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Simple Steps to Eliminate SI pain

3/5/2013

16 Comments

 
In healthy movement, the sacrum moves relative to the inominate bones.  When the sacral promontory moves forward into the pelvic bowl, the motion is called nutation; counternutation is the opposite motion.  The optimal position for the sacrum in standing and sitting is slightly nutated between the inominates.  This is the goldilocks position: not too tight and not too loose. 

During sitting and standing, you can diminish stress on the SI joints by maintaining a neutral pelvis.   
In my practice I work with a lot of people who have low back pain, and sacroiliac (SI) pain.  How we stand, how we sit, and how we move in our bodies over time, contributes to our dysfunctions and potential pain syndromes.

Being mindful of HOW we stand and sit are simple steps to begin to unravel the increased loading and compression on the spine and SI joints, as well as the tension and pull on corresponding ligaments and muscles. 

Before going over standing and sitting, let’s look at the anatomy:  The pelvic girdle is comprised of the 2 pelvic (inominate) bones and the sacrum.  The inominate bones join in the front by a thick fibrocartilage disc similar to that of the vertebral discs.  This area is called the pubis or pubic symphysis.  In the back, the inominate bones attach to the sacrum, creating the sacroiliac joints.  

The function of the pelvic girdle is to transfer the loads between the trunk and the lower extremities via the spine and hips (lumbopelvic-hip complex).  There are 35 muscles that attach directly to the pelvic girdle.  Therefore, the mobility and stability of the SI joints depends on the interaction of these muscles, ligaments, fascia and nerves that surround the pelvic girdle.

Learning how to stand

Look around you, most people stand with their pelvis out in front and their shoulder’s and ribcage back (as in the pic below).  
This posture causes the sacrum to fully nutate, meaning that this is the maximally closed position of the SI joints.  This position can create low back and SI joint aching during prolonged standing.
SI compression with poor standing posture
Incorrect Alignment: Anterior Pelvic Sway
Correct your alignment by shifting your hips back, allowing your trunk to move forward so the line of gravity travels through your joints: shoulder, hip, knee and ankle.  Now the pelvis is in neutral: the pubic bone and ASIS line up vertically, and the SI joints are in optimal position.
Improve SI pain by standing better
Joints are in a plumb line.

Learning how to sit

Many people slump their spine and pelvis while sitting watching TV, or sitting slumped at the computer.  In this posture, the weight of the body is positioned behind the SI joints.  This places the SI ligaments under load, the sacrum is tucked (counternutated), and pressure is at the tailbone (coccyx).  
Eliminate SI pain
Photo by Felipe Dias
The stress of this position will stretch the ligaments of the SI joint, and can also create tailbone pain.  Maybe you can relate to having pain while trying to walk after sitting like this for awhile.  The initial steps are excruciating until you are able to walk it out as the ligaments regain their normal position.

Correct your alignment by sitting on your ischial tuberosities (SITS bones).  The pelvis and spine should be in neutral.
Picture
Susan McLaughlin is a physical therapist who specializes in the management of pelvic floor and orthopedic dysfunctions. She is the owner of ALIGN integration|movement in Salt Lake City, UT.  Helpful tips and other self care strategies can be found at www.alignintegrationandmovement.com.
16 Comments
Jane Bell link
3/13/2013 05:15:12 pm

Great post!

Reply
Teresa Ladouceur link
11/27/2013 10:01:58 am

Awesome information! Thanks for posting this!!!!!

Reply
Susan
11/27/2013 11:30:32 am

Teresa,
Thanks for reading!
Susan

Reply
Roberto link
11/27/2013 11:59:01 pm

Very interesting. I suffer since two years of this pain (back of legs) and it started from the sacroiliac zone. Do you think it could be possible that a wrong bicycle saddle (too hard) has caused the beginning of this pain ? ... I can't get out of it. I'm a triathlete and practice a lot of sports including Bike, MTB and SkiAlp ... but the worse feeling I got is when I run. Thanks for your time. Roberto (ITA)

Reply
Susan
11/30/2013 12:56:47 am

Roberto,
Sounds like your SI joints could be at play here among other things. I would say that it is less about the bike saddle and more about your body positioning. Where are you located? Maybe I can find a colleague in your area that I can refer you to.

Susan

Reply
Roberto link
12/2/2013 02:32:15 am

Many thanks for your reply. I'll consider this... I just wanted to know your thought if the hardness or shape of the saddle could be a further tip to consider. I'm hearing a lot of people about this. Most of them suggest to care and do more stretching, specific exercises, body posture, breath control (baffle), etc
I've never spent time in stretching and probably now I'm paying the bill all in once :-/
By the way I live in Udine Italy
Bye bye & thanks again for your time

Brigita
12/12/2013 01:32:49 am

Thanks for sharing your knowledge with us.I suffer of SI pain and I am very happy that I find your eksercises for it. Could you please explain me the second movement.How can I extend my hip back without moving my pelvis?When I do this movement I can't move my hip without moving my pelvis or I just thing so. I Feel just a small movement, is it o.k''?
Thanks for your time, Brigita from Slovenija

Reply
Susan
12/16/2013 11:15:03 am

Brigita,
Which exercise are you speaking of? In this post there aren't any exercises. Can you post your question under the specific blog post with the exercises. Thanks, Susan

Reply
lafitmodel
3/8/2014 05:40:41 am

After going to P.T. chiro's, rolfers, osteopaths, Sports Medicine functional rehab for SIJ issues. The psoas major + the ilio psoas are tight because they are weak, I would just release, release, stretch, stretch, per Liz Koch, and it's fine but also need to strengthen psoas, glutes, hamstrings to get the pelvis back over feet. Finding that the psoas muscles have atrophied due to chronic sitting, driving etc. My issues DID NOT improve until I STRENGTHEN the muscles that support the pelvis

Reply
Susan
3/8/2014 05:57:36 am

lafitmodel,
Yes, it is important to balance out the muscles attaching to the pelvis as well as all the muscles that contribute to the kinetic chain! Thank you for sharing your experience! Susan

Reply
Rachel
3/21/2014 11:15:51 pm

lafitmodel, I too have been to PT's, rolfers, sport med rehab, etc...and my psoas is still tight. I am committing myself to things I have learned here, but please tell me or point me in the right direction as to how you strengthened your psoas. I want to do it safely. :)

Reply
Susan
3/22/2014 01:05:10 am

Rachel,
Where are you located? I have found Neurokinetic Therapy to be a valuable tool in my practice for balancing muscles within the kinetic chain. Here is a link to the find a practitioner page:
http://neurokinetictherapy.com/certified-practitioners
Susan

Dr.Ramana Murty
5/21/2016 10:07:18 pm

Excellent advice.Iam a Prof. of Dermatology in India and a person with bilateral SI ACUTE ARTHRITIS of 10 days duration.A fit athletic person, Iam sh8cked why I got it

Reply
Connie
9/29/2016 01:06:39 pm

I suffer terribly with SI joint pain and especially when I have been sitting for long periods at work. I don't generally slump like the picture above; however, I tend to cross my legs and wondered if that might be my issue. I am also curious if you could suggest a chair or anything I can use during the day to help. Usually by the end of the day I can't even walk it out any longer. Thank you,

Reply
Ruth
10/19/2016 09:15:21 am

Hi I am a mother of two. Have a 2year boy and a month old little girl. I have been suffering from acute SI joint dysfunction since 2weeks. Could you please give me some tips on how to go about caring for my little one and my son without straining my back further. Thank you.

Reply
Ann Renee Hobbs
1/29/2023 04:59:18 am

Hello,

Can you request a colleague in the Owings Mills, Maryland area, for the treatment of S.I. Joint care?

Thank you.

Reply



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