It is common to feel pain in the lowest part of the back with an irritable SIJ. In addition, the SIJ can refer to the buttocks, front of hip and groin, outer thigh and sometimes to the outside calf area. Problems in this area come from long-term poor postural habits, trauma due to falls, multiple births, autoimmune conditions, to name a few. Except for cases of severe hypermobility, the SIJ moves no more than a few degrees.
With an acute injury it can often be easy and quick to fix but how many people have had manual manipulations over and over again but continue to have the same pain? Are we “moving” the SIJ with manual therapy/manipulations? A study that looked at movement of the SIJ before and after manipulation used a system called Roentgen Stereo Photogrammetric Analysis (Tullberg, 1998) to measure miniscule changes in the joint. Though the position of the SIJ felt symmetrical to touch, there was no real change between the two bones. Subsequent studies have stated similar outcomes of insignificant joint changes. Numerous studies effectively confirm that the SIJ can be the primary source of pain as confirmed by a pain-relieving injection into the joint. Clinically, patients often report temporary relief of pain with SIJ manipulation and this can be a great tool. However, the soft tissue system cannot be ignored if long term improvements are expected. Weakness, pain and swelling cause compensatory movements and thus the muscles, tendons, ligaments, nerves, the joint capsule, and/or fascia must be addressed.
What to do for a painful SIJ? As everyone is unique, a thorough head-to-toe evaluation of movements and posture is critical. Treatments include any and all of the following: hands-on manipulation of joints, myofascial release, exercises, education on proper everyday movements including squatting, sitting and standing, modifying shoe wear, modalities such as Class IV Laser and Trigger Point Dry Needling.