Sacroiliac (SI) Joint Pain — Non-specific pain and misdiagnoses

Graphical illustration of SI joint pain.

© SebastianKaulitzki | shutterstock.com

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All About Cause, Symptoms and Effective Treatment of SI Joint Pain

Is the pain in your lumbar spine back a constant source of trouble in your life? A dull nerve pain that radiates into your legs, a pulling pain in your buttocks? And from time to time your lower back feels wobbly? These symptoms pester not only you, but also many other people – sometimes over a very long period of time.

We know that this kind of pain is not only a physical but also an emotional burden for you and all the others who suffer from it. Did you know that up to 22.5 percent of all back pain is caused by disorders of the sacroiliac joint, the sciatic nerve and the muscoloskeleton system in the pelvic region? 1)

In this article, you will learn everything you need to know about the sacroiliac joint and the various pain conditions. We will also tell you why this unpleasant pain occurs and how you can get rid of it by doing very simple exercises. The fact is: In our experience most patients manage their pain best when they themselves become active.

In our detailed exercise chapter you will find an exercise video as well as instructions, so you can follow these exercises step by step. If you want to get rid of your pain immediately, it is best to start right away with the exercises against sacroiliac joint pain.

Roland Liebscher-Bracht

Roland Liebscher-Bracht

Germany's most trusted pain specialist and author of several bestselling self-help books on the treatment of pain conditions.

 
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Roland Liebscher-Bracht is Germany's most trusted pain specialist and author of several bestselling books on pain treatment. Together with his wife, Dr. med. Petra Bracht, he has developed a revolutionary method to treat pain conditions. With the help of the so-called "osteopressure", where you press specific points on your body, and special stretching exercises, pain can be stopped entirely without medication or surgical intervention. This pain treatment allows you to alleviate pain by yourself. Find out how exactly this works in this article or our numerous YouTube videos.

Roland Liebscher-Bracht

Germany's best-known pain specialist and author of several bestselling books on self-help against pain.

 
Read more

Roland Liebscher-Bracht is Germany's best-known pain specialist and author of several bestselling books on pain treatment. Together with his wife, the physician Dr. Petra Bracht, he has developed a revolutionary new form of pain treatment: With the so-called "Osteopressur", in which certain points on your body are pressed, and special stretching exercises, pain can be stopped completely without medication or surgical intervention. It is particularly important that this pain treatment gives you the opportunity to help yourself against your pain in a self-determined way. You can find out exactly how this works in this article and in the numerous YouTube videos.

1. Symptoms of Sacroiliac Joint Pain


1.1 Non-Specific Symptoms and Common Diagnostics

“Sacroiliac joint syndrome” is one of the many differential diagnoses for lower back pain. Therefore, statements on the frequency are as problematic as an exact diagnosis. The prevalence of SI joint syndrome fluctuates between 10 to 26.6 percent. 2)

As with many other diseases or pain conditions, the symptoms of SI joint pain are often unspecific. Pain that originates from your lower back and radiates mostly on one side only 

  • into your buttocks,
  • groin area,
  • and possibly even up to your knee

is called a typical SI joint syndrome.

The pain caused by a blocked or tilted sacroiliac joint can be acute or chronic. Often, you can feel it only when moving in an awkward way, sitting too long, or, and that’s a classic, taking a wrong step or picking up a load incorrectly. Once the pain is there, it often comes back to haunt you regularly and, in some cases, even does not disappear at all. Patients suffering from SI joint syndrome often complain about fluctuating pain and its spontaneous onset. 3)

  • Pain in your groin,
  • in your lateral pelvic area or
  • in your hips

can occur in connection with a SI joint syndrome, but also manifests in other “diseases”; such as herniated discs or hip arthrosis.

Many patients also complain about problems when sitting which makes them take a lopsided sitting posture as a matter of habit. What kind of trouble this and more general compensating positions invite, is described in detail in our chapter about Causes.

Doctor touching the knee of a patient.

© PortraitImagesAsiabyNonwarit | shutterstock.com

From Symptoms to Diagnosis?

If it comes to lower back pain that persists for several days and can end in immobility, most patients consult their doctor of choice. Understandably so – nobody suffers just for the fun of it! In the initial interview or exam, your doctor will ask the usual questions. To get a picture of the symptoms, he or she will probably want to know, among other things, when you experienced the physical symptoms for the first time.

How Can the Patient Trigger the Pain and Under What Circumstances Can It Possibly Improve?

Pre-existing conditions, the family’s medical history and the exact localization of the pain also play a decisive role in the search for the cause.

The answers to these questions usually lead back to the symptoms described above: buttocks, legs, hips, groins and the entire lower area of the spine (lumbar spine) are in pain. Once the doctor in charge has obtained sufficient information about the patient’s medical history, a physical exam follows, during which some tests may be carried out with the patient.

If the pain was not the result of an accident or other obvious causes, the physician uses so-called provocation tests to examine the reaction of the sacroiliac joint to certain movements.

Provocation Tests

There are several kinds of provocation tests of the sacroiliac joint. If you have visited your doctor’s office because of the pain conditions mentioned earlier, you may know some of them. In most clinical examinations, the patient lies down on the treatment table. The treating physician can then use a pain provocation test (often changing the position of the legs and back and moving the lower limbs into different positions) to determine the patient’s typical symptoms.

Often, a combination of several tests is used, since no test alone can reliably confirm the diagnosis “SI joint pain”. 4) If several tests trigger the typical complaints, the diagnosis is relatively certain. But what good does it do you? In most cases your doctor will focus on the SI joint and not pay attention to the actual root cause.

1.2 Why Diagnoses Are Not Always Relevant For Us


You will probably be surprised if we tell you that SI joint syndrome diagnosis is only of secondary importance to us. Much more relevant is that you understand the causes of your pain and what you can do yourself to get rid of it for good. To do this, we focus on the cause rather than fight only the symptoms. You most likely have already tried this with painkillers and a compensating posture for some time now – but probably without the desired results.

Please do not get us wrong: diagnoses are important for a meaningful and effective therapy.

However, in our experience, most back pain can be narrowed down to one and the same cause. Yet, it does not show in any X-ray or other imaging procedures such as MRI or CT.

We want to save you from rushing any decisions: possibly undergoing a recommended surgery or taking strong painkillers. Many patients come to see us because even after an operation the pain is still there and so are their problems. In some cases, they suffer even more than before and are scheduled for another operation. This does not have to happen!

In the following chapter, we would like to use our knowledge to educate you about the origin of your pain and share our experience from over thirty years of pain therapy with you. Learn what really causes your SI joint pain.

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2. Cause: What Really Triggers Your SI Joint Pain


You would like to know the cause of your SI joint pain or your recurring blockages immediately? Here, we explain to you in detail how your sacroiliac joint is designed and what functions it is supposed to perform in your body.

2.1 Functions of the SI Joint

Graphic displaying the SI joint.

© SebastianKaulitzki (edited) | shutterstock.com

If you look closely at the picture, you can see that the SI joint has a crucial function in your body. It forms the connection between the lumbar spine and the pelvis. You can also see that our body has two sacroiliac joints, one on the left and one on the right. In the vast majority of cases, however, only one of the two is afflicted with pain.

The two joints are flat and each form the transition between the iliac crest and the sacrum. Because of this intermediate position, the sacroiliac joints have only minimal room for maneuver. This is made possible by muscles, ligaments and dense connective tissue, the fascia. They normally provide stability in the joints so that they can perform their shock-absorbing function without problems.

At the same time, however, the danger of a loss in stability becomes apparent here. If the supporting muscles and fasciae become more unstable due to muscular imbalances, being subject to prolonged incorrect stresses or short-term external forces – an awkward step or an impact , e.g. in an accident – this can lead to an imbalance in the supporting apparatus. The result: joint surfaces rub against each other or tilt. Pain develops. Our early warning system is activated. We must act or change something in our movement pattern

Woman sitting at a desk, clutching her back and forehead due to the pain experienced.

© Andrey Popov | fotolia.com

2.2 Sitting for Long Periods of Time Is the Main Cause of SI Joint Pain

The most common trigger for sacroiliac joint pain or SI joint blockage is prolonged and constant sitting. Our modern society has developed into a “sitting society” that moves less and less. But the structures of our body are geared towards movement. And that means, above all, diverse and varied motions that run through all joint angles and positions.

Unfortunately, our current movement patterns do not meet this requirement in any way, which is what causes most pain in the first place.

As a result of sitting in offices, in the car, in front of the television or computer, our frontal body structures, muscles and fasciae, become shorter and shorter and are increasingly under tension.

If we now want to do the opposite of sitting, i.e. standing up to walk, the body bends forward. Then the largest extensor, our gluteal muscles, has to counteract this tension created in the front, as otherwise we could only walk in this bent position.

Pressing bench in a gym.

Unfortunately, most doctors and therapists come to the same conclusion time and again: in their opinion, tension should be relieved by massage and both back and buttock muscles should be strengthened so that they can counteract more easily. But this is a mistake and can sometimes lead to more pain.

The actual cause lies in the front part of the body and usually goes undetected.

The hip flexor, which shortens more and more when sitting and forces us into a bent position when standing up, is responsible for the strong tension around the SI joint and our spine.

For us, the solution is quite logical: We have to start with treating the shortened front body structures to relieve the back again. If the pressure on the lumbar spine were to persist for longer, not only would the sacroiliac joint cause pain and problems, but also secondary symptoms such as inflammation, joint abrasion (arthrosis) and slipped discs could develop over time. 

In the following treatment section, you will learn how to best help yourself with what you have learned here.

Roland Liebscher-Bracht is performing a pain-free exercise.

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3. Treatments for SI Joint Pain


In the treatment of diseases or pain conditions, the diagnosis is certainly pivotal for the type of therapy and its follow-up measures. Unfortunately, despite the latest technological advances, wrong diagnoses happen quite often and so the cause of the problem is mostly not addressed. Instead, many doctors cling to stopping the pain. After all, their patients are suffering and they want to help them as soon as possible. Most of the time, however, the treatment methods have the opposite effect and delay the healing process unnecessarily.

3.1 This Is Why You Should Not Have Your SI Joint “Reset”

If your SI joint is indeed dislocated or blocked, we believe that it is of no use in the long run to have it reset by an orthopedic surgeon or physiotherapist again and again. If you have read our chapter on the causes carefully, you will understand that the pain is caused by tense muscles and fasciae between the ilium and sacrum and the pelvic ring.

If the tension remains, the tensile forces will continue to be so strong that they will pull the surfaces of the joints towards each other – the joint will always tilt due to the imbalances.

This, in the long run, cannot only damage your joint, but other parts of your body could be affected as well.

3.2 Other Conventional Methods for Managing SI Joint Pain

When treating pain of any kind, in most cases drugs are used to inhibit the inflammation and to relieve the pain within a few minutes. 5)

However, in case of SI joint syndrome and other back problems, painkillers are rather counterproductive.

A variety of pain medication.

Understand Pain Now and Eliminate It in the Long Run

Pain reduces our quality of life and burdens our everyday existence. We want to show you that pain, even if it is felt all over your body, has a meaning. If you feel the pain and interpret it as an important alarm signal, you can take effective action against it. Medication suppresses the pain for a short time and you can relax better, but in the long run it will not eliminate the actual cause. 

The pain will probably come back sooner or later – perhaps even more severe than before or in places that were previously pain-free. So, we should no longer ignore pain. Instead, we should listen to our body and understand exactly what it wants to tell us.

📌Alarm Pain 

We think of pain as “alarm pain.” They’re like the warning signals of your body. Through pain you get the chance to understand your body and to heal it with the right methods. This is where we come in. 

Infiltration Therapy and Other Minimally Invasive Procedures

In the case of infiltration, a mixture of anti-inflammatory drugs and local anesthetics is injected at the site where the pain is felt. This should reduce inflammation and alleviating the symptoms significantly. As with other surgical procedures, there is a risk of infection and injury to blood vessels or neural pathways. More pain, sensitivity disorders or other motor deficits can be the result. After infiltration treatment, muscle weakness and temporary loss of sensation in some parts of the body must be expected.

In most cases, this therapy achieves short-term relaxation of the muscles, but this only lasts for a few weeks. 6) Overall, however, there is a complete lack of meaningful studies regarding the therapeutic effectiveness of SI joint injections. 7)

Illustration of a SI Joint Transplant

© SebastianKaulitzki (edited) | shutterstock.com

Minimally Invasive Fusion

Maybe you suffer from a recurrent blockage of the SI joint and have long been tired of going to the orthopedic surgeon every time to have it set right again. Quite apart from the fact that we do think little of that to begin with, your doctor probably does not know any other way out either and may even offer you to fix your SI joint. In this supposedly “small” procedure, your sacroiliac joint is fixed in place with three implants to ensure long-term stability.

The word “fixation” alone should really get your attention.  A joint is meant to enable motions inside your body, transmit and cushion them.

Tensed-up muscles and fasciae are caused in particular by lack of exercise and one-side repetitive movements. Now it is easy to imagine what kind of effects such a fixing has on the surrounding connective tissue or muscles and fascia. These atrophy and become matted over time. A new imbalance develops, which the body sooner or later tries to compensate in a natural way.

In addition: Studies on the effectiveness of such operations are far and between and some of them indicate unfavorable outcomes when the SI joint is stiffened. 8) 

In contrast, we offer you risk and side-effect free treatment alternatives. No matter what your current situation is: You have the possibility to get rid of your pain for good with very simple means. And the best thing about it is: In three of the four therapies you are the therapist yourself! You decide on the place and time. The days of hoping to finally get a physical therapy appointment and the long hours in the waiting room have come to an end.

Because the only thing you do during this time is sit and hope. And by now you have learned that too much sitting is the main cause of your complaints. So, what are you waiting for? Get going with us and start enjoying your life again.

3.3 The Liebscher & Bracht Therapy

We have developed a therapy for treating pain conditions that offers you three ways to help yourself:

  • osteopressure — our latest development,
  • fascial rolling massage and
  • bottleneck stretching.

The last of these three are designed to get the most out of your body when used regularly and keep you flexible and agile until old age.

In our experience, most patients only need one to three sessions to be almost completely pain-free. However, in order to stay this way in the long run, your active cooperation is essential.

Fascia Roll Massage Balls

With the fascia roller massage you can remove even the smallest problems, such as gummed-up and matted spots in your connective tissue (fascia) and thus finally get rid of the pain. Because: Your connective tissue is equipped with pain receptors and motion sensors that measure tension and send it to your brain.9)

The goal of the fascial roller massage is to move or shift the interstitial fluid. The fascial tissue is supplied with new fluid, old waste products can dissolve, and acidosis is minimized. 10)

Osteopressure Tool

The Light Osteopressure allows you to push away your pain yourself. It is our layman’s version of osteopressure which, with the help of a presser set, enables you to help yourself. You can press 27 different pressure areas of your body and release the tension on muscles and fascia yourself. 11)

Woman performing bottleneck stretches.

Bottleneck stretching is the most important part of our therapy and your main task. With the help of stretching exercises you can compensate for the lack of exercise in your life. The muscular and fascial tensions that come with our sedentary lifestyle can be kept at a low or even completely eliminated for good by regular exercises.

It’s the Combo That Does It

In a combination of at least two of the three introduced self-help methods you will find your personal concept for a painless life. The best thing about it: You can do no wrong! It is important that you carry out the fascial roller massages and the bottleneck stretches regularly in order to achieve quick but also enduring results. However, the exercises are always a “must-have” in your therapy and form the foundation of your lasting success. Science confirms how important personal responsibility and cooperation of the patient is in the therapy of SI joint related sciatica. 12)

In the following you will find a video in which our pain specialist Roland Liebscher-Bracht personally introduces the exercises to you. The exact execution of the individual exercises can also be followed step by step below.

Roland Liebscher-Bracht is performing a pain-free exercise.

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Roland Liebscher-Bracht is performing a pain-free exercise.

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Roland Liebscher-Bracht is performing a pain-free exercise.

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4. Simple Exercises Against SI Joint Pain


As you have probably heard many times before, sufficient and varying exercising is an essential building block for a healthy and pain-free life. Sitting activities increasingly permeate our daily lives, so that muscles and fasciae in our whole body become stiffer and stiffer. With our exercises you can finally expand your range of motions again and thus work against the development of tension and pain yourself. 

Now watch now the video with the exercises in join-in length:

Woman using a fascia tool to massage her SI joint.

4.1 Fascial Roller Massage

Fascial roll massage with the Medi-ball: Roll your buttocks with the fascial ball to pain-sensitive areas.

  • For this rolling massage you need the a medi foam ball.
  • Sit down on a mat and stretch out both your legs.
  • Take the Medi-ball and place it under one half of your buttocks.
  • Support yourself with your two arms behind your upper body and place the leg at an angle where the ball is not under your buttocks.
  • Now work in spiral motions around those points that are most tense and sensitive to pain.
Woman stretching.

4.2 Bottleneck stretching

Exercise 1

  • Stand up and place your right foot behind yourself, while bending it a little.
  • Lean back and try to move your pelvis with you as well.
  • Now you should be able to feel a slight pull at the inner part of your right thigh.
  • Keep stretching for around two minutes and make sure to use the muscles in your stomach to work on your pelvis, too.
An elderly woman is sitting on a chair. Roland Liebscher-Bracht shows her how to stretch.

Exercise 2

  • For the second exercise, sit down on a chair.
  • The goal of the exercise is to dissolve as much tension in your right buttock as possible.
  • Keep your posture as straight as an arrow and place your right leg above your left.
  • Next, shift your hip forward a little and move your upper body to the left and then to the right. Additionally, you can turn slightly sideways. This way you can pin-point where you feel the most stretching pain in your buttocks.
  • Stay like this for roughly two minutes. Keep breathing steadily and try to stretch further with every breath you take.

📌 Checklist for Liebscher & Bracht Exercises

To make sure nothing goes wrong with our exercises, we have put together seven important tips. They should help you to easily integrate the exercises into your daily life and achieve optimal results.

✅ Practice six days a week and do each exercise at least once a day.

✅ For each exercise you should invest two to two and a half minutes. If you are just starting to do the exercises or if the pain is still too much, you can also gradually increase the intensity. Remember, however, that stretching for only a few seconds has little or no effect.

✅ Always use your personal pain scale of one to ten as a guide. The best results are achieved if you work on a scale of eight or nine for each stretch. Nine means: You feel an intense pain but can still breathe calmly and do not have to muscled-guard.

✅ A pain that is still bearable is the most important point of reference for you. So, don’t be afraid of it: Your body will tell you that you are counteracting the muscular „contractions“ in exactly the right place.

✅ Be patient – even if it is difficult. It may take some time for your brain to store new movement programs. But if you stay on the ball and make the exercises your daily routine, you can regain your freedom from pain.

✅ Use professional aids and not cheap products to treat your pain. If you rely on a defective product here, this can have a negative effect. We have therefore taken great care in the development of our aids and developed them especially for pain treatment.

✅ If the pain increases due to the exercises, there is no reason to panic. That things get worse initially can be a normal reaction of your body. If your overall body statics change as a result of regular exercise, the musculoskeletal system will have to adapt to this gradually. If, however, you feel worse all the time instead of better after the exercises, your body signals that you may be overdoing it. Then simply take a break for a day or two and/or reduce the intensity a little bit during your next training sessions in order to increase it again in small steps. In this way, you gently guide your body to the eight or nine on the pain scale that is right for you.

Roland Liebscher-Bracht is performing a pain-free exercise.

Join Over 12,000 Subscribers Who Are Managing Pain Themselves.

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All gain. No pain.

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Roland Liebscher-Bracht is performing a pain-free exercise.

Sign up for our free weekly newsletter and get interactive exercise videos and articles about pain management and health delivered to your inbox.

All gain. No pain.

Join Over 7000 Subscribers Who Are Managing Pain Themselves.

Roland Liebscher-Bracht is performing a pain-free exercise.

Sign up for our free weekly newsletter and get interactive exercise videos and articles about pain management and health delivered to your inbox.

All gain. No pain.

Sources & Studies [+]