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Back or Hip Pain? Is it actually coming from your SI joint?

Updated: Jan 29

Written by: Dr. Ashley Bertorelli, PT, DPT

 

If you’ve never heard of the SI joint, or are unfamiliar with the term, let’s get you educated!  I have a special interest in the SI joint because its involvement in hip and back pain often gets missed, and people who come in for “hip pain,” “groin pain,” and or “low back pain” don’t have a hip, groin, or lumbar spine problem, they actually have an SI joint problem!  And some patients come in and end up with a great result who have in the past failed PT, chiro, Ortho, Pain management, or other providers, because they were being treated for the wrong thing.  So let’s learn more…



The SI joint is where the surfaces of the sacrum (big bone at the base of the spine) and the ilium (bony pelvis, or where you put your hands on the hips) meet together and function as the transition between the spine and the pelvis and hips. The main roles of the SI joint are to provide stability and offset the load of the trunk to the lower limbs, but it also provides some movement and mobility to the pelvis.  You have two SI joints- one on the left, and one on the right.  If you put your thumbs in the little dimples of the lower back, you’re right on/near the region of the SI joint.  The SI joint is quite large- both wide and deep, so pain specific in the SI joint can be felt near the surface, or rather deep within one side of the lower back.



Signs that your pain may be coming from your SI joint:

  • Pain with sit to stand transitions

  • Pain in one side of the lower back when leaning backwards or lunging

  • Pain on one side- left OR right, it can change sides sometimes especially for those with hypermobility!

  • Pain that is quite low in the back, and off-center

  • Stiffness/Limited mobility of one SI joint can also cause pain in the outer hip, or into the front of the hip/groin, and can be mistaken for hip bursitis or a hip flexor or groin problem. The pain can also "move" from outer hip to groin to lower back.


Risk factors for SI joint pain:

  • Prolonged and static postures on a regular basis

  • Asymmetrical postures including sitting and sleeping postures (tucking one knee up, crossing legs or ankles, etc.)

  • History of fall(s) onto the bottom or hip

  • Overuse of one side of the body (or history of playing soccer, baseball, basketball, etc.)

  • Athletic dominance on one side of the body

  • Hypermobility syndromes

  • Pregnancy/PMS/Menstruation or other hormonal fluctuations that may impact joint mobility/laxity

  • Arthritis and degeneration

  • Repetitive motions or activities, especially dominant on one side of the body


What else can your pain be, if not SI joint?

  • It CAN be coming from your lumbar spine- Your PT can rule in/out lumbar spine involvement

  • It CAN actually be coming from your hip joint or surrounding hip muscles, tendons, and/or bursa- Your PT can rule in/out hip involvement


If you KNOW your pain is coming from your SI joint, what should you do?

  • Your #1 option and best bet is seeing a Physical Therapist knowledgeable and skilled in evaluating and treating SI joint problems.  Interventions usually include a combination of manual therapy mobilizations, mobility exercises, and strengthening/stabilizing exercises.  Our clinics in Troy, NY and Clifton Park, NY have many highly skilled Therapists to choose from that can help you out!



If you have any questions about our Therapy, feel free to email care@thegrpt.com  We're here for you, so don't be afraid to reach out and ask questions! And as always, SHARE this article with a friend dealing with persistent, stubborn back, hip, or SI joint pain. Maybe something has been missing from their treatment program!

 

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