piriformis
syndrome may occur without a SI sprain and be misdiagnosed as a SI sprain. Pain
may radiate into one leg, either because there is pressure on some of the nerves to
that leg, as some of them passes through the piriformis muscle (which crosses the SI
joints); or because of a stretch of the hamstring or adductor muscles due to a shift of
their origins caused by the ischial and pubic bones having moved by a subluxation
of the SI joint.

The hormones of pregnancy soften the sacroiliac ligaments to allow extra movement
of the sacrum, to enable the baby to pass through the pelvis at childbirth.
Unfortunately this also means that pregnant women are more susceptible to
sacroiliac joint strains. Also it is possible for one or both joints to become subluxed
and ‘jammed’, which can lead to an obstructed delivery and an emergency caesarean
if it is not corrected. Fortunately strained sacroiliac joints in pregnancy are easily
treated, though it is important to see an osteopath who specializes in pregnancy, as
not all osteopathic colleges train their students in the most suitable techniques.
Unfortunately many pregnant women with sacroiliac joint strains are told that it is
‘normal’ and they have to live with it.
Sacroiliac Joint Pain may be the result of inflammatory disease processes such as
ankylosing spondylitis, which can eventually lead to fusion of the SI joints. Fractures
can be caused by acute trauma, such as a car accident, causing severe pain.
Conventional treatments include injections and surgery. Manipulation is best from
an osteopath, who will make a complete bio-mechanical analysis of the joints and
muscles of the spine and pelvic girdle; and treat where appropriate using both
manipulation of the relevant joints and soft tissue work on the muscles.

Osteopaths have always believed the sacroiliac joints move and can become strained,
and have always treated sacroiliac joint strains and dysfunction. Until recently,
medical doctors and physiotherapists didn’t believe that sacroiliac joints could
move, let alone become strained. This is because of the teachings of a famous British
orthopaedic surgeon called James Cyriax, who died in 1985 at the age of 80. He
always maintained that SI joints couldn’t move or become strained, and that
osteopaths were fraudulent for claiming that they could, which delayed the
recognition of osteopaths. He taught crude and rough manipulation techniques to
doctors and physiotherapists, ignoring underlying causes. Since his passing, it has
become widely accepted that sacroiliac joints can move and become strained, and
osteopaths are now widely recognized and regulated by statute. Unfortunately his
methods are still widely practiced by doctors and physiotherapists.

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