Understanding the Sacro-Iliac Joints, Stopping the Pain and Weird Symptoms

Sacro-iliac joint pain can be understood as a case of "broken pelvis" -- in which the "break" occurs at the three major joints of the pelvis:  one at the pubic bone (pubic symphysis) and the two at the sacro-iliac joints.  The "break" consists not of a fracture of bone, but as a break in the integrity of the pelvis -- displacement (misalignment) of the bones and strain at the joints.  Another term would be, "Pelvic Distress."

This entry explains the condition and provides access to a self-relief regimen (program), at the end.


Who is This Program For?

Causes of a Twisted Sacrum

This Mayo Clinic entry describes causes of a twisted sacrum.

Sacroiliitis — Comprehensive overview covers symptoms, causes, diagnosis, treatment of inflammation of the sacroiliac joints. 

ref: Overview - Sacroiliitis - Mayo Clinic

Causes for sacroiliac joint dysfunction include:

  • Traumatic injury. A sudden impact, such as a motor vehicle accident or a fall, can damage your sacroiliac joints.
  • Arthritis. Wear-and-tear arthritis (osteoarthritis) can occur in sacroiliac joints, as can ankylosing spondylitis — a type of inflammatory arthritis that affects the spine.
  • Pregnancy. The sacroiliac joints must loosen and stretch to accommodate childbirth. The added weight and altered gait during pregnancy can cause additional stress on these joints and can lead to abnormal wear.
  • Infection. In rare cases, the sacroiliac joint can become infected.
In my clients' experience, nearly all cases come from traumatic injury, with far fewer from pregnancy. Traumatic injury includes falls (bicycle, horse, rooftop, skating, ladder, etc.) and motor vehicle accidents.

How a Twisted Sacrum Causes Sacro-Iliac Joint Pain 

When a sacrum is twisted in its position in the pelvis, we call that, "displacement". It's out of place. With displacement comes distortion of pelvic shape, which puts strain on ligaments, soft tissue, and muscles in the pelvis,. The brain senses those strains and, in a protective response, triggers muscular spasms not just in the pelvis, but as far-away as the neck and jaws.


Non-spasm pain may radiate from the S-I joints into the pelvis, lower abdomen, groin, or sex organs -- or further.


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What it Takes to Correct S-I Joint Pain

The first step to correct S-I joint pain is to determine how the sacrum is displaced (misaligned). Two major possibilities are a twist and a shift of one side of the sacrum, downward; shift and twist generally occur together.  Along with that displacement comes a twist of pelvic position that makes twisting movements easier in one direction than in the other.

The two videos, below, provide instruction in self-appraisal, to determine the misalignment.  Follow the instructions.  It's a simple movement.

The value to you of what follows in this entry depends upon your having the misalignments people find, with those instructions. The reason: if your sacrum is misaligned, the regimen at the end can help; if not, then you need something else. Do the self assessment.

SELF-ASSESSMENT OF SACRAL POSITION

SELF-APPRAISAL OF TWISTING

The movement is:
1. Legs together.
2. Squeeze.
3. Draw one side back.
4. Open legs.
6. Bring that side forward.
Repeat in reverse.

Sense which side is more difficult to bring the hip forward.  That's the jammed-forward side.  The video tutorials specify which side is your "working side".

CONDITIONS OF S-I JOINT PAIN

In investigating sacro-iliac (henceforth, S-I) joint problems, I have arrived at findings that make sense of the condition and its causes and that point precisely to what we must do to relieve S-I joint pain.

In this entry, I explain S-I Joint Pain Syndrome in detail, give you an instructional video to get started with self-relief, and provide access to a complete regimen (list of steps) to give yourself lasting and durable relief.

Let's start with symptoms. Look for yours.


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SYMPTOMS OF S-I JOINT PAIN SYNDROME

  • pain across the low back (one or both sides)
  • a "deep pulling" sensation in the spine, like a taut wire
  • pain just below the waistline, in back (one side)
  • pain deep in buttock(s) that doesn't respond to direct treatment
  • deep pelvic/abdominal pain (ache, "lightning"-like pain), sometimes with nausea
  • numbness in front or side of thigh
  • pain at the top rim of the pelvis, at sides or back
  • pain deep in the hip joint
  • sciatica (if accompanied by other symptoms)
  • groin pain
  • testicular pain
  • bladder pain
  • "pulling" or "stretching" pain at the low back
  • pain along the spine
  • pains in the ribs
  • restricted breathing or the sense that the breathing diaphram is involved
  • neck or jaw pain (reflexive contractions)
THE SACRO-ILIAC (S-I) JOINT LIGAMENTS ARE NOT THE CAUSE OF S-I JOINT DYSFUNCTION, BUT THE VICTIM OF IT.


A BASIC UNDERSTANDING OF THE CAUSE OF SACRO-ILIAC PAIN

In brief, S-I joint pain comes from excessive and unbalanced forces on the S-I joints that trigger painful muscular reactions and cause radiating pain from the S-I joint into the pelvis and places more distant from the S-I joints.

Those forces may have started with an accident, such as a fall that displaced the sacrum from its centralized position, but they are maintained by alterations of movement and muscular coordination, which alter the direction and shape of forces that meet at the pelvis. Those forces originate both from below (hips and legs) and from above (muscles of the trunk) -- and persist both during rest and during walking. They don't respond to stretching.

The strains in the pelvis get registered by the brain as an emergency situation. The brain causes contraction patterns, which (triggered automatically by the nervous system as an emergency response) reflexively stabilize the situation. They grip and hold everything in place. It's a kind of stabilization of the situation -- but it's stabilization in a condition of pain. These muscular contractions to stabilize the emergency situation of the pelvis are gripping patterns so strong that they cause pain and other symptoms, even at a distance from the S-I joints, such as in the ribs, legs, or neck.

Compression and twisting forces that converge at the S-I joints cause stress at the joint surfaces, strain the S-I ligaments, trigger reflexive muscular contractions throughout the trunk and legs that cause muscle and radiating nerve pain (that may be mistaken for spasm) -- and that never let up, day or night.

This complex collection of symptoms, we call, S-I Joint Pain Syndrome, a syndrome being a collection of symptoms.

A BASIC UNDERSTANDING OF THE NEW REGIMEN to CORRECT  S-I JOINT DYSFUNCTION and STOP THE PAIN | SOMATIC EDUCATION

The medical model, which uses drugs and surgery generally targets a specific symptom or location of pain, but does not, typically, deal with the changes of muscle/movement memory.

Standard manipulative therapies focus on the locations of pain but not on larger patterns of altered movement, the more central cause of the problem that keeps it in place, despite manipulation.

Unlike standard therapy, somatic education uses action (movement) patterns to engage and free -- and then re-pattern -- the muscular tension patterns that cause S-I joint dysfunction and pain to persist.

The key term, here, is, "patterns". Thomas Hanna, in his book, Somatics | ReAwakening the Mind's Control of Movement, Flexibility and Health (available at many public libraries and via amazon.com), talks about how those tension patterns form and the process of ending them and their symptoms -- by an entirely new process -- without stretching, strengthening, or soft-tissue manipulation. Instead, it corrects muscle/movement memory.

Bones go where muscles and weight-bearing forces pull them, so by correcting muscle/movement memory, it normalizes movement and weight bearing forces and the sacrum progressively shifts to a healthier and healthier position.

Somatic education works effectively and causes no undesirable side-effects, other than occasional, short-term soreness.


To relieve S-I joint pain, we
  1. Unlock the Situation. We reduce the tension levels of the involved muscles, sufficiently to permit repatterning of musculo-skeletal actions/forces. 
  2. Reshape muscular tension and movement patterns through practice of movement patterns. Those movement patterns cultivate new muscle/movement memory consistent with healthy S-I joint function. 
  3. Reinforce healthy, free, balanced patterns of movement -- not by strengthening, but by practicing coordinated movements that reinforce new muscle/movement memory and movement integrity.
    You'll find free access to the relief regimen at the end of this entry.

    TWO VARIETIES OF S-I JOINT PAIN

    Bi-lateral (two-sided) S-I joint pain is simpler than one-sided SI joint pain. Bilateral S-I joint pain involves the compression at both S-I joints.

    One-sided S-I joint pain combines compression and twisting forces with asymmetrical (off-center) pelvic shape and muscular pulls (pelvic rotation with elevation with one hip).

    Asymmetrical (off-center) muscle pulls and posture place more stress on one S-I joint than the other.

    Symptoms commonly appear at different locations, side to side, and people commonly mistake the location of pain as the location of the S-I problem. They may also mistake groin pain as a sign of psoas muscle dysfunction, rather than as radiating pain originating at an S-I joint.

    Though one might be tempted to regard S-I joint pain as a ligamentous problem, it is that only secondarily; primarily, it is a neuromuscular problem resulting from soft-tissue strain within the pelvis, as described, earlier. I am emphatic about this point and will explain, shortly.

    THE LOCATION, STRUCTURE, and FUNCTION OF THE SACRO-ILIAC JOINTS

    The sacro-iliac joints exist at the waistline, in back, anywhere from two to three inches either side of the midline.

    By touching the region, you can feel ridges on both sides with your fingertips. These are not the S-I joints, but the edges of the neighboring hip bones. To the inside, you feel a depressed region. Where the depressed region meets the ridges, there you find the S-I joints.

    The sacrum is the meeting point of tensional and compressional forces meeting from above and below, as noted earlier. The shape of its joint surfaces is beveled to keep the sacrum from falling forward into the pelvis. When forced forward, it gets jammed between the neighboring hip bones (ilia).

    Compression forces at the S-I joints come from muscles of the trunk in contraction, primarily the paraspinal and psoas muscles, and the quadratus lumborum. Additional compression forces from the trunk come from the muscles of the abdominal wall (obliques, rectus abdominus), involved in the asymmetrical pulls of Trauma Reflex.

    Pulling forces at the S-I joints, themselves, come from muscles that span between the legs and the pelvis -- the psoas muscles, the hamstrings, buttocks, and front thigh muscles. These pulling forces combine in the movements of walking and the weight-forces of sitting to direct force into the S-I joints. In the healthy condition, those forces induce movements; in the unhealthy condition, they induce strain.

    Let's pause to re-set our way of looking at what I am describing.

    To this point, I have described the situation in anatomical terms -- but anatomical terms are inadequate to understand what is going on with S-I joints; functional terms are needed -- terms that describe sensations and movement: somatic responses.

    In the remainder of this piece, I will use both anatomical and somatic terms -- anatomical terms so you can visually imagine what I am describing (if you know anatomy) and somatic descriptions (descriptions of sensations and movement). You can imagine in yourself what that might feel like (assuming you have developed enough body-sense to do that).

    THE LIVING EXPERIENCE OF S-I JOINT PAIN

    A number of life-conditions set the stage for S-I joint pain -- the most notable and common one being a hard fall (onto one side of the pelvis or the tailbone/sacrum) or blow to the pelvis. This cause of S-I joint pain commonly results in one-sided S-I pain.

    Another cause is sitting too long in a condition of high tension and stress, as in desk, phone or computer work. That pattern of tension involves the groin, front hip joint, and back muscles and jam both sides of the sacrum forward. This cause of S-I joint pain results in two-sided S-I pain. A fall onto the tailbone may also cause bi-lateral S-I joint pain.

    Now, how do these causes affect the S-I joints?

    As the legs move in opposite directions when walking, walking induces a moving twisting motion into the pelvis right at -- you guessed it -- the S-I joints. When the S-I joint on one side is jammed, walking movements make the non-jammed side move too much and strain ensues in the ligaments of the too-mobile joint. The strain and pain appear at the side opposite of the jammed S-I side.

    And what happens to tissue that is chronically under strain? It gets inflamed. Inflammation is nature's way of forcing fluids and nutrients into tissue that is strained (or injured) so it can heal.

    THE VIEW FROM ABOVE

    But wait! There's more!

    We just described the effect of "tension from below" (the legs). What about "tension from above" (the trunk)?

    When tight trunk muscles bind the sacrum more tightly to the lumbar spine, the ordinary, round pelvic movements of walking are no longer as free of the lumbar spine. The lumbo-sacral junction is "stiffer"; the round, "figure 8" pelvic movements of walking must be re-distributed: less at the lumbo-sacral junction (L5/S1) and more at the S-I joints.

    So, the S-I joints get strained by movements both from below and from above. They get it from both ends.

    How'd you like to be in the middle, mediating between two uptight parties intent upon taking action that affects YOU?? That's the situation of the S-I joints.

    So, with each step of walking, the S-I joints take the brunt of movement.

    How the Psoas Muscles are Affected: An Effect, Not the Cause

    Now, the psoas muscles have a special part to play, here. They cross the span between "below" and "above", connecting "below" with "above" (from the inner groin, through the abdominal cavity, to the spinal column as high as the top of the diaphragm). When the psoas muscles tight, they "seal the deal" -- jamming both what's below and what's above into the sacrum.

    Tight psoas muscles are often blamed for symptoms of S-I joint dysfunction, but are a secondary effect of twisted sacrum. Attempts to free tight psoas muscles without first straightening the sacrum may trigger rebound pain; when the sacrum straightens, as in the regimen given, below, psoas pain fades out.


    But wait!  There's still more!

    ONE-SIDED S-I JOINT PAIN

    It's true that injuries usually occur to one side, rather than exactly from the back or exactly from the front, isn't it?

    What happens with any injury, is that Trauma Reflex (cringe response) gets triggered -- a tightening centered at the injured region and including all of the tensions involved in changing our movements to protect the injury.

    An injury to one side triggers one-sided tightening that commonly shows up as a side-tilt ("C-curve" scoliosis) and a rotation (postural twist) -- typically with one hip up and the same-side shoulder down and back. With the side tilt and twist, weight distribution goes off-center and the musculature must compensate (for balance -- the essential meaning of the term "compensations").


    In the trunk, the muscles above induce compression forces more into one S-I joint than the other. Below, the hip joint muscles contract differently, left-to-right, and in different ways on the two sides.  (In the healthy state, those muscles do not contract in a "unitary", all-or-nothing manner, but selectively, according to the position-in-movement of the legs. In the dysfunctional state, they stay contracted at all times in the pattern of injury-and-compensation, even in movement, and that contraction introduces drag, compression and strain into the situation.)

    And guess what that does to the sacrum.

    If you can't guess, I'll tell you: it maintains the twist -- rather forcefully and seemingly indefinitely.

    That twist may also come from a blow to the pelvis, as in a fall (bicycle, horse, cliff), an athletic injury, or a motor vehicle accident -- with the same ensuing muscular contraction patterns (Trauma Reflex).

    S-I joint strain, anyone?

    CLARIFYING COMMON DESCRIPTIVE LANGUAGE

    Now, I want to take a moment to address the term used to describe deviations of the sacrum from its healthy, centered equilibrium: "up-slip".

    There ain't no "slip" to the up-slip. The the S-I joints aren't slippery -- but their shape does allow for some movement, when walking. 


    When the sacrum gets twisted, it's moved into an unnatural position. It goes there because of forces sufficient to change its position, either suddenly (from a blow or from lifting something heavy in a twisted position), or over time (long-term, off-center postural changes).

    It doesn't “slip”; it is rather forcefully pulled, compressed and twisted. It is drawn and pushed, and "shifts” into an altered position in the midst of those tensional and compressional forces. It’s displaced -- partially dislocated. A one or two millimeter displacement is sufficient to produce major symptoms I have described: changes of movement and postural shape, mysterious muscular gripping far from the S-I joints, and radiating nerve pain through the pelvis and legs.  An "up-slip" feels like an "in-grip" at the waist or in the abdominal cavity -- just some perspective more true to people's experience of the condition than the word, "up-slip".

    OK. Now we have not only a compressed S-I joint (from above and below) but also a torqued/twisted sacrum felt as pain just below the waistline in back -- maybe on one side, maybe all the way across. Have you felt it, that way?

    So, what to do, now?

    ACTIONABLE UNDERSTANDING

    Well, for one thing, we see that ongoing forces are inducing S-I joint strain and that those forces are maintained by muscle/movement memory -- habituated reflexes maintained in, coming from and governed by the nervous system. "Habituated" means, "learned" or "acquired".

    We also see that the strain on ligaments is not the fault of the ligaments, but of the nervous system and muscular actions shifting the position of the bones that the ligaments connect to each other.

    That means that we can't correct the problem in any lasting way by addressing the ligaments (and to stretch or loosen the ligaments may reduce their strain, but it also may lead to hypermobile S-I joints without correcting sacral position).


    It also means that we can't massage away the problem (have you noticed?).  It means that we have to free the person from the grip of habituated reflexes and establish free, balanced, and well-coordinated movement.

    This is not as complicated as it may sound. It involves learning patterned movements more in keeping with healthy S-I joint function.

    Strain comes off the sacrum, S-I joints, and low back. Healthy, centered equilibrium-in-movement -- and physical comfort -- returns.

    Have I said it?

    But here's the question:  how??

    THE PANDICULAR RESPONSE -- THE "WHOLE-BODY YAWN"

    There exists a neuromuscular response, an action pattern, ideally suited for retraining postural reflexes and movement -- the pandicular response.

    Everyone has experienced the pandicular response. It’s the “morning yawn and stretch” – and not the athletic stretch, by the way.

    Pandiculation is what cats, dogs, and every animal with a backbone does, upon arising from rest. People call it, "stretching", but it isn't stretching; it's contracting and then slowly relaxing and shaking.

    Pandiculation sends a cascade of sensory signals to the brain sufficient to refresh the body-sense. Muscular control improves -- muscles come free from contraction and become supple, so you move more freely. It's not a mental process; it's refreshing.

    The most familiar form of the pandicular response is yawning -- but the pandicular response takes more forms than just familiar yawning.

    The pandicular response, applied methodically through specific, controlled movement patterns, changes the muscle/movement memory of S-I joint pain, so that muscles coordinate differently; bones migrate to a new position and a healthier movement pattern. The S-I joints are relieved and symptoms fade out.

    This new, clinical use of the pandicular response frees muscles affected by injury from tension and pain and unlocks the S-I situation so we can make changes. Unlocking the situation is "Unit 1" of the regimen for S-I joint pain.

    Lasting changes occur rather quickly (obvious after two practice sessions), rather than slowly or not at all, as in stretching. Changes accumulate with practice. Symptoms of S-I joint dysfunction fade out as the sacrum centers.

    For S-I joint pain, we use a variety of movements that addresses all of the muscles and movements involved in S-I joint syndrome.

    Those movements instill healthy patterns of movement that cause the bones of the pelvis to reposition into a new, healthier location; repositioning reduces strain on ligaments and allow the S-I joint surfaces and ligaments to heal.

    Because of tissue changes and inflammation, soft-tissue healing from S-I joint pain may take weeks, once the neuromuscular changes have been made. However, certain symptoms abate quickly -- some even in a single practice session. Aided and supported by somatic education exercises, improvements occur in an ongoing progression.

    Because the movement patterns involved are so unusual, they're easier to teach in step-by-step instructions and to learn by doing, as taught in the video tutorials featured in the regimen, than to describe in a word-description, here.

    See the link in the section, below, to send for the regimen containing links to the YouTube tutorials.

    THE REGIMEN | A RECIPE for RELIEF

    The regimen consists of a series of somatic education exercises done in a specific order. It's freely available. You can get started for free and most of the exercise tutorials are free.
    As in a cake recipe, no one ingredient constitutes the entire recipe, and there are steps of preparation; a somatic education exercise may be viewed as an ingredient and a regimen is a recipe. The "gentle back exercise" given first, in the regimen, is such an ingredient and a step of preparation and is not expected to relieve your symptoms by itself (although it works for simple back pain); it's necessary preparation that addresses an element of the pain pattern: back tension.


    TO GET THE REGIMEN

    To get the full regimen for self-relief (free), you may enter your email address to receive it, below.  

    A quick-response email message will come to your email address requesting permission to mail to you. Once you give permission, an email message will come to you, automatically, with the link to the regimen page

    You use links embedded in the regimen page either to display video tutorials or to get to the purchase page of the program that contains that exercise.

    Read the entire regimen through, once, without concern for remembering. Then, follow the video tutorials of the free exercises of Unit 1, to get started

    published with permission

    RESOURCE for RELIEF:
    Coaching by Lawrence Gold

    copyright 2014 Lawrence Gold
    This writing may be reproduced only in its entirety and with accurate attribution of its authorship.


    13 comments:

    Vera said...

    Ongoing sacrum and low back feels like spasms occur often. 4 weeks physical therapy no help. In 4th month of this. Ins. says no to mri. I have arthritis in L5. So tired of this pain. Cortisone injection, steroids, muscle relaxed and tramadol. Help!!!

    Sarah Jasson said...
    This comment has been removed by a blog administrator.
    Gloria said...

    I am having difficulty making progress in meditation because I cannot reach full muscle relaxation due to persistant tension in right thigh. I have scoliosis, right leg is shorter than left, left hip thrusts forward. Is there any reason that I should not try your method? I have worked with psoas muscle with no results. Thanks for your website.

    Anonymous said...

    Your article is a god send for me. Why? For the last 25 years I've suffered badly from an undiagnosed syndrome of pain but not one physical therapasit has understood. Exercise has always been the order of the day. All the stretching, massage, manipulation, exercise, steriod injections etc hasn't worked one other than put me back in bed for complete rest. I do have SI joint dysfunction bi laterally, a weak psoas, back pain, torso pain, neck pain and painful spasms of the quads amongst other mysterious body aches and pains. Your article explains to a T what I've lived with all those years. In additon, the Labrum in my hip had frayed extensively away from the bone and cartilage had gone. It all adds up. Thank you so very much for posting... like I said it's been a godsend for me.

    Anonymous said...

    I have a fused right SI joint from a MVA in 1999. My left SI, muscles and tendons have been very bothersome in the past 5 years. I have been telling my doctors for years that I feel twisted and after reading your article, now I know why! Because of that fusion I'm not sure if I can get any relief.

    EVogl said...

    Hello!
    Where can i enter my email to receive the regimen described?

    Lawrence Gold said...

    Scroll to the end.

    in your service,

    Lawrence Gold

    yourfriendJes said...

    Can the psoas affect urination

    Lawrence Gold said...

    The psoas would not affect urination. As this entry states, a twisted sacrum may affect urination.

    Anonymous said...

    I have a hypermobile sacrum- and it causes pelvic pain, especially bladder pain. I can't seem to get it to stabilize. I will try these exercises. What are your thoughts on prylotherapy?

    Lawrence Gold said...

    to "anonymous"

    Prolotherapy assumes that the problem is slack ligaments. The therapy is supposed to tighten them.

    The diagnosis of "hypermobility" misses the point. The jammed side is the problem, and that's a product of unbalanced and distorted weight-bearing stresses causing the sacrum to ride out of its centered and balanced position.

    Prolotherapy doesn't correct such imbalances.

    Anna said...

    Nice post...

    mumnmgr said...

    I've been doing your free exercises for right SI pain for 2 weeks and am about halfway through them. I have pain, but it's different than it was and I can't sleep on my sides comfortably. I take ballet 4 times a week, but it has stopped aggravating the pain since I've been doing your program. I know I needed to retrain the muscles on my right side around hips as they weren't firing correctly. I stopped doing one of the exercises (on belly, leg forward far to the side, lift head...) because it hurt on the right when I put my head back down. If I continue thru the free program, do you think the pain will go away? how to proceed? buy the full program and try it, or would you recommend a brief consultation. Thank you, I think this is the right answer for me.

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