The ilium bone is on the outside of the sacrum. Where the ilium and sacrum meet on each side, create the the SI joints. A joint is where two bones come together and ligaments connect one bone to another. Each SI joint, the right and left, have multiple ligaments connecting them.
The ligaments at the top of the joint connect the ilium and sacrum to the lumbar spine. There are ligaments on both sides of the sacrum connecting it to each ilium. There are also large, broad ligaments connecting the top and bottom of the SI joint. The SI joint also has connections to the tendon of the hamstring muscles.
In addition to joints and ligaments, muscles connect to the bones via tendons.
There are multiple muscles that connect to and cross to the SI joint. Muscles contract and pull on the bones, which allow us to move our joints and bodies. The superficial muscles of the SI joint are the glute max, which has connections up to the sacrum and ilium. The thoracolumbar fascia connects to the center of the spine and the latissimus dorsi muscle underneath. We have vertical muscles along the spine, the erector spinae muscles, also known as the paraspinal muscles.
Deep to those paraspinal muscles, there are the multifidus muscles connecting to the vertebrae in the back, as well as the sacrum deep to the glute max muscle. The piriformis connects the sacrum to the femur. The lateral, or outer, hamstring muscle is known as the biceps femoris, and its tendon originate from fibers of the ligament in the SI joint, the sacrotuberous ligament, as well as your “sit bone”.
In addition to the muscles, we have superficial nerves that innovate the SI joint.
They provide sensory innervation such as pain, heat, and cold sensations. They start deep in the spine and branch out to become superficial, coming to the surface right at the level of the ilium and the SI joint, and then branch around the ilium to the side and the front of the hip.
The SI joint functions to dissipate forces from the lower limbs to the trunk, storing energy in the ligaments and absorbing shock. The SI joint can absorb energy passing from the legs as it attempts to pass through to the torso, and can be a very common area for pain.
How Your Lower Back Could Cause Your SI Joint Pain
The most common source of lower back pain originates from the sacroiliac joint (SI joint). Research shows that 15 to 30% of those with lower back pain have their pain in the region of the SI joint. This can be due to restrictions at the joint, injury to the ligaments, tendons, muscles, and superficial nerves.
How We Assess SI Joint Issues in Our Office
All evaluations begin with observing the patient in the waiting room. We can learn something just by observing someone’s behavior and posture while they are in the waiting room and how to ambulate into the treatment room.
Once we get into the treatment room, we take the patient’s history, where we sit down and have a discussion about where the pain came from, what the pain feels like, what caused the pain, what makes the pain better or worse, and if it’s limiting their daily life and their movements.
Once we have the history and an understanding of what’s going on, we can start the physical examination. The exam usually starts with the patient performing specific active movements to assess if they can actually move that region of their body, or if it is limited due to the pain.
Next, your doctor will perform orthopedic tests. We evaluate different structures to rule in what we think might be the cause of pain and rule out other types of pain that might mimic the same symptoms.
We do muscle tests to assess the strength of the muscle and to determine if the muscle is causing the pain. We can do nerve tension tests to assess the sensitivity of the peripheral nerves that travel through the body. We do skin rolling and pinching to assess if the superficial nerve endings are sensitive and causing pain. We also perform passive movements and mobilizations to assess if the joint and ligaments are the structures that are causing the pain. Once we are confident with our diagnosis and we know where the pain is coming from, we can move on to the treatment.
How We Treat SI Joint Pain With Chiropractic Care
Treatment will always depend on the results of the examination. If the exam shows that the joints or the ligaments are the cause of pain, treatment would likely involve adjusting or mobilizing. If the patient’s condition is overly tender or painful, mobilizing the joint would include gentle movements with some pressure to help provide movement to the joint. We can do mobilizations with pelvic blocks to prop the pelvis up to help it relax into that position. Another option is to use an adjusting tool called the activator to provide gentle adjustments. We can also use the drop table to adjust as well as perform manual adjustments.
If the exams show that the muscles are the cause of pain, we want to do manual therapy or myofascial work. Deep tissue fascial work involves deep pressure to reduce any densities in the tissue, which can be very painful but can be very effective. Instrument-assisted soft tissue work, scraping, or Graston involves a stainless steel tool to help promote local blood flow in the region and help reduce tightness in the muscle.
Superficial nerves are addressed if they are found to be the cause of pain. This treatment involves suction-type treatment. It can be through pinching the skin or cupping to help create more space between the different structures of the skin (the fascia and muscles) and promote local blood flow.
Once we have finished treatment in the office, we move on to discuss at-home care, which can be some of the most important parts of the treatment. At home care provides a way for the patient to have something to take home with them and do in between their visits as supportive care for their in-office treatment. Home exercises are meant to provide a pain-free way to move that area of the body.
Once the pain is decreased and the area is less tender, the exercises can increase in difficulty to help improve tissue tolerance. Improved tissue and load tolerance helps improve overall function and helps to reduce future injury.
