It’s your neck, it’s your knee, it’s your lower back! No, it’s your sacro-iliac joint!
Sometimes you feel invincible. Despite having had two surgeries on my spine, my body felt so great at the time, I decided to take a kickboxing class. Turns out that wasn’t such a great idea (and that I’m not invincible after all). After a few kicks, I felt tremendous pain in my lower back and simply couldn’t go on. I knew the incident wasn’t disc-related – the pain was completely different, yet just as intense.
After a few days, the discomfort eventually dulled and subsided. I returned to my usual activities – Pilates, yoga and swimming. Weeks later, I picked up my then toddler, and felt as though the right side of my pelvis had separated from the rest of my body; it was excruciating. And then it felt better. I would bend down to pick up something, and it would return. Round and round. While the episodes became less recurrent, I knew something had shifted, but I wasn’t quite sure what. My right leg felt longer and my foot supination worsened, forward folds became uncomfortable, my pelvis started to rotate to the left, my right hip became bothersome, and I experienced the occasional creak in my neck. I stayed like this for two years, thinking I must have damaged my back or spine. Except I hadn’t. I had posteriorly rotated my sacroiliac joint.
The sacrum is a triangle-shaped bone located at the base of the spine and the sacroiliac joint (SIJ), a rail and groove joint, is the bridge between each ilium and the sacrum. In Latin, sacrum means sacred bone and for a good reason! The sacrum is the foundation of your pelvis, your center of balance and the first shock absorber on the highway of your spine.
While little movement generally happens at the SIJ, it is commonly more stable in men, who have four articulations at the joint whereas women only have three. Think of it this way: a door with less hinges is less stable than one with multiple attachment sites, as each anchor provides stability.
SIJ pain is common in the field of movement, especially in the Yoga, Pilates and dance circles, where many practitioners are hypermobile. When you consider a woman’s wider pelvis (to allow for birth), ligament laxity from hypermobility and/or pregnancy, it’s easy to see why many women are SIJ casualties, but the truth is both men and women can experience SIJ pain. This can stem from lifting heavy items without proper form and a lack of core engagement as well as repetitive movements, such as running or cycling. Repetitive Warrior Ones and twists that aren’t complemented with enough cross-training, can also create less than optimum conditions for SIJ integrity. But an SI joint injury can also be caused by something as unfortunate as missing the curb, a fall or a car accident.
How does sacroiliac rotation manifest itself? While it’s different for every individual, common complaints include low back, hip and knee pain. Let’s look at the mechanics for a moment. When the joint moves either posteriorly or anteriorly – even only millimetres – the surrounding tissues are forced to accommodate this new ‘normal’. They begin winding themselves up, affecting your posture from your feet to your neck.
Referred pain can be felt in the psoas (on the involved or non-involved side) as it begins to work overtime to stabilize the pelvis. Other muscles, including the tensor fascia latae, gluteus maximus, quadratus lumborum and adductors, also hop on the wagon of dysfunction in an attempt to fulfil a job description for which they are not trained, and can spasm. Common observations of SIJ dysfunction can range from a lack of internal hip rotation on the involved side, while external rotation becomes sloppy, to leg length discrepancy, or off axis forward folds due to pelvic rotation.
So what’s next? Come back on Friday to learn how I helped rehabilitate my SI joint along with the help of a manual therapist.