Treatment for Sacroiliac Joint Pain

What is the Sacroiliac Joint?

The joint is comprised of the area in which the sacrum and iliac bones meet.

Stabilization of the SI Joint: Two Types

Form Closure

Form closure is the stability that happens when the tight fitting joint surfaces of the SI joint are close together. This is very much dependent on the size and shape of each person’s structure.

Force Closure

Force closure is the support offered to the SI joint by the ligaments and muscular systems.

Most research is is clear that no muscles directly move the SI joints, but its important to understand how their dysfunction can promote sacroiliac joint dysfunction.

Addressing Sacroiliac Joint Pain

Sacroiliac joint treatment options beyond medical interventions are quite simple, in fact. They need to be separated into 2 different scenarios:

What to do when the sacroiliac joint is OUT:

As mentioned previously, there are not any muscles in particular that move the SI joints. However, there are some movements that are useful in assisting the mobilization of the sacroiliac joints.

Unfortunately, sometimes its not possible to get the joints back into balance on your own. Many times with patients, I have to help them by anchoring certain parts of their pelvis or sacrum while they perform movements in order to re-balance the area. Therefore, its recommended to see a trained professional to help with this.

The good news is, on more than a number of occasions, someone walks into my office with sacroiliac joint pain of a 9 on a 10 scale, and within 5 minutes, I can get them down to a 2 or a 3. This just demonstrates how much potential to cause pain these joints have, AND how quickly it can be resolved by doing the right steps to resolve it.

What to do when the sacroiliac joint is IN:

Once significant pain is resolved, and sacroiliac joint inflammation is reduced, corrective exercises and stretches must be implemented in order to effectively restore balance to the muscular “slings” that support the area.

Sacroiliac joint exercises need to focus on two areas. Some of the key muscles that need to be addressed are found in two different “layers” of muscles.

The Inner Unit:

The inner unit muscles are a deep set of muscles that help stabilize your entire core and are frequently shut off, or possess inappropriate activation patterns during periods of pain. They include:

-The muscles of the pelvic floor
-The transverse abdominus
-The multifidus
-The diaphragm

These muscles must be isolated to ensure proper activation and sequencing, then integrated with the next group of muscles, called the Outer Unit.

The Outer Unit:

The outer unit is further segmented into 4 systems, but in essence, involves the following muscles:

-The gluteals (all of them)
-The spinal erectors
-The abdominal wall
-The groin muscles
-The hip flexor and quadricep muscles

The real trick to resolving any problem with back pain seems to always come back to the correction of the deep muscular stabilizer systems of the body, then re-integrating them with the larger, more powerful muscles.

If you don’t follow this sequence, your results will be limited to symptom relief for the short term. I have seen this time and again in my practice with patients who have progressed their programs too quickly just to “get stronger”.

When I end up seeing them after the many therapists they have seen prior to me, I have to take them back to the beginning anyway. In this situation, unfortunately, they have been taught to OVER activate the larger muscles, and I have to re-train them to focus on the micro-movements that need to be done.

Lesson here: Whats worth doing is worth doing RIGHT the first time!