Common Training Issues: SI Joint Pain
Ever done a set of heavy squats or deadlifts only to have your SI joint flare up? Do you find yourself rolling your legs side to side trying to alleviate the pain? How about waking up after a terrible night’s sleep due to an on-going irritation in your lower back? Don’t worry, you’re not alone.
SI joint dysfunction is a very common injury. I suffered from it for years and encounter many clients who have the same issue. This article will shine some light on what is going on and how you can manage the symptoms.
First let’s do the disclaimer bit. This article isn’t intended to fix your SI joint pain. It’s only words, it can’t do that. Every individual is different and it’s naive to think there’s a one size fits all approach. What this article can do is provide a little bit of education in to areas you may not have looked before and teach you ways you could rectify any weaknesses. I’ll be covering 5 places to check in order to manage SI joint pain.
Disclaimer part 2. Prehab is important; so is training smart and not ego lifting. However, if you want to get good at anything, you MUST work hard as well. The fact of the matter is, no amount of prehab in the world can completely injury proof yourself. You can only reduce the likelihood of injury, you cannot eliminate it. The risk of injury is proportional to how hard you train. When pushing your body to the max, there is always the risk that something could get injured regardless of how balanced your body or how good your form. This isn’t me being pessimistic, far from it. I just think it’s an important home truth for you to know. I want to make sure you can do everything in your power to reduce lower back pain symptoms and enjoy your training.
What it the Sacroiliac joint?
Your Sacroiliac joint does exactly what it says on the tin. It’s where your Sacrum meets the Iliac Crest. If you’re not too familiar with anatomy, the Sacrum is a big weird shaped bone at the bottom of the lumbar spine and the Iliac Crest is the kind of Elephant ears looking part of the pelvis. The Iliac Crest must be able to glide nicely forwards and backwards next to the Sacrum for simple movements such as walking and running.
When there is a weakness, tightness, instability or injury in the body, muscle can pull these bones out of alignment. The Iliac Crest can become rotated, causing it to grind against the Sacrum. What’s unfortunate is that this same area is very dense in nerve fibres called the Sacral Plexus. Nerves can become impinged and trapped leading to the sensation of pain. A simple, yet logical solution to alleviating the pain would be to stretch and strengthen all the muscles around the area that have become weak and tight.
Where to look
Check the feet
If you use something a lot, it’s in your best of interests that it works right. This couldn’t be truer than for the feet. If we have an issue with foot position, it can creep up on us eventually in the form of knee and lower back pain. When you add weight lifting to the equation, you accelerate any potential injury development due to the load being put on the body.
With SI joint dysfunction, you have a clear asymmetry with the body. One side must be aligned different to the other, hence why the irritation is occurring. Imagine that you’re in a jungle with ginormous trees around you. There are two identically sized trees in front of you with a bridge connecting one to the other at the top. The tone of the bridge is maintained by the trees being an equal distance apart.
Now imagine what would happen if the base of one tree started to collapse in. Even a small 5-10° inwards rotation would impact the rigidity of the bridge at the top. The bridge would become slack and less stable.
This is the exact same principle as when you have one foot flatter than the other. The Pelvis (bridge) loses stability and has to tighten other muscles around it to rebalance the structure. This usually comes in the form of the lower back. When muscles that shouldn’t technically be tight change characteristics, this is when dysfunction occurs.
Take home point: If you have SI Joint pain, check that one foot isn’t flatter than the other.
Check the Anterior Hip
Remember Einstein’s theory of relativity? Neither do I but as you can probably imagine it’s pretty smart. Off the top of my head I remember him saying something like “For every action, there is an equal and opposite reaction”. This is very much true for the hips. Think of it like this, if there’s tightness in one area, there’s an equal amount of tightness in the opposite area. The symptoms of SI joint pain occur in the back of the body, but I don’t see many people looking at the front of the body.
As I explained earlier SI joint irritation is predominantly caused by grinding of the Iliac and Sacrum bones. The Iliac (Elephant ear bone) has a muscle called the TFL that attaches to it at the front on the ASIS (anterior superior iliac crest). This is the sticky out boney part of your hip. If this muscle is tight and weak it pulls the front of the hip down. If the front goes down, the back goes up (Einstein’s Law). This change in position at the back of the pelvis is what can cause the grinding and pain.
Take home point: Train and stretch your anterior hip muscles as well as your glutes. These are very important for balancing out hip musculature. Banded marches and isometric dead bugs with a foam roller are excellent places to start.
Check the Rhomboids
Rhomboids? Aren’t they in your shoulders? If this was your first reaction then I’m impressed with your anatomy knowledge. The Rhomboids are indeed in the shoulders and located at the top of the thoracic spine and shoulder blades. They can’t act on the hips in any way but they can impact positioning when doing something like a deadlift.
Movement is ridiculously complex. That’s what I actually like about it. Someone could have zero pain when squatting but get a lot of discomfort when deadlifting. It’s problem solving at its finest. You have to not only look at where their restrictions are, but what movement they’re doing, in what conditions, with what load.
If Deadlifting aggravates your SI joint then it’s 100% in your best interest to address the area. However, the Rhomboids being tight, or more specifically, one being tighter than the other can trigger the issues again. Let me explain.
To keep an upright torso and take load away from the lower back whilst deadlifting, you need to be able to protract and depress your shoulders (push them down and forward). To do this, the Rhomboids need to be able to lengthen. If one is tighter than the other, this throws off balance in bilateral scapula positioning. In English, this makes one arm “technically” longer than the other. When this happens, the bar may leave the floor unevenly, causing the hips to rotate and twist, therefore irritating the SI joint.
Take home point: Always assess globally. The shoulders can play a role in hip positioning depending on what you’re doing.
Check the core
I used to think that compound movements were all that you needed to train the core. I was wrong. If the only core training stimulus you get comes from squats and deadlifts, you’re majorly missing a trick to managing your SI joint pain. To explain this one, I’m going to have to revert back to a text book.
When treating dysfunction, a lot of people focus on the site of pain, i.e. this area hurts, I shall foam roll, stretch or massage this area. This isn’t technically wrong but it’s overlooking other key factors. The core is a very broad term. It’s much more than just your abs and plays a ginormous role in spinal stabilisation. Muscles like the traverse abdominals and inter/external obliques wrap around the midsection in various different directions. They attach to an area called the Thoracolumbar fascia (TLF), the Christmas tree part of your lower back. Being able to stabilise this area of the body is extremely important for managing SI joint pain. Why? Because the TLF covers the region where the Sacrum and Iliac Crest meet.
If the core is weak then you will promote “laxity” in the SI joint when under load. The glutes and deep hip stabilisers can get lazy, leading to compensations in the lumbar spine musculature. If you don’t perform simple anti flexion/extension movements (such as plank variations) and you have recurring lower back irritations, this would be an ideal place to start. But wait.
More is not more. Aiming to do sets of 1-2 minutes in a plank position would not be advisable. I would actually look to start at a very low intensity and build up your tolerance. If you pick the wrong starting point, there’s a chance that core work could actually exacerbate symptoms, not improve them. Start with kneeling planks where you can control your breathing and work your way up until you are able to do more advance movements with full control.
Take home point: You need to strengthen all the muscles that attach in around the hip. The core muscles will help hold the Iliac Crest (Elephant Ears) in place which may help reduce them grinding against nerves and causing pain.
Check your mindset
“I think, therefore I am” – Some really insightful guy.
Pain mechanics are cool. Without going too balls deep in to science, pain is actually felt in the brain and not necessarily the body. Now if you were to stub your toe pretty hard, I’m sure you’d say “I definitely felt that in my little toe and not my head Chris”. However, although the pain is local to the site of impact, it’s only painful because your brain is alerting you that there’s harm or danger to a certain part of your body. Pain is a warning signal.
These signals can be amplified based on stress levels, anxiety or beliefs. If you believe something is going to hurt, it will. The way the brain can control pain feedback is incredible. A good example is Buddhist monks. Those guys are absolutely nails because they’ve gained the ability to control their mind and not react to pain. In one instance, a Buddhist monk in the 1960’s was set alight with gasoline but did not move a single muscle and maintained his meditative position. Despite burning to death, he was able to control his brain so that the sensory input of unfathomable pain +was not registered. Anyway, back to the SI joint.
If you think you have a bad back, you have a bad back. In reality you have a few tight muscles, a few weak areas, some inflammation and at worse a tiny bit of joint degeneration which may need time to heal. I know that sounds very black and white but it is true. I used to psyche myself out when deadlifting, I was so worried about injuring myself again when lifting I sometimes wouldn’t even attempt to pull the bar. This was a belief system impacting strength, not the muscles themselves. The first thing you need to do when approaching back pain, or any pain for that matter is believe that you can improve it. Through the right training, nutrition and supplement interventions you can 100% manage and reduce pain so that training becomes enjoyable again.
Take home point: Your thoughts become things, don’t let your mindset prevent you from lifting heavy weights again and achieving your dream physique.
Chris Knott works as a strength and body composition coach in Manchester, UK. He specialises in maximising pain free movement to develop strength and muscle. Interested in working with Chris, he offers online training and nutrition packages in the form of his holistic wellness company Reborn To Transform.