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 body^1,3.

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.

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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.

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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.

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.)

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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 to help recognize them before they problematic.