The Sacroiliac Joints, or SI Joints for short, are the joints in your pelvis. These are unique joints that are different in structure and function than other joints of the spine. At Life Chiropractic in Grass Valley with almost everyone coming in with lower back pain I find some alteration in function of the SI Joints.
Yet, only a small fraction of the time do I have to directly adjust the SI Joints. When the SI joints lose normal function and alignment they cause an alteration in how you sit, how you walk, how you move. And, this over time can cause lumbar disc problems, lower back pain, and hip pain.
Let’s dive a little deeper into the Sacroiliac Joints:
How the Sacroiliac Joints Cause Low Back Pain
- The sacroiliac (SI) joints connect the sacrum (base of the spine) to the ilium (part of the pelvis).
- These joints are critical in transferring weight between the upper body and the legs.
- SI joint dysfunction occurs when there is too much or too little movement in these joints, leading to pain in the lower back, buttocks, or even legs123.
- Causes of SI joint pain include:
- SI joint pain can mimic other causes of low back pain, making diagnosis challenging23.
The Historical Denial of SI Joint Movement
- For much of the 20th century, medicine largely denied that the SI joints moved. The prevailing belief was that these joints were essentially immobile in adults, except possibly during pregnancy53.
- Early in the 1900s, SI joint dysfunction was a common diagnosis for low back pain. However, influential studies in the 1930s and 1940s shifted medical focus to herniated discs as the primary cause of back pain, minimizing the SI joint’s role53.
- This shift was reinforced by the belief that the SI joint’s strong ligaments and irregular surfaces prevented meaningful movement, leading many clinicians to dismiss SI joint dysfunction as a pain source53.
- Modern research has shown that the SI joints do move—albeit minimally—in young, healthy individuals, and this movement can decrease with age due to natural fusion of the joint surfaces65.
While the movement of these joints might be minimal, that doesn’t diminish the importance of movement of these joints. Any joint that has movement has it because that motion is essential for normal, healthy function. And, when you lose that movement it starts a cascade of reactions that result in pain and over time joint degeneration.
Why This Matters
- Under-recognition of SI joint dysfunction led to many cases of low back pain being misattributed to other causes, such as disc problems, for decades53.
- Today, it is estimated that 15–30% of chronic low back pain cases may originate from the SI joints, highlighting the importance of considering this diagnosis23.
Key Takeaway:
Although medicine long denied that the sacroiliac joints moved or could cause pain, it is now clear that even small movements or dysfunction in these joints can be a significant source of low back pain for many people16523.
How To Correct Sacroiliac Joint Problems:
I mentioned that while a loss of motion in the SI joints is a common source of lower back, pelvis, and hip pain; it is often not the cause of this condition.
Over my decades of chiropractic practice I’ve come to realize that the majority of the time the SI joints become restricted or misaligned they are not the cause of the problem and often do not need to be adjusted.
When I see someone with an imbalance in the lower back or pelvis I always assess the pelvis to see if the SI Joints are moving properly. When they are not moving or are misaligned my next step is to determine if the primary imbalance is in the SI Joints or is it coming from the lower lumbar spine.
If my analysis indicates the primary imbalance is in the low back at L4 or L5, or higher up at the junction of the mid and lower back; I will first adjust those areas. Then I will return to the pelvis to see if it is in balance and moving properly.
I’d estimate that 80-90% of the time I do not need to do anything with the SI joints. Addressing the imbalance in the lumbar spine almost always corrects the restriction in the SI joints. When it doesn’t then I will assess and adjust the Sacrum (tailbone) or the Sacroiliac Joints.
If there is a painful SI joint, that joint rarely if ever needs to be adjusted. It is irritated and inflamed because it has been working too hard because of imbalances elsewhere. It might take a few days to a week of improved motion for that inflammation to resolve.
The most common time I will adjust the SI joints are with a woman who has given birth and is experiencing low back pain. Pregnancy causes a relaxation of the ligaments that can result in a misalignment.
About Dr. Berkowitz
Dr. Bill Berkowitz is a dedicated chiropractor who brings reliability and depth to his practice at Life Chiropractic in western Nevada County. Focused on addressing chronic issues like low back pain, headaches, and anxiety, Dr. Berkowitz delivers patient-centered care rooted in proven methods without unnecessary extras.
Life Chiropractic, founded by Dr. Bill Berkowitz, offers reliable and results-driven chiropractic care for residents of western Nevada County. With a focus on foundational health solutions, the practice prioritizes quality and effectiveness to help clients achieve relief from chronic issues without unnecessary add-ons.
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