In investigating the conditions that can beset the sacro-iliac (henceforth, S-I) joints, I have arrived at a number of findings that make sense of the condition and point precisely to what we can do to relieve S-I joint pain.
We will consider both one-sided and bi-lateral S-I joint pain.
SYMPTOMS OF S-I JOINT PAIN SYNDROME
- pain across the low back (both sides)
- pain just below the waistline (one side)
- pain deep in buttock(s)
- deep pelvic/abdominal pain (ache, “lightning”-like pain), sometimes with nausea
- numbness in front or side of thigh
- sciatica (if accompanied by other symptoms)
- groin pain
- testicular pain or burning bladder sensation
THE BASIC UNDERSTANDING
In brief, S-I joint pain arises from excessive muscular compression (tension) and twisting forces on the S-I joints originating both from below (legs) and from above (longitudinal muscles of the trunk) during walking. Those compression and twisting forces converge at the S-I joints, drawing the pelvic bones into a distorted arrangement that places strain on SI ligaments, causes pain, and triggers reflexive muscular contractions throughout the trunk and legs that themselves cause pain. This complex array of symptoms, we may call, S-I Joint Syndrome.
The S-I ligaments are not the cause, but the victim of those forces.
To relieve S-I joint pain, we
1) Return the resting tension levels of the involved muscles, which are habituated into a contracted, shortened state, back to complete rest/relaxation and complete resting length,
2) Cultivate/restore healthy, free, balanced patterns of movement and rest in those muscles
I will discuss how I do that, later.
Bi-lateral S-I joint pain simpler than one-sided SI joint pain. Bilateral S-I joint pain involves the compression and twisting forces named above (but not yet described). One-sided S-I joint pain combines compression and twisting forces with asymmetrical muscular pulls (pelvic rotation with elevation with one hip), caused by Trauma Reflex.
Everyone has experienced Trauma Reflex. Caused by pain, it’s a protective withdrawal response of the painful part away from the direction or cause of pain. Its other name is “cringing”.
(the cringing response triggered by injury) is almost always asymmetrical because any given injury generally occurs to one side.
Trauma Reflex is not a momentary muscular action like the stretch (myotatic) reflex, but one that lasts at least as long as the pain of injury persists — and commonly much longer — up to decades. When it lasts for decades, it’s that the injury has left such an impression on the brain that it displaces the healthy, familiar body image so that it’s as if the injury is always “happening right now” — along with the reflexive pulling away (muscular tightening).
Asymmetrical muscle pulls (and asymmmetrical posture) place more stress on one S-I joint than the other.
Though one might be tempted to regard S-I joint pain as a ligamentous problem, it is not; it is a neuromuscular problem that produces ligamentous strain as a by-product. I am emphatic about this point and will explain, shortly.
THE STRUCTURE, FUNCTION, AND LOCATION OF THE S-I JOINTS
The sacrum is the meeting point of tensional and compressional forces meeting from above and below, as noted earlier. The sacro-iliac (or ilio-sacral) joints are the less mobile of the joints involving the sacrum (meeting of sacrum and ilia or “wings” of the pelvis); the other joint is the lumbo-sacral junction (meeting of sacrum and lowest lumbar vertebra, “L5”).
In the healthy state, most of the sacral movement occurs at L5/S1; some movement occurs at the S-I joints. Said another way, because it is more tightly bound to the ilia than to L5, the sacrum is functionally “more part of the pelvis than it is part of the spinal column”.
See how the muscles above the S-I Joints can compress them.
In the unhealthy state, the sacrum becomes (functionally) “somewhat more part of the spinal column and somewhat less part of the pelvis” and compression and twisting forces at the S-I joints strain the ligamentous connection.
Compression forces at L5/S1 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 run the span between the legs and the pelvis — the psoas muscles, the hamstrings, hip joint flexors, buttocks, and femorii rectus (you like the Latin?) — and combine with the movements of walking and the weight-forces of sitting to affect the S-I joints.
It is here that we 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; what is needed are functional terms — terms that describe sensations and movement: somatic responses. The cringe response (Trauma Reflex) is an example of a somatic response.
In the remainder of this piece, I will use both anatomical and somatic perspectives — anatomical terms so you can visually imagine what I am describing and somatic descriptions so you can imagine in yourself what that might feel like (assuming you have developed enough proprioceptive awareness 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 sense of urgency. You know — ordinary urgency, the feeling of pressure and the drive to haste (as the ads say, “Hurry!”)
Urgency is made of two emotions or drives — the drive to do something and fear.
Those two emotional states trigger two opposing neuromuscular reflexes of stress — Landau Reaction and Startle Reflex. I’ll describe them briefly.
In brief, Landau Reaction
is an emotional, neuromuscular behavior of coming to a heightened state of alertness, of readiness for action, of hurry or of enthusiasm, and/or of driving yourself to do something you don’t want to do; it tightens the paraspinal muscles, posterior shoulder muscles, buttocks, hamstrings, and calves in readiness for mobilization into action (movement). It takes those loosey-goosey vertebrae and wields them into a more rigid functional unit capable of supporting weight — the “spine”.
Startle Reflex is an emotional, neuromuscular behavior of shrinking away from experience, of making oneself small and immobile, and of curling into oneself — in anxiety or fear.
When we become habitually triggered into Landau Reaction, as most of us are in this society, our back muscles tighten. Their pull compresses the lumbosacral junction (L5/S1) and stiffens us, there. Our sacrum becomes (functionally) somewhat more bound to the spinal column because it is being pulled into the lumbar spine. It’s jammed. That describes things from above.
Now to describe things from below.
When the hamstrings tighten in Landau Reaction, they pull the legs back (into extension). Any movements of the legs forward, as in walking, then require additional muscular force from the hip joint flexors, psoas and femoris rectus muscles. Habituated Landau Reaction thus leads (by compensation) to tight hip joint flexors. This pattern of co-contraction makes the legs functionally “more part of the pelvis” — binds and jams the legs into the pelvis, making them less independently free to move. The legs feel heavy and walking slows, dragging the ilia along with them in opposite, twisting directions.
The hamstrings are reflexively connected with the low back muscles. When they tighten, the low back muscles tighten.
When we tighten in Startle Reflex, the reflexive movement is into collapse and curling up. People rarely curl up completely, but the musculature tightens in that pattern and posture changes accordingly into a partial crouch.
That crouch pattern involves the abdominal muscles and the hip joint flexors, including the psoas muscles. The movement is into retraction (pulling in) of the legs in preparation for collapse and curling up. The hamstrings and hip joint flexors actually tighten in readiness to pull the legs in and collapse and curl up.
Now, how does that 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 legs are jammed into the pelvis, this way, each step of walking forces the ilia (location of the hip joint/acetabulum) to move with the legs somewhat more than in the healthy state. (In the healthy state, the ilia move in a complex, round motion with each step, but rather less than when the leg-pelvis muscles are tight — and within the tolerance of the S-I joints.)
Now, what happens to the ligaments of the S-I joints with this kind of excessive motion? They get strained.
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 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??
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 lesser trochanters of the legs, through the abdominal cavity, to the spinal column as high as the tendons (crura) of the diaphragm). When they’re tight, they “seal the deal” — jamming both what’s below and what’s above into the sacrum.
So, with each step of walking, the S-I joints take the brunt of movement.
That’s sufficient to account for bi-lateral S-I joint pain.
But wait! There’s more!
ONE-SIDED S-I JOINT PAIN
Back to Trauma Reflex.
It’s true that injuries usually occur to one side, isn’t it?
What happens with any injury, as we’ve noted, is Trauma Reflex — 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 asymmetrical 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 asymmetrically, 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 unhealthy state, they stay contracted at all times in the asymmetrical pattern of injury-and-compensation, even in movement, and introduce 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 induces a twist — and rather forcefully and for a long time.
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 sacrum doesn’t exist in an empty space like a laboratory skeleton and just kind of “slip” up — and the S-I joint isn’t slippery. The sacrum exists in a tensional/compressional equilibrium, and rather securely so, the meeting place of forces that change moment to moment and that affect its position. It doesn’t “slip”; it is rather forcefully pulled, compressed and twisted — and for a long time – it is drawn and “floats” into an altered position over time, in the midst of those tensional and compressional forces. It’s partially dislocated. Just some perspective.
OK. Now we have not only a compressed S-I joint (from above and below) but also a torqued/twisted sacrum felt as pain below the waistline — maybe more on one side, maybe all the way across. Can you feel it?
What do we do, now?
Well, for one thing, we see that ongoing forces are inducing S-I joint strain and that those forces are coming from habituated neuromuscular reflexes — meaning coming from and governed by the nervous system.
We also see that the strain on ligaments is not the fault of the ligaments, but of the nervous system.
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 de-stabilizes the joints they hold secure). 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 Landau Reaction, Startle Reflex, and Trauma Reflex and establish free, balanced, and well-coordinated movement that gives back to the sacrum, S-I joints, and lumbo-sacral junction (L5/S1) their healthy, centered, free movement at balance.
Have I said it?
But here’s the question: how??
I thought you’d wonder.
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. Applied methodically to contraction patterns via controlled and regulated movement patterns, the pandicular response frees a person from involuntary muscular tensions, such as those that cause S-I joint pain.
The pandicular response works more in the spirit of a yawn than in the spirit of stretching. Like the Trauma Reflex, everyone has experienced the pandicular response. It’s the “morning stretch” – not the athletic stretch, by the way – but the sensuous strong contraction of muscles followed by an easy release. This action sends a cascade of sensory-nerves signals to the cerebral cortex of the brain (sensory and sensory-association areas) sufficient to forge or reforge the link of the sensory and motor areas of the brain – to awaken or improve voluntary control of muscles and movement – to shift control of muscles and movement from involuntary, habit-driven levels of the brain to the voluntary level. Muscles come free of contraction and so relax and lengthen.
The pandicular response is the action of awakening and refreshment of movement the way the Trauma Reflex is the action of withdrawing and protecting from pain or injury. It’s an action found among all creatures with a spinal column, including birds, horses, dogs and cats. It’s genetically inherent.
Everyone has experienced the pandicular response. What’s needed is to do it in movement patterns that involve the muscles of the trunk and legs that cause S-I joint syndrome.
For example, the action of the back muscles is to induce lumbar curve. To engage the pandicular response with these muscles, one may lie prone (belly down) and lift one leg (straight knee), then slowly lower it. The action engages the spinal extensors, gluteus maximus and hamstrings. Gravity creates the feeling of weight that causes a cascade of sensory-nerve impulses to the sensory neural network of the brain and allows us to feel the movement of lifting more vividly. The slow lowering takes allows more time, and therefore, more learning of the action of relaxation and lengthening of those muscles. Lasting changes occur rather quickly, rather than slowly.
In practice, we use a more fully elaborated movement pattern that engages more of the movement system at a higher level of integration (for faster, more complete changes). For S-I joint pain, we use an array 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 float into a new, healthier position and that allow the S-I joints to heal.
Because of tissue changes and inflammation, healing from S-I joint pain, once the neuromuscular changes have been made, may take weeks. Aided and supported by somatic exercises, they do occur.
Because the movement patterns involved are complex, they don’t especially lend themselves to word-descriptions; it’s easier to show them than to describe them. I have posted examples of such movements on YouTube for public use.
To get the full regimen for self-relief, please click here and send the resulting email message (blank). (“Regimen” means “list of recommended actions” — not “body of instruction”.) Email with the regimen will return to your email address, automatically.
Ending Chronic Back Pain
SOMATIC EXERCISE PRE-RECORDED PROGRAMS
Consult with Lawrence Gold for an exact program to relieve S-I ioint pain.