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

Sacro-iliac joint syndrome includes many symptoms, some of them unexpected and seemingly unrelated. This entry describes them and explains their cause.

Sacro-iliac joint dysfunction 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 S-I Joint Dysfunction and at the end, offers access to a self-relief regimen (program) that will extinguish the symptoms and get you feeling good, again.


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.

Click on image above to see entire comment.

 

What it Takes to Correct S-I Joint Pain

Two approaches to stop S-I joint pain are radio frequency nerve ablation (burning the nerve) and S-I Joint Fusion. Nerve ablation costs about $2,100 and lasts 9-12 months before the nerve regenerates -- making repetition necessary. Surgery costs about $22,000 and has the side effects detailed in the article at the end of this section. Neither corrects the problem, but only minimizes symptoms.

Structural manipulation is another approach. However, because of the muscular tensions triggered by a twisted sacrum, tensions that become habituated ("quasi-permanent"), adjustments to the sacrum don't "take". Distorted muscular pulls distort the forces going through the pelvis, distort the pelvis, and problems return or never go away.

Another approach is available, one that costs far less, has no negative side effects, and restores comfort and full function. I explain it in this article.

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".

 

Click for this article by Dr. Centeno.

 Click the image for this article by Dr. Centeno.

 

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.


Click on image above to see entire comment.

 

SYMPTOMS OF S-I JOINT PAIN SYNDROME

  • a tired feeling across the low back, both sides
  • pain at the waist, in back, on one side (opposite side S-I joint jammed)
  • 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 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 and may see dimples. Where the dimples meets the ridges, there you find the S-I joints.

    The sacrum is the meeting point of weight-bearing forces converging from above and below, as noted earlier. The shape of the sacrum's 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).

    Other forces at the S-I joints come from muscles of the trunk in contraction, primarily the spinal and psoas muscles, and the quadratus lumborum ("QL"). Additional forces from the trunk come from the abdominal muscles (obliques, rectus abdominus).

    Pulling forces at the S-I joints, themselves, come from muscles 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 cause movement; in the unhealthy, jammed condition, they cause strain and pain.


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

    To this point, I have described the situation in terms of muscles and bones -- but it's easier to understand what is going on with S-I joints if we think in terms of sensations and movement.


    For the remainder of this piece, I will use both anatomical and movement terms -- anatomical terms so you can visually imagine what I am describing (if you know anatomy) and movement terms so you can get a better feel for what I am describing.


    THE LIVING EXPERIENCE OF S-I JOINT PAIN

    A number of life-conditions set the stage for S-I joint pain -- the most 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 -- and not always on the side you might expect.

    Another cause of S-I joint discomfort is sitting too long in a condition of high tension and stress, as at a desk doing work by phone or on a computer. 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 two-sided 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 causes strain in the ligaments of the too-mobile joint. The strain and pain appear at the side opposite of the jammed S-I side; the jammed side may not hurt.

    And what happens to ligamants that are chronically under strain? They get inflamed. Inflammation is nature's way of forcing fluids and nutrients into tissue that is strained (or injured) so it can heal. But under this kind of strain, no healing is possible -- basically because it is not a damage situation, but an ongoing strain situation.

     

    THE VIEW FROM ABOVE

    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 place where sacrum and spine meet is "stiffer"; the round, "figure 8" pelvic movements of walking must be re-distributed: less at the spine (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.

     

    Tight Psoas Muscles: An Effect, Not the Cause

    Now, the psoas muscles have a special part to play, here. They join what's "below" with what's "above", connecting the inner groin, through the abdominal cavity, to the spine as high as the top of the diaphragm, behind the stomach. When psoas muscles are 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 worse than a moment ago; when the sacrum straightens, as in the regimen given, below, psoas pain fades out.

     

    ONE-SIDED S-I JOINT PAIN

    Isn't it true that injuries usually occur at one side, rather than exactly centered at the back or front?

    What happens with any injury is that Trauma Reflex (cringe response) gets triggered -- a tightening centered at the injured region and radiating outward to involve all of the tensions involved in cringing.

    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 muscles must compensate for the imbalance to maintain balance in movement.


    In the trunk, the muscles above induce compression forces more into one S-I joint than into 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; 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 (skateboard, roller skates, bicycle, horse, cliff, ladder), an athletic injury, or a motor vehicle accident -- with the same 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".

    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's not so much a "slip” as a hard, even grinding shift with a pop or clunk; it is rather forcefully pulled, compressed and twisted. It shifts into an altered position. 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 as far as the neck or jaws 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.

    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", persistent and resistant.

    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 sa
    cral 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 cringe response and develop balanced,  well-coordinated movement that supports the sacrum properly.


    THE 3 BIGGEST MISTAKES PEOPLE MAKE
    WHEN TRYING TO GET OUT OF PAIN

    This is not as complicated as words make it sound. It involves changing muscular conditioning by patterned movements consistent 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 an action pattern related to yawning that is ideally suited for retraining muscle/movement memory: it's called, the pandicular response.

     ON 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 moving or even shaking (you've seen a dog do this movement).

    Pandiculation sends a cascade of sensation to the brain sufficient to refresh the body-sense and refresh muscular control. Muscles relax and become supple, so you move easily and comfortably. It's refreshing.

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

    We can activate the pandicular response in many movement patterns, so that muscles coordinate differently. Bones go where muscles pull them, so exercises that use the pandicular response can cause the sacrum to migrate to a new healthier position and movement pattern. The S-I joints are relieved and you get relief. Imagine imagining that.

    This new use of the pandicular response can be made to unlock the S-I situation so we can make changes. Unlocking the situation is "Unit 1" of the regimen for S-I joint pain.



    For S-I joint pain, we use a variety of movement patterns that addresses all of the muscles and movements involved in S-I joint syndrome.
     
    If you're used to exercises or therapies that produce such small changes that you can hardly tell if anything is different, this is different. With somatic education exercises, l
    asting changes occur rather quickly (obvious after two practice sessions) and accumulate with practice. First, your movement and posture change, and then the symptoms of S-I joint dysfunction fade out.

    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 fade  quickly -- some even in a single practice session. With somatic education exercises, improvements occur in an ongoing, cumulative progression.

    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.




     HOW WELL PEOPLE DID WITH THE REGIMEN
    (OLDER VERSION OF COMFORTING YOUR S-I JOINTS PROGRAM)


    TO GET THE REGIMEN

    To get the full regimen to renovate yourself out of pain, 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.

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

    published with permission

    also available

    copyright 2014-2017 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!!!

    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.

    Lawrence Gold said...

    to mumnmgr

    When an exercise makes you cringe from pain, skip it and move on; you'll come back to it, later, when you're more fit for it.

    This question is answered in the introductory track of the program, Comforting Your S-I Joints | http://somatics.com/page7-S-I_program.htm.

    Buy the full program; it's guaranteed (no time limit).

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