I’ve been thinking about the Sacroiliac (SI) joint recently. Actually I’ve been thinking about it for nigh on 8 years which is when I first managed to mangle my own. But this year I’ve had a serious relapse and have been suffering as a result.
But, it seems I’m not alone.
My own client list includes a few SI joint issues and looking over facebook it seems there are several of my connections also talking about similar.
It’s a common problem it seems.
It also seems that many physiotherapists are pretty useless when it comes to fixing it. Back when I originally injured mine I went to a physio for a few sessions, I soon stopped when i realised that i could (and did do) a better job on my own. My recent flare up was different and I received some great treatment from John Kelly of www.dublintherapy.com.
Go see John, he knows his stuff.
He also lifts weights. A lot. This means he’s going to be a better therapist than most because he trains and understands the mindset of a person who trains as well as the stresses we put our bodies through.
But back to the SI.
I’m going to offer a few opinions here. Bear in mind I’m no therapist, so what I say may not be right for you. I’m also going to leave out the sciency stuff because there’s a great post been written recently by Bret Contreras, and he’s much smarter than I am. You can read that here.
The SI is the point where the spine sits into the pelvis. I like to think of it as a lock and key type of structure. The Sacrum is a (for the sake of simplicity) triangular key that sits into a lock formed by the Ilium, or pelvis.
Another way to think of it is the Sacrum in the keystone holding up an archway.
You can see the similarities. The Sacrum corresponds to the Keystone (D), the ilium corresponds to the Voussoirs (B) , the Aboutments and footers can be the legs.
So that’s basically what it is. the problem arises when it is out of alignment. In the arch picture, if we were to damage the keystone the entire arch becomes unstable, this is fairly true of our own body. And like the arch pictured is self supporting, no cement is needed to hold it up, the SI joint has remarkably little holding it together. It’s mostly held in place by a network fascia crossing it like a basket weave. Kind of like a sling. And most of the time this is fine.
This is all well and good but it doesn’t take the pain away!
When the SI flares up, by god does it hurt.
When mine is giving my problems several things happen, many of which seem to be common amongst the people I talk to.
- The hip flexors tighten
- the erector spinea tighten
- the glutes go to sleep
These are all symptoms that Dr Janda collectively called Lower Crossed Syndrome. And until this is brought under control the SI keeps being pulled out of whack.
In essence when the Hip Flexors are tight they inhibit the Glutes. when the Spinal erectors are tight they inhibit the lower abs. This can pull the pelvis into an anterior tilt, or in other words, your arse sticks out.
How can we combat this?
As I said, I’m just a bloke who shouts at people and makes them lift heavy stuff and hit things. You really need to go see a therapist, but make sure it’s someone who actively trains.
But I digress.
Things we need to do:
- loosen out the tight areas
- retrain the “switched off” areas
This means mobility work, stretching, muscle activation drills and strength training.
the following are some choice drills:
- Kneeling hip flexor stretch
- kneeling adductor stretch
- kneeling quad stretch
- Down dog
- tripod down dog (or as I call it “Dog taking a piss”)
- Gymnastic bridge drills
- Pigeon Pose
- supine glute stretch
- Up Dog & Cobra poses
- Bird Dog / Superman
- Side lying clams
- bridge drills
- Fire hydrants
- Scorpions both supine and prone (also mobility)
- Pilates side kick drills (also muscle activation)
- Cossack stretch
- Dragon lunge
- Cat & Camel
- Wrestler & Gymnastic bridge drills
- Glute bridge
- Romanian deadlifts
- Farmers Walks
- Reverse Crunch
- hanging knee/leg raise
- Lunge variations, but be careful as single leg work puts extra stress on the SI joint.
Basically we need to stretch the tight areas, then activate the “sleepy” areas. If it is a case that the tight muscles are inhibiting the others. Then by stretching a tight muscle we can temporarily inhibit it and allow it’s opposite number to come back online.
If we then go through a strength session for the recently activated muscles, specifically the low abs and the glutes, this can further inhibit the problem muscles.
Until recently I always recommended stretching the glutes, but I’m currently rethinking this, at least in terms of priority.
You see the glutes are often asleep or at least inhibited by their opposite number, the hip flexors including the rectus femoris (part of the quadriceps). Perhaps stretching the glutes as much as I was actually allowed the hip flexor to tighten it’s grip and actually pull the SI back out of line?
I’d also finish every workout with a good stretch focusing on the low back, hip flexors and inner thigh. For this I like variations on Yoga’s sun salutation. There are many variants but try to find one with the Warrior poses, these are great for SI issues.
But I’ll reiterate, this is my opinion only……
A quick edit:Fellow fitness pro Laura Winstin-Seitz just dropped me the following message on Facebook:
“ What a great topic to discuss. So many of my clients as well as colleagues deal with SI joint pain.
I’m in full agreement with the mobility progression. Another great stretch for that is to stand with your legs just outside of the hops and toe in. It opens up the entire lower back area allowing for the SI joint to gently drop back into place.
Thank you for sharing! “
The position she is describing is very similar to the classic Wing Chun stance, the one used in the Sil Lim Tao form. By toeing in, softening the knees, allowing the tailbone to sink and standing relaxed
for time (the form can take 20 minutes with no movement from the waist down) it can releive a lot of pressure from the hip area and bring relief to the SI.But there you have it, a Goosey Guide to relieving your SI pain.
If you liked this post and found it informative then you’d be blown away by a few of the additions made by a few friends, including two top physio’s on the topic on my facebook page. Join the discussion HERE
All the best