Have you ever experienced the frustration of a wobbly pelvis or mysterious discomfort in your lower back? If so, you may have encountered the challenges posed by the sacroiliac joint. In this blog, we embark on a journey of understanding, offering insights and guidance on navigating the complexities of SIJD. Together, we’ll unravel the mysteries, explore effective remedies, and provide exercises to restore stability and find relief.

SI joint Anatomy

The sacroiliac joint is a complex joint that connects the sacrum (the triangular bone at the base of the spine) to the ilium (part of the pelvis). It plays a crucial role in transferring forces between the spine and the lower extremities during various movements.

Research and biomechanical studies have provided insights into the movement patterns and range of motion at the SI joint. While the exact degree of movement varies among individuals, the following evidence-based information can guide our understanding:

Nutation and Counternutation: The primary movement at the SI joint is nutation and counternutation. Nutation refers to the forward and downward rotation of the sacrum, while counternutation refers to the backward and upward rotation. These movements occur in response to weight-bearing, walking, and dynamic activities.
Limited Range of Motion: The range of motion at the SI joint is relatively small compared to other major joints in the body. Research suggests that the average range of nutation and counternutation is approximately 2-4 degrees in each direction.
Force Closure and Ligamentous Support: Stability at the SI joint is maintained through a combination of bony architecture, ligamentous support, and muscular control. Ligaments such as the anterior sacroiliac, interosseous sacroiliac, and posterior sacroiliac ligaments play a significant role in providing stability and limiting excessive movement.
Influence of Pelvic Muscles: The muscles surrounding the SI joint, including the gluteal muscles, deep core muscles, and hip rotators, contribute to its stability and control. Proper activation and coordination of these muscles are essential for maintaining optimal biomechanics and preventing excessive stress on the joint.
Altered Movement Patterns in Dysfunction: Sacroiliac dysfunction or pathology can lead to altered movement patterns at the joint. Research suggests that conditions such as sacroiliac joint hypermobility or hypomobility may affect the joint’s ability to properly distribute forces during movement, potentially leading to pain and dysfunction.

It is important to note that individual variations in SI joint movement and mechanics exist. Factors such as gender, age, and previous injury history may influence the range of motion and functional capacity of the joint. Pregnancy-related hormonal changes can also affect ligamentous laxity, which in turn affects motion at the joint.

Physical Therapy for Sacroiliac Joint Pain

Physical therapy plays a crucial role in the treatment of SI joint pain by addressing both the underlying causes and the associated symptoms. Here are some commonly used exercises and manual therapy techniques:

Core Strengthening Exercises: Strengthening the core muscles can help improve stability and support for the SI joint. Exercises such as planks, bird dogs, and pelvic tilts can target the deep abdominal muscles, back muscles, and hip muscles. These exercises help enhance core strength, reduce stress on the SI joint, and improve overall posture.
Stretching Exercises: Stretching exercises can help relieve tension in the muscles surrounding the SI joint. Examples of effective stretches include the piriformis stretch, hip flexor stretches, and hamstring stretches. These stretches target the hip and leg muscles, alleviating stress on the SI joint and promoting flexibility.
Muscle Energy Techniques (METs): Muscle Energy Techniques or SI Joint Pain: Muscle energy techniques (METs) are manual therapy techniques commonly utilized by physical therapists to address SI joint dysfunction and alleviate associated pain. METs involve the active contraction of specific muscles in a controlled manner to improve joint mobility, correct alignment, and restore balance. These techniques can help release muscle tension, reduce joint restrictions, and promote optimal functioning of the SI joint.
Functional Training: Functional training involves performing exercises that mimic daily activities or sports-specific movements. This approach helps strengthen the muscles and joints involved in these activities, promoting proper biomechanics and reducing strain on the SI joint. Your physical therapist will design a personalized functional training program tailored to your specific needs and goals.
Low-Impact Aerobic Exercises: Engaging in low-impact aerobic activities, such as swimming or cycling, can be beneficial for individuals with SI joint pain. These exercises help maintain cardiovascular fitness without placing excessive stress on the SI joint. Always consult your physical therapist to determine the most suitable aerobic exercises for your condition.

Exercises to Alleviate SI Joint Pain:

3 Beginner SI Joint Stabilization Exercises

Supine Bridge:

Lie on your back with your knees bent and feet flat on the floor.
Engage your core muscles and lift your hips off the ground until your body forms a straight line from your shoulders to your knees.
Hold the position for a few seconds, then lower your hips back down.
Repeat for 10 to 15 repetitions.

Standing Hip Abduction:

Stand next to a wall or use a chair for support.
Lift one leg out to the side, keeping it straight and your toes pointing forward.
Hold for a few seconds, then lower your leg back down.
Repeat on the other side.
Perform 10 to 15 repetitions on each side.

3. Isometric Hip Adduction

Start by lying down on your back on a mat or a comfortable surface.
Bend your knees and place your feet flat on the ground, hip-width apart.
Engage your transverse abdominis, which is your deep core muscle, by drawing your belly button towards your spine. This engagement should create a slight tension in your abdominal area.
Position a small exercise ball or a pillow between your knees.
Squeeze your knees together gently, activating your inner thigh muscles.
Continue to engage your transverse abdominis by maintaining the tension in your abdominal area throughout the exercise.
Hold this position for a specific amount of time, usually 10 to 30 seconds, or as long as you can maintain good form and muscle activation without strain.
Focus on breathing steadily throughout the exercise. Inhale deeply through your nose and exhale slowly through your mouth.
Release the squeeze and relax your inner thigh muscles.
Rest for a few seconds and repeat the exercise for the desired number of repetitions, usually 8 to 12.

Conclusion

Sacroiliac joint pain can significantly impact one’s daily life, but physical therapy offers effective strategies for managing and alleviating discomfort. Through a combination of targeted exercises, manual therapy techniques, and muscle energy techniques, physical therapists can help restore proper alignment, improve joint mobility, and reduce pain associated with SI joint dysfunction. Remember to consult with a healthcare professional or a licensed physical therapist to receive a thorough evaluation and develop a personalized treatment plan that suits your unique needs. With the guidance of a physical therapist, you can regain control over your SI joint pain and enhance your overall well-being.