Sacroiliac Joint and Lower Back Pain

Use the Muscles of the Joint to Move the Joint

Do you have lower back pain? Are you thinking it might be your SI joint? Even if your answer is no, this article will still give you an insight to safe joint movement. The principle in this article is to help you understand how you may be able to improve and/or stay away from injuries in all your joints. According to the Northport Wellness Center, “SI patients who deal with chronic lower back pain spend about twice as much money on health-related expenses each year, “with total mean direct annual costs of >$8,000.”” https://www.northportwellnesscenter.com/blog/statistics-on-si-joint-inflammation How great would that be if you had that extra money?

 If you found this Blog, then you are probably already interested in the vinyasa style of yoga. So, now the question is, will vinyasa yoga help your SI joint? That will depend largely on how you practice your yoga. But first, let’s get into the SI “joint”.

The Sacrum and the Ilium bones.

You may be asking, “why is the word joint above in quotations”? If you are, well that’s a great question. If you’re not, well, now you are asking that question. It is in quotation because most research points to very little movement in the SI joint, 3 degrees at best. Although, because it is such a tight fit between the Sacrum and the Ilium; 3 degrees can be a lot. Actually, it appears that much of the stability of the SIJ (Sacroiliac joint) comes from the Sacrum being wedged into the Ilium. What’s more, is that discomfort in the SIJ can be caused by not enough movement or too much movement in the joint.  

According to the International Journal of Spine Surgery, “… the [SI] joint does not have as much stability of its own against the shear loads but resists shear due the tight wedging of the sacrum between hip bones on either side and the band of ligaments spanning the sacrum and the hip bones….  Sacroiliac pain can be due to, but not limited to, hypo- or hypermobility, extraneous compression or shearing forces…” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7041664/#:~:text=The%20SIJ%20range%20of%20motion,compared%20to%20the%20male%20sacrum.

Muscles that are connected to and effect the Sacrum.

Of course, the ligaments that connect the Sacrum and the Ilium also play an important role in the support of the SIJ. However, it is the muscles that we have control over giving us the direct ability to help protect the SIJ. Below are examples of some of the muscles that affect the Sacrum and its relation with the Ilium.

The Gluteus Maximus.

The Gluteus Maximus affect the sacrum and the Ilium. I know, I know, pretty much everyone that is into any kind of fitness wants those sexy gluts. However, we need to be careful when we focus too much on vanity. We need to make sure that it will not take away from our health. Otherwise, our health will take away from our vanity; and we surely don’t want that! Don’t get me wrong, I’m a sucker for vanity! After all, “the deepest of oceans have their shallowest of shores.”

Now back to the glutes. If you have overworked and under stretched glutes, this could cause an SIJ issue by possibly pulling the Sarum downward even tighter into the wedge of the Ilium. If one side is tighter than the other this can pull the Sacrum out of alignment. Another issue could arise when we focus on toning (working out) just one part of our body. For example, say you only work the glutes. This can start to pull bones in only one direction, therefore; causing a misalignment within the hips or the superior portion of the Femur (upper part of leg bone) being pulled back too far. It is important to exercise the body from as many different angles as we can.

The Piriformis.

The most important muscle in stabilizing the SIJ maybe the Piriformis. The Piriformis connects to the internal surface of the sacrum and then inserts into the upper leg bone. However, unlike the Glutes; nobody cares about a jacked or sexy lookin’ Piriformis muscle, so it is often ignored. For example, when we practice yoga, we do so many hip openers like revolved triangle, revolved lunge, twisted standing finger to toe pose, pigeon pose and many more. All these are great for the hips, glutes and the piriformis. However, while practicing yoga we tend to focus on flexibility more than we focus on strength. As a result, this could cause SIJ pain from too much movement in the joint (too much flexibility).

If you do mostly gym style workouts or mostly strengthening exercises, then there is a good chance that stretching your piriformis will help; for example, any yoga pigeon type stretches. If you mostly do yoga, or mainly stretching exercises, then you probably will benefit from strengthening exercises (see YouTube videos below).

I’ll throw in one more category. If you don’t exercise much at all, then most likely you will benefit from both strengthening and stretching exercises. Here are a few Doctors on YouTube that I thought were knowledgeable. This first video is from Dr. Kristie Ennis. I really liked the strengthening exercise at the end of this video. https://youtu.be/7lntsHN0ezw

Here is Dr. Michael Rowe from Michigan. Again, at the end of this video is a great strengthening exercise.   https://youtu.be/05hIp-yEIlQ.

Kjetil Larsen from Norway might be a little difficult to fallow. It seems that English is his second language and he uses a lot of anatomical terms, but I feel like he is the most knowledgeable and he is my favorite. https://youtu.be/Lli_rI4Dj0Y

Notice that pretty much all of these stretches for the piriformis are variations of pigeon pose in yoga. I think that the easiest stretch for the Piriformis is figure 4 as you lie down on your back.   

The Erector Spine Muscles

A few of the Erector Spine muscles; namely the Longissimus Thoracis, Iliocostalis and the Multifidus are muscles that run along pretty much the entire length of the back side of the spine and are connected to the Sacrum. These are used in up-dog, airplane pose, and Salabasana in yoga; or at the gym, deadlifts (either straight leg or squat style), good mornings, rows, prone superman (same as Salabasana) and back extensions. The Multifidus is also used in twisting poses which also affecting the SIJ. Multifidus are another group of muscles that are often ignored because we typically don’t think of them as being HOT! However, they are just as, or more important to the core than the six-pack is. Again, it is important to not allow vanity to injure us. If all we want is a six-pack, we could easily bring our entire pelvis into too much of a posterior tilt brining it out of alignment. 

The last muscle on our list is the Latissimus Dorsi. The Latissimus Dorsi is a huge muscle covering much of the back. Once the Latissimus Dorsi reaches the Sacrum it becomes mostly fibrous.  

These are most the muscles that are attached to and affect the Sacrum. However, there are many more muscles that are not attached to the Sacrum but can affect the Sacrum.

As You Move Your Body – Use the Muscles of the Joint to Move the Joint

Moving into any kind of forward fold, especially with tight hamstrings, can put undue stress on the SIJ. This stress can be exaggerated if we pull ourselves deeper into the stretch. A sitting forward fold is a great example of this. Forward folds primarily focus on stretching the hamstrings. The hamstrings are connected (originate) at the Ischium bones (the sit-bones). The Ischium bones are pretty much directly connected to the lower portion of the Sacrum via Ligaments, primarily the Sacrotuberous Ligament. If we grab a strap in our forward fold, and wrap the strap around our feet and then pull on the strap using our arm muscles we are using the strength or the contraction of our arms to stretch the Hamstrings. The tight Hamstrings will hold our hips and lower portion of the sacrum in place, while our arms hoist our torso forward. As a result, our spine which is inside of our torso, is being pulled forward. The lowest part of the spine is the Sarum; therefore, our hips are stuck in place as the top portion of our Sarum is being forced to pivot forward just so we get our head closer to our shins!

As mentioned above, the SIJ has very little movement, only about 3 degrees. Therefore, using force that is so distant from the Sacrum, such as our arms pulling on a strap, could pivot the Sarum too far forward creating misalignment with the Ilium (hip bones) causing pain. Most often, after our forward folds, we do our twisting poses. So, first we jerk our sacrum back and forth, then we start to twist it left and right, yikes! What do we do now?  

Use the muscles of the joint to move the joint. In this case with forward folds and the SIJ, try relaxing your arms and abs. Instead, use your erector-spine muscles which are a part of your core muscles. These are the muscles that start at your sacrum and Ilium. They run all the way up your spine to your first vertebra. Their main function is to arch the back, like in Salambasana, AKA prone superman. They also tilt the pelvis forward, just what you’re looking for in a forward fold. Using your back muscles instead of your arms, will not only be a safer bet for your SIJ, but it will also strengthen your erector-spine muscles that are so necessary for a healthy spine and an upright posture.

As you begin your sitting forward fold, allow your legs to be straight. Reach your heels away from you and you pull your toes toward you. Use your back muscles to tilt your pelvis forward. You can use your arms here to lift your hips a little off the floor so that the ground does not prevent your pelvis from tilting forward. Arch your lower back as you sit as tall as possible and start to reach your lower ribcage toward your knees. Focus on your sacrum, not your pelvis. Imagine the sacrum tilting forward as you feel the muscles in your lower back engage while supporting and creating a tilt of the sacrum. As a result, you are using the muscles of the joint to move the joint.

What about twisting poses? Let’s start with Ardha Matsyendrasana (Half lord of the fish pose), a sitting spinal twisting pose. In some ways, this seated twist can be more detrimental to the SIJ than the seated forward fold. At least with the seated forward fold it is the “somewhat” giving hamstrings that are preventing the pelvis from tilting forward enough. However, in a seated twist, it is the unmovable Earth that is restricting your pelvis from moving. What’s more, is the sacrum has even less mobility to twist than it does in flexion and extension (tilting forward and back). The SIJ has about 1.5-degree movement in axial rotation (twisting).  

We do the same thing here. So often we grab our leg and use our arm muscles to twist the spine as much as we can. As we sit on the floor, the floor will keep our pelvis grounded, as the twist in our spine works its way down to our sacrum creating an extreme axial rotation in the SIJ. Well, the word “extreme” is relative. Here it means any rotation greater than 1.5-degrees, which is not really a lot and probably is all too easy to reach. How do we work around this?

Use the muscles of the joint to move the joint. We mentioned the Multifidous muscle above. It is primarily an erector spine muscle (arching the back). However, it also directly assists in twisting the spine (torso). The Latissimus Dorsi (a large muscle in the back with many functions) and the internal and external obliques (making up a portion of the abs), are a main force in trunk rotation (twisting). To help ensure that there is not too much rotational strain on the SIJ, again, relax the muscles that are not directly associated with the movement. Instead of using your arms to twist, use your core muscles.

If you are twisting to the left, then try to twist your Lumbar spine (lower torso) and Sacrum to the right. This will engage your core muscle in a way to help protect the SIJ. Try twisting without the use of your arms. Notice that in order to get a deeper twist (without the use of the arms), it is necessary to engage the lower torso muscles in a way to twist the lower torso, pelvis and the sacrum, in the opposite direction of the upper torso. By using the muscles directly associated with the twist and allowing these muscles to create the twist, you help to ensure that the sacrum is facing straight ahead, not twisting past the tiny little 1.5-degrees. Again, an added benefit is that you are strengthening the muscles that are associated with that joint, in this case, your spine.

Each individual with a SIJD (Sacroiliac Joint Dysfunction) needs an individualized treatment. It is not a “one size fits all”. It is my hope that this information along with your treatment from your Health Care Provider will bring some relief.

For each individual without a SIJD, it is my hope that you never get one and that we all remember to use the muscles of the joint to move the joint.