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SI Joint Pain: Symptoms, Causes And Treatment

SI Joint Pain: Symptoms, Causes And Treatment
Naked man with lower back pain on white isolated background. Back view. Close-up.
vadimguzhva via Getty Images
Naked man with lower back pain on white isolated background. Back view. Close-up.

Anyone who has suffered from SIJ (sacroiliac joint) pain knows that it can cause some serious discomfort. Specifically this pain can be located in your back, hip, and perhaps even down your leg. Severe SI joint pain can lead to pain with day-to-day activities such as getting in and out of bed, walking up stairs or getting in and out of the car.

First let's talk about the anatomy of the SIJ.

For a long time it was thought that the SIJ was immobile. It is a very inherently stable joint; however, it is now known that mobility and movement of the SIJ is not only possible, but also essential for shock absorption during weight-bearing activities.

This is a protective mechanism in the human body to alleviate some of the strain on the lumbar spine. What this motion looks like varies between individuals, but the quantity of motion is always small.

There are a number of very strong muscles that surround the SIJ, including the erector spinae, psoas, quadratus lumborum, piriformis, abdominal obliques, gluteal muscles and hamstrings. Even though these strong muscles surround the joint, none of them actually act directly on it to produce active movements. Instead, movements are produced indirectly by gravity and by these muscles acting on the trunk and lower limbs.

Enough with the anatomy talk. Let's chat more about how we can work on alleviating your pain!

The Purpose of the SIJ

Given its structure, the SIJ is designed to relieve stress and forces. It acts as a buffer between the hip and lumbar spine. It transmits forces from the spine sideways into the pelvis and then into the lower limbs (and vice versa). Think of your body as a car. Your SIJ acts like the shock absorbers without which you can get into trouble.

How Important Is the SIJ, Really?

A fantastic study completed by Dr. Stuart McGill looked at the forces transmitted to the SIJ during a 60-pound squat. He found the total force transmitted to this SIJ during this activity was 6.5 kN (think enough to lift the equivalent of a small car, which is 1,461 pounds of force going through the SIJ).

In terms of SIJ dysfunctions, they commonly fall in to two categories:

1. Instability - the joint moves too much

2. Stiffness - the join moves too little

Research published in Clinical Biomechanics in 1989 determined that muscle balancing is key, and in order to have optimal SIJ stability and movement you need to focus on what they called the powerful two.

What are the 'powerful two'?

1. The gluteus maximus, a.k.a. your biggest butt muscles

2. Biceps femoris, a.k.a. your hamstrings

These researchers also determined that weakness in the posterior chain (glutes and hamstrings) and tight psoas muscles can lead to aberrant SIJ motion and loading.

This means that in order to correct a hypermobile SIJ, we need to focus on the surrounding muscles, especially those in the posterior chain, and correct any imbalances. Most commonly this means improving the strength of the gluteals, hamstrings as well as your lats (think upper back muscles) but individual cases do vary.

So what should you do if you have SIJ pain?

If you have SIJ pain, or you think you have SIJ pain, the best thing is to see a trained professional who can diagnose you, let you know exactly where your pain is coming from and help you develop a plan to fix it.

And to keep your SIJ functioning properly and pain free, work on optimizing your posture, core stability, hip mobility and stability, along with strength and motor control.

You don't have to live with pain!

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