Back To Basics.
The sacro-iliac joint, or Si joint for short, can be an area of discomfort for lots of people. If this area of the pelvis isn’t functioning properly, it can lead to an array of issues often felt in the lower back, the hips, the legs, and the gluteal regions of the body1,3.
It would be nearly impossible to discuss all of the potential issues that could arise from a dysfunctional Si joint in a single blog post. For the sake of simplicity, I’m going to illustrate three basic examples where the Si joint could be implicated, and how massage therapy may be able to help.
1. Climbing the stairs
Climbing a staircase will activate a variety of muscles and stabilizers on the weight baring leg. We can refer to this as loading because in this instance, the hip is loaded with the weight of the body.
If the muscles in the back, the core, or the opposite side hip do not activate sufficiently when transitioning to the next step, over time the Si joint may adapt, and a movement behavior (or pattern) may begin to emerge. This potentializes a scenario where the Si joint can be subjected to a considerable amount of load on a regular basis.
Image by katemangostar on Freepik
The movement behavior, that is the pattern or sequence of muscles that get activated in this way, insufficiently supports the Si joint in the process of lifting the leg. The muscles may become hypertonic, essentially too tight, and restrict how the Si joint ought to move, potentially leaving the opposite side feeling like it’s doing all, or most of the work in order to compensate. Symptoms including pain, could be variable or maybe absent altogether, but the deficit in the quality of movement should be evident6.
In this case, massage therapy can be an effective tool at addressing the structural problem of the hypertonic muscles. The side that’s restricted can be worked on to improve the range, and the motion of how the hip and Si joint interact with one another.
Massage therapy can also help teach oneself to become better aware of certain movement behaviors, and how to adopt better muscle mechanics, and to use the stair climbing muscles more effectively.
2. Driving a vehicle
Driving a vehicle can have a number of implications to the Si joint. Again, for simplicity, let’s assume an Si joint dysfunction is already present and creates a restricted state on the left side of the body. As the driver exits the vehicle and places their left leg on the ground, the weight of the body will begin to shift from the car seat and transfer to the leg.
Shutterstock | Stock image ID: 1890730546
If the Si joint on the right side of the body is relatively mobile compared to its restricted counterpart, and it does not have the supporting musculature in place to maintain a stable transition of load, the glute muscles on the right side may overcompensate by pulling too much on a specific area in the lower back, possibly creating a pinching sensation throughout the movement.
An argument could also be made for low riding vehicles, such as sports cars that are lower to the ground, thereby the car seat also being lower to the ground. They may increase the likeliness for these movement behaviors to occur. One reason being the amount of hip flexion a person needs to overcome, to go from seated to standing would be greater.
3. Bending and reaching over
Think about the position one takes when bending over to load or empty a dishwasher, or even picking up a moderately heavy object, like a grocery bag from off the floor.
This scenario differs from the other two examples because here, there’s demand placed on the Si joint’s rotational capabilities, which is further influenced by the arm reaching forward while in a bent over position.
(Technically speaking the Si joint doesn’t rotate, the entire pelvis and hips move in several different ways, but we’ll keep to the term rotation to keep things simple.)
Image by Freepik
Generally speaking, if the arm on the right side is reaching while stooped over, the left pelvic and hip area will rotate backward ever so slightly. This movement should enable the right pelvic and hip area to rotate forward, just a little bit, contributing to the degree of reach a person can have.
If a dysfunction in either of the Si joints is present, the forward or backward movements that occur when a person reaches in this way could be functionally implicated.
If we extrapolate these movement behaviors over time and include other factors in the mix; like the amount of bending the person is doing, the weight of the objects being lifted up, the degree of twisting involved when stooped over, and any pre-existing conditions the person may have, to name a few, they can have undesirable consequences which may significantly impact a person’s state of physical health3.
Massage therapists are trained to use their body, and develop proper body mechanics early on in their education. That knowledge can be used to identify these sorts of movement behaviors, and can be passed on
What is it and how do I get it?
Image by Freepik
Pain that is linked to the nerves themselves is referred to as a neuralgia. An example of this would be shingles, where symptoms result from a complex process involving a viral infection and is systemic in origin. Complications with your kidneys is another form of a systemic nerve pain, where the area of perceived pain can be felt not necessarily in the kidneys, but in the lower back regions of the body.
Another type of nerve problem that can also be linked with nerve pain is a compression syndrome, where one or more of the structures within the body is putting pressure next to, or directly on the nerve it’s self.
Common examples of compression syndromes include:
- Carpal Tunnel Syndrome
- Piriformis Syndrome
- Thoracic Outlet Syndrome
One thing in common the above syndromes share, is that when the compression factor is removed, symptoms generally resolve completely, unless the compression has somehow damaged the physical structure of the nerve beyond its ability to repair.
(Above is an Illustration of how a muscle, the piriformis muscle, can compress an area of the nerve(s) deep within the buttocks. The coloring of the nerve pathway in red does not necessarily depict an area of pain, rather the region affected by the compression.)
Generally, nerves don’t do a very good job at repairing themselves, but certain components of a nerve can, like on the outer covering of a nerve in some cases, or the nerve fibers in our nose for example, which actually regenerate quite frequently, every 8 to 10 days or so.
Here’s a video I did that talks about how the Si joint works. It may even give you some insight into your Si joint, and how it may be contributing to your back pain scenario.
Compression syndromes are conditions where massage therapy can bring a tremendous amount of value to a person who may be suffering from them, but identifying them can be tricky.
Compression syndromes don’t always present with pain.
Numbness, tingling, clumsiness, as in the difficulty of responsiveness of the muscles in the hands and fingers, or feet and ankles for example, can result from certain compression syndromes, and perhaps they leave one feeling like they’re excessively clumsy because they drop things easily, or find that they trip over they’re foot and lose their balance all too often. Temperature changes, such as feelings of one hand or foot being colder than the other, can also be linked with certain compression syndromes.
Symptoms like these can easily be passed off as typical signs of aging, and left to accumulate and linger, but in reality aging is only one factor out of many, and these sorts of problems can actually happen at any age.
Regular massage therapy can offer the opportunity to discuss these concerns with your massage therapist as they develop, so that the small things that get brushed off, have an avenue where they can be talked about, and identified for what they are, before becoming any worse.
Is your back sore? Your Si joint could be part of the problem.
 Raj MA, Ampat G, Varacallo M. Sacroiliac Joint Pain. [Updated 2022 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470299/
 Peripheral neuropathy. Johns Hopkins Medicine. (2021, August 8). Retrieved October 11, 2022, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/peripheral-neuropathy
 A. Vleeming,M. D. Schuenke,A. T. Masi,J. E. Carreiro,L. Danneels,F. H. Willard, Journal of Anatomy Volume 221, Issue 6 p. 537-567, The sacroiliac joint: an overview of its anatomy, function and potential clinical implications
First published: 19 September 2012
 Newman DP, Soto AT. Sacroiliac Joint Dysfunction: Diagnosis and Treatment. Am Fam Physician. 2022 Mar 1;105(3):239-245. PMID: 35289578.
 Added MAN, de Freitas DG, Kasawara KT, Martin RL, Fukuda TY. STRENGTHENING THE GLUTEUS MAXIMUS IN SUBJECTS WITH SACROILIAC DYSFUNCTION. Int J Sports Phys Ther. 2018 Feb;13(1):114-120. PMID: 29484248; PMCID: PMC5808006.
 Cohen SP. Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment. Anesth Analg. 2005 Nov;101(5):1440-1453. doi: 10.1213/01.ANE.0000180831.60169.EA. PMID: 16244008.