The S-I joint is one of the most misunderstood areas of the human body. It has been the source of
much controversy in the medical community for many years. Much of the debate relies on the fact that
there are few reliable evaluation methods for the S-I joint.

Contrary to disc injuries, which can be evaluated using many types of diagnostic tools, examining
the S-I joints has proved to be quite unreliable. Clinicians need to rely mostly on their experience
rather than simple methods used to examine the low back. Most medical professionals do not
acknowledge it as a source of pain and dysfunction. So patients leave a medical office with an
incomplete evaluation and often times, an inaccurate diagnosis.

The S-I (Sacro-Iliac) joint is comprised of two bones; the sacrum and the ilium. You have two S-I
joints (left and right). They are located basically where the spine meets the pelvis. Look for the
two dimples in your low back. These two joints allow for very little movement overall as compared to
other more prominent joints such as your hip or shoulder. The pelvic girdle is generally described
as the two S-I joints, the pubic symphysis (pubic bone in front), the two hip joints, and the bottom
two vertebrae (L4, L5).

What do you feel? 

Pain located at or near the S-I joint on one side or both sides. Pain located in the low back,
buttock, and/or groin area. Another common symptom of a S-I joint dysfunction is “sciatica”.
Sciatica is best described as a sharp, often shooting pain that begins in the buttocks and goes down
the back of one leg. S-I joint dysfunction may also cause nerve irritation of the nerves that supply
the groin or front of your thigh.

Other symptoms include:

• Weakness in one leg or both legs; difficulty standing on one leg and raising
  the other leg (like marching)
• Numbness and tingling in one leg (pins & needles)
• A burning pain located near the “dimples”
• Difficulty raising from a chair
• Muscle discomfort in the buttock, hip, or low back (over 30 muscles attach
  to the pelvis; from the hip, buttock, thigh, low back.

How does this happen? 

S-I joint dysfunction is usually caused by an imbalance in the muscles of the hips and glutes and it
can also be caused by a fall or other traumatic event, such as a car accident.

A condition known as “hypermobility” may also predispose an individual to S-I joint dysfunction.
“Hypermobility” is best described as a condition in which the joints have too much mobility. This
condition generally affects women more than men. Different hormone levels present in women,
specifically “relaxin”, can influence hypermobility. This hormone is released to prepare the body
for pregnancy, and its level in the blood changes throughout pregnancy process. It basically causes
the ligaments to “relax” and allow for more movement to occur in the pelvic girdle region.

The best treatment options

First of all, the evaluation is critical to the success of treating a S-I joint dysfunction. Most
dysfunctions can be treated with manual techniques that generally involve “mobilizations”,
“manipulations”, or “muscle energy techniques”. These techniques must be applied by a skilled
medical professional, such as a physical therapist. These techniques can prove to be quite helpful
when utilized appropriately following a thorough evaluation.

Once appropriate manual techniques have been administered, a comprehensive exercise program must be
implemented to address the following areas, specifically muscle imbalances:

• Lumbar stabilization program: strengthening abdominals and buttock muscles • Improve flexibility
in lower extremity musculature

Some cases may only need a detailed exercise program that addresses the muscle imbalances. You can
learn more about how to identify and address your muscle imbalances by visiting http://www.losethebackpain.com

Some S-I joint dysfunctions may linger on for months and even years. Remember, if you are engaged in
a current treatment plan with little to no improvement, seek other options. If you think you may
have a S-I joint dysfunction, the first step is to find a healthcare professional who is skilled and
experienced in addressing muscle imbalances.

For more information on S-I Joint Dysfunction and how to treat it effectively, read the latest Back
Pain Advisory from The Healthy Back Institute. You can get a free copy of it here: http://www.losethebackpain.com also available free access
to the back pain forum and a free audio recording “ 7 Mistakes Most Back Pain Suffers Make”

Submitted by:

• Name: Dr. Robert V. Duvall, DPT, MPT, ATC, MGFI
• Date: 01/29/07 at 19:59
• Email: duvallarticles@yahoo.com
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