The sacroiliac (SI) joint links the pelvis to the lower spine, sitting at the base of the back where the sacrum meets the iliac bones on either side. Its primary function is to transfer the weight of the upper body, acting as a shock absorber between the torso and the legs. SI joint pain is a common, often debilitating condition that can significantly impair daily activities like sitting, standing, and walking. Since the joint is supported by a strong network of ligaments, any disruption to its normal movement can lead to chronic discomfort. This article explores the mechanics of SI joint pain and the specific role of chiropractic care in addressing this particular source of lower back and pelvic discomfort.
What Causes Sacroiliac Joint Pain
Sacroiliac joint dysfunction arises when there is an abnormal amount of motion in the joint, which can be categorized into two primary mechanisms. The first is hypomobility, meaning the joint moves too little, which often leads to stiffness, muscle tension, and pain that typically presents on one side of the lower back and buttock. This reduced mobility can be a result of degenerative changes like arthritis, where the protective cartilage wears down and causes the bones to rub together.
The second mechanism is hypermobility, or excessive movement, which results in instability and a feeling that the joint is loose. Hormonal changes, such as those that occur during pregnancy, can loosen the ligaments supporting the SI joint, leading to this instability. Trauma, such as a fall or car accident, can also injure the stabilizing ligaments, allowing for increased motion and subsequent pain.
Pain from SI joint dysfunction can be difficult to distinguish from other types of lower back pain, as it commonly radiates into the buttock, hip, and sometimes down the leg, mimicking sciatica. The pain is often worsened by activities that stress the joint, like standing for long periods, climbing stairs, or rolling over in bed. Gait abnormalities or a leg-length discrepancy can also place uneven stress on the pelvis, leading to SI joint pain.
How Chiropractors Approach SI Joint Treatment
A chiropractor begins the treatment process with a detailed physical assessment aimed at isolating the SI joint as the source of the patient’s pain. This diagnostic phase includes motion palpation, where the practitioner manually feels the joint’s movement during specific patient motions to identify areas of restriction or excessive play. Specific orthopedic tests, such as the Faber test or Gaenslen’s test, are also used to provoke pain in the SI joint, which helps confirm the diagnosis over other causes of lower back pain.
Once SI joint dysfunction is confirmed, the primary goal of chiropractic treatment is to restore normal motion and alignment to the joint. For cases of hypomobility, a chiropractor will typically use a specific chiropractic adjustment to introduce a quick, controlled force into the restricted joint. Techniques like the diversified technique or low-force methods, such as drop table adjustments or the Activator method, are commonly employed to realign the joint.
In instances where the joint is hypermobile, the approach shifts away from forceful manipulation and focuses more on stabilization and low-force mobilization techniques. The application of sustained, gentle pressure, or the use of specialized tools, aims to reduce the inflammation and pain caused by improper joint movement without increasing the existing instability.
Ensuring Long-Term Stability and Pain Relief
To prevent the recurrence of SI joint pain, chiropractic care extends beyond the adjustment to include a comprehensive rehabilitation program. The newly aligned joint needs to be supported by surrounding musculature to maintain stability, especially in cases of hypermobility. A primary focus is on strengthening the core muscles, gluteal muscles, and pelvic floor, which act as the body’s natural stabilizers for the pelvis.
Exercises such as pelvic tilts, bridges, and the bird-dog pose are often prescribed to engage these stabilizing muscles without placing excessive strain on the joint. Stretching is also incorporated to address tightness in muscles that may be pulling the pelvis out of alignment, such as the piriformis or hamstrings. However, patients with hypermobility must be cautious with deep stretches, as they can sometimes exacerbate joint instability.
Lifestyle modifications are another important component of maintaining long-term relief and minimizing stress on the SI joint. Chiropractors often provide guidance on proper lifting techniques, maintaining ergonomic seating posture, and avoiding long periods of sitting or standing. In some cases, a chiropractor may recommend the use of a sacroiliac belt to provide temporary external support to a hypermobile joint during activities. If a patient requires advanced strengthening or if the pain is complex, the chiropractor may suggest a referral to a physical therapist or a medical doctor for further evaluation, such as imaging or injections.