Sacroiliac joint (SI) dysfunction refers to poor stability, function, movement, or overall health of one or both of the sacroiliac joints.

These two joints are located on each side of the top of your pelvic bone, and connect to the final segment of your spine. They are located directly behind the dimples found in the lower back area.

While these joints typically have a small range of motion, they play an important role in your stability by supporting and distributing the weight of your upper body to your lower body.

They absorb impact while you walk or run, and allow for these movements by aiding in hip rotation. Sacroiliac joints allow your hip to rotate downwards or upwards, which is necessary for movements like sitting or bending.

For individuals who become pregnant, these joints widen to allow for childbirth.

The sacroiliac joints perform many important jobs, but that unfortunately makes them susceptible to dysfunction. The sacroiliac joints can become inflamed, hypermobile, stiff, or damaged, which affects both the function and comfort of these important joints.

Dysfunction of the sacroiliac joints can create instability, pain with movement, or radiating pain that can range from mild to severe.

Pain associated with these joints is often felt in the lower back, but may also affect the buttocks, hips, thighs, and legs, too.

This sacroiliac joint pain not only disrupts day-to-day movements, but can cause an individual to strain other parts of the body while compensating for the lack of function or movement.

Start Healing with Hive

There are a variety of factors that can cause and contribute to sacroiliac joint dysfunction.

Injuries or other conditions, repeated strain on the pelvis and hips, poor posture, muscle imbalances, pregnancy, and childbirth can affect the function and mobility of these joints. Below, we’ll look a bit closer at some common causes of sacroiliac joint dysfunction:

Pelvic Floor Dysfunction

Every person has a pelvic floor. It is a group of muscles in the pelvis that support your body’s balance and stability, protect your pelvic organs, and provide bladder, bowel, and sexual function.

The pelvic floor is very involved in the function of the sacroiliac joints, and plays a direct role in sacroiliac joint dysfunction. This is because the pelvic floor muscles can become weak, tight, inflexible, or poorly coordinated, which directly affects the sacroiliac joints and impairs pelvic alignment and stability.

Pelvic misalignment, instability, or muscle imbalances directly affect the sacroiliac joints and their ability to function or move efficiently.

For example, tight pelvic floor muscles create tension that can restrict the mobility of the sacroiliac joints. On the other hand, weak pelvic floor muscles may fail to provide necessary support to the pelvis and body, creating stress on the sacroiliac joints as they try to compensate for this lack of support.

Therefore, pelvic floor dysfunction can be a direct cause of sacroiliac joint dysfunction. When treating sacroiliac joint problems, the pelvic floor should not be ignored, especially if you are experiencing other symptoms of pelvic floor dysfunction such as constipation, incontinence, painful sex, and more.

Pregnancy and Childbirth

Pregnancy and childbirth can have major effects on the sacroiliac joints (as well as the pelvic floor). Pregnancy puts a lot of extra weight and strain on the pelvis and hips, which affects your posture and can create strain on the sacroiliac joints.

Pregnancy creates a lot of changes in the body, particularly hormonal changes, which can contribute to sacroiliac joint dysfunction. These hormones relax the ligaments in your body and can make the sacroiliac joints more mobile.

While joint mobility is usually a good thing, hypermobility in these joints can make the body unstable and prevent the joints from functioning as usual.

Childbirth also affects the sacroiliac joints, as they experience pelvic trauma from vaginal delivery and are affected by pelvic floor dysfunction during postpartum healing.

Spinal Misalignment and Posture

Due to the interconnectedness of the sacroiliac joints, spine, and pelvis, any form of misalignment or muscle imbalances in this area can have a negative impact on the health of the SI joints and the body’s overall stability.

There are many things that can impair your alignment and cause sacroiliac joint dysfunction, such as the following:

• Poor posture: Poor form during exercise or even daily movements can affect your body’s alignment. Prolonged sitting or standing, repetitive sports, or poor pelvic floor health can lead to spinal or pelvic misalignments that can affect the sacroiliac joints.
• Muscle imbalances: Having tightness or weakness in other areas of the body such as the hips, back, or abdominals can reduce stability and put stress on the sacroiliac joints.
• Other conditions: Some individuals who have conditions such as scoliosis, herniated discs, or unequal leg lengths may have impaired spinal or pelvic alignment.

Injury, Trauma, or Other Conditions

Unfortunately, sacroiliac joint dysfunction can be caused or exacerbated by previous conditions, surgeries, injuries, or other experiences.

This typically includes injuries or conditions that cause direct impact or strain to the pelvis, but can also be conditions that indirectly impact the joints by causing pelvic floor dysfunction or general muscle weakness. Some examples can include:

• Past injuries or surgeries can cause trauma to the pelvis, spine, or lower back which may result in damage, inflammation, and stiffness in the sacroiliac joints. Additionally, injury or surgical procedures can create scar tissue that may be restrictive or painful.
• Individuals with connective tissue disorders such as Ehlers-Danlos syndrome are more likely to experience sacroiliac joint pain from hypermobility and instability.
• Chronic stress, coughing, or straining from bowel movements puts pressure on the pelvic floor, which can strain the SI joints.
• Pelvic conditions like chronic pelvic pain and pelvic organ prolapse can contribute to sacroiliac joint dysfunction by impairing muscle function and creating pelvic floor dysfunction.

Physical therapy for sacroiliac joint dysfunction uses a holistic treatment approach by addressing both core and pelvic health in order to restore joint stability and function.

Your physical therapist will work to reduce pain, restore function, and enhance comfort by using a variety of treatments, such as the following:

Spinal and Pelvic Alignment

As mentioned before, the sacroiliac joint connects the bottom of the spine to your pelvic bone. Therefore, ensuring you have good spinal and pelvic alignment is essential for proper function of your SI joints.

To address pain and discomfort from misalignment, your physical therapist may use treatments like spinal manipulation or joint mobilization. These treatments improve your range of motion, decrease pain, and reduce stiffness.

Additionally, your physical therapist will address the cause of your spinal or pelvic misalignment. Misalignment is often due to things like poor posture, muscle activation, muscle coordination, or muscle balance.

To address these causes of misalignment, you can expect to engage in exercises that will improve your body mechanics during activities, as well as postural imbalances while you exercise, sit, stand, or walk.

Your physical therapist will correct any compensatory patterns in your activities or movements that contribute to your SI pain or that strain other parts of the body such as the pelvic floor.

They’ll help teach you to correctly engage your muscles when you lift items or when you change body positions, and utilize strengthening exercises that target the core, hips, and pelvic floor.

Balancing these muscles and engaging them properly can help reduce strain on the sacroiliac joint and prevent pain. We’ll discuss core strengthening and pelvic floor training next!

Core Strengthening

In order to reduce strain on the sacroiliac joints and better encourage coordination between the pelvis and core, your physical therapist will curate an exercise routine to strengthen your core muscles.

Strengthening your core will allow these important muscle groups to better support movement, improve stability, and encourage balance.

Your physical therapist will also work on the flexibility and mobility of your core, hips, and pelvis. Addressing tight muscles in these areas through stretching and other treatments will help reduce misalignment and straining.

The health of your core depends on the health of surrounding muscles, too—such as your glutes, hips, pelvis, and pelvic floor!

Pelvic Floor Training

As mentioned before, the pelvic floor plays a very important role in the health of your SI joints. Your physical therapist will examine your pelvic floor to find any signs of weakness, tightness, or a lack of coordination.

To address these issues, they’ll utilize a variety of treatment methods to relax your muscles, improve their strength, and encourage better control and coordination.

To regain your pelvic floor control and coordination, they’ll utilize treatments like neuromuscular re-education and biofeedback, which will help you practice engaging your pelvic floor muscles and even present the results in real time.

To help relax your pelvic floor muscles, improve mobility, and address painful trigger points, your physical therapist will utilize manual therapy treatments.

Manual therapy is manipulation and mobilization of muscle tissue, nerves, ligaments, and other underlying structures. Manual therapies may be done internally via the vagina or rectum, or externally to the hips, abdominals, and pelvis.

You can also expect to engage in exercises and activities that will strengthen your pelvic floor muscles and surrounding structures. This will be important for providing support and stability to your sacroiliac joints.

Pain Management

Sacroiliac joint dysfunction can cause significant pain in the lower back and other surrounding areas.

While the providers at Hive Therapy and Wellness work hard to address the root cause of this pain, they can also provide a variety of treatments that can provide effective pain relief as well as improve muscle function. This can include manual therapies such as tissue scraping, dry needling, or cupping.

In addition to manual therapy, your physical therapist can address muscle function and pain through other treatments like electrical muscle stimulation or therapeutic modalities. Therapeutic modalities include heat or cold therapy, TENS, and more!

At-Home Care and Behavioral Modifications

As a part of your holistic treatment plan, your physical therapist will be sure to teach you how to manage pain at home and prevent future complications with your SI joints.

This can include a home exercise and stretching program, addressing poor posture habits, altering movements or mechanics that may worsen your pain, and encouraging better habits for pelvic floor health.

Following these recommendations from your therapist both during and after treatment will help protect your SI joint health in the long run.

Hive’s providers care about your health and want you to feel fantastic. Therefore, they may utilize a variety of treatments to properly address any causes of sacroiliac joint dysfunction and to provide a comprehensive treatment experience.

While under the care of Hive’s physical therapists, you can expect to engage in any of the following treatments:

• Neuromuscular re-education 
• Manual therapy
• Exercise prescription 
• Dry needling 
• Cupping 
• Tissue scraping 
• Behavioral modifications 
• Therapeutic activities 
• Electrical muscle stimulation
• Spinal manipulation 
• Therapeutic modalities 
• Biofeedback