We all have two Sacro-Iliac joints on each side of the sacrum. This is where our spine connects to our pelvic bowl. Needless to say, S.I. joints are critical for injury prevention and stability.
Sacrum is the base of the spine. It looks like a downward-pointing triangle.
The Iliac bones (they look like elephant ears in the image) attach to the sacrum via the S.I. joints and form most of the pelvic bowl. The whole structure is supported by/bound by various ligaments.
What is the job of those ligaments?
As with all ligaments in the body, it is to keep this structure stable - to prevent movement.
Here is what Joseph Shaw, MD, Orthopedic surgeon has to say about the SI Joint:
“The conventional wisdom is that herniated discs are responsible for low back pain, and that sacroiliac joints do not move significantly and do not cause low back pain or dysfunction. The ironic reality may well be that sacroiliac joint dysfunction is the major cause of low back pain, as well as the primary factor causing disc space degeneration and ultimate herniation of disc material.”
How does the S.I. joint get hurt?
When the ligaments are too loose - due to overstretching or by genetic predisposition, the S.I. joints can move out of alignment. Or, when there is trauma - like falling on the sacrum - then the S.I. joints may get displaced, torqued, or loosened/destabilized.
If the ligaments are not thick or strong enough to prevent the misalignment, we experience S.I. pain and dysfunction. This can be excruciating and debilitating because it involves the nerve tissue - primarily lumbar and sacral spinal nerves.
Is it good to stretch the S.I. joint ligaments?
Absolutely not. Stretching them will make the S.I. joint more loose, destabilize it, and make it more injury prone.
Surprisingly many people try to stretch their S.I. joint and around sacrum. Twists, deep forward bends, and hip openers such as the Pigeon Pose pull on the S.I. ligaments and make the S.I. joint more loose and unstable.
If you have a history of S.I. pain, please avoid any of those stretches.
What to do to treat S.I. pain?
1. Get it checked. See an Orthopedic doctor, or an Osteopath, or a good Chiropractor to determine if your S.I. joints are misaligned.
If they are, you'll need to put them back into alignment with manual adjustments and S.I. stabilization exercises.
2. Strengthen it.
If aligned well, the best thing for S.I. joint is strength. The sacrum is the foundation of the spine. It has to be strong to support any activity and movement.
Strengthening will tighten those ligaments and stabilize the sacrum. There are many exercises to strengthen the S.I. joints - all mainly to do with leg extension as the exercise in the photo (Donkey Kicks).
3. Get a massage.
Hands-on treatment of the surrounding muscles (Glute Maximus, Piriformis, deep rotators, and paraspinal attachments of Erector Spinae) relieves pressure on a misaligned S.I. joint. While, as massage therapists, we are not trained to 'put the joint back into place,' we can help guide it there.
Treatment of the ligaments will also help smooth out any bunched up/glued up tissue and adhesions.
Word of caution: go see a therapist who has had experience treating S.I. joint dysfunction. Ideally, someone with Neuromuscular Therapy training and experience like some of our therapists at East West Massage.
by Slava Kolpakov