It’s easy to blame nagging low-back pain on a muscle strain or even a disk problem. But that’s not always the real cause.
A surprising culprit: Up to one-third of chronic low-back pain can actually be traced to pelvic instability. The sacroiliac (pronounced sak-ro-il-ee-ak) joints, commonly called the SI joints, are located on both sides of the pelvis, connecting it to the lower part of the spine (sacrum).
If this little area of the body gets out of whack, that is when the trouble begins. Unlike other joints throughout the body, a healthy SI joint doesn’t flex and extend. Instead, it’s considered a “gliding” joint, meaning that the ligaments holding it together can shift, but that shifting is ideally kept to a minimum. The SI joint’s main job is to hold the lower spine and pelvis together to increase stability.
Certain life events can cause excess movement in the SI joint, however. Pregnancy is a big one—the SI joints can be affected when ligaments and joints in the pelvic area loosen before giving birth.
For women who are years beyond childbearing age—and men, too—SI joint pain is slightly different. Usually affecting only one side of the pelvis, this type of SI joint trouble leads to a chronic, nagging pain in the lower back, which typically worsens when bending over from a standing position. Sitting, which the average American does for up to 13 hours per day, is another risk factor for SI joint pain—it weakens these joints and promotes inflammation.
If you have SI joint pain (marked by a consistent ache on either side of the base of your spine) or suspect that your SI joints may be contributing to low-back pain, see an orthopedic specialist to confirm your diagnosis. Movement tests and an X-ray or a CT scan will be performed.
A clue to watch for: If your pain improves when lying down, this is a sign that the SI joints may be involved. (This can also be a sign of spine degeneration, which can affect the SI area.)
In addition to the exercises below, most doctors recommend the following to help relieve pain due to one or both SI joints…
• Ice. It reduces inflammation and produces a brief numbing effect that temporarily relieves pain. Ideally, ice the affected area for 15 minutes three times a day. What to do: Lie on your belly with an ice bag on the painful area. You can alternate ice packs with a heating pad after the first 24 hours of treatment, when inflammation has subsided, to increase blood flow to the area.
• Massage. For some people, this helps…for others, it can aggravate the problem. If you would like to try massage, ask the therapist to use gentle pressure to promote circulation but avoid deep tissue work.
• SI belt. It is designed to relieve overtaxed ligaments by decreasing motion in and around the pelvis. The research on these belts is mixed. One study reported significant pain reduction in those wearing the belt, while other research found no such benefit or a worsening of pain for a small number of people.
If you want to try an SI belt, a good product is the New Serola Sacroiliac Hip Belt (about $45, depending on size). But if pain seems to worsen with a belt, stop using it.
• Pain-relief medication. If the therapies described above and exercise routine below don’t give you adequate relief, you may need to add pain medication such as ibuprofen (Advil) or topical arnica gel.
The main goal of a workout to relieve SI pain is to balance the strength of the muscles and tendons surrounding the joints so they can provide stability. Exercises that work the transverse abdominis (the deep ab muscles that support internal organs)…the deep external hip rotators that connect the sacrum to the thighbone…and the gluteus muscles will also help the SI joints remain strong yet supple. If you’re in pain, relax the muscles and do these exercises when pain has lessened. Try the following 10-minute routine three times a week—you should get relief within three to six weeks…*
• Squats. What to do: While holding a light weight (five pounds to start, working up to 10) or a 10-pound bar overhead (keep your shoulders down), stand in front of a mirror with a chair behind you to assist with the exercise.
(Holding a bar or weights overhead helps keep the body in correct alignment.) Engage your abdominal and back muscles as you bend your knees, lowering yourself toward a sitting position. (If your lower back begins to sway, you have gone far enough and need to pull your naval in toward your spine.) Allow your hips to fall back toward the chair until your buttocks lightly touch the chair, but do not sit down. Aim for your upper thighs to be parallel to the floor. Hold the squat for 10 to 20 seconds, while breathing deeply, then slowly return to a standing position. Repeat three to five times.
• Hand/knee balance. What to do: Get down on all fours in a tabletop position with your back as level and flat as possible. Your hands should be directly under your shoulders and your knees under your hips. Begin by stretching your right leg back and lifting it to hip height, then slowly lift your left arm forward in line with your ear. Keep your pelvis stable and centered and your core muscles tight. Hold for 10 seconds. Then return to the tabletop position and repeat on the other side. Alternate sides for one minute.
• SI stretch. What to do: Lie on your back on an exercise mat or carpeted floor with your legs straight and your arms outstretched to your sides. Bend your right knee toward your chest, then let it fall across your body to the left, letting your hips roll with it. (Keep both your shoulders on the floor.) Relax and breathe in and out for a minute before repeating on the other side.
*As with any exercise program, check with your doctor first.
