Sacroiliac Pain: An under-diagnosed problem

Sacroiliac Pain: An under-diagnosed problem

by Charles S. Masarsky, D.C.
Stripes Okinawa

In my chiropractic practice, it is not unusual to meet a patient complaining of low back pain that has not responded to previous care. Typically, care for a low back patient focuses on the last five vertebrae in the low back – the lumbar region. Injections or surgery in this region can bring substantial relief, but only if the lumbar vertebrae are really the problem. Sometimes, the problem is just below the lumbar region, in a pair of structures called the sacroiliac joints.

Anyone Can Get It
According to a publication by the Mayo Clinic, sacroiliac pain can be difficult to diagnose, for a variety of reasons. Yet, it is a common problem. Anyone can get it, be they active or sedentary, civilian or military. For example, sacroiliac pain afflicts almost one-third of construction workers. Competitive athletes often develop sacroiliac problems even in the absence bad falls or other obvious injury.  

Sacroiliac problems are particularly common among women who have recently given birth. The ligaments that hold these joints together are loosened during pregnancy due to a hormone called “relaxin.” This allows the pelvis to move more freely to make the birthing possible. After pregnancy, the ligaments tighten to restabilize the sacroiliac joint. If the joint re-tightens into a malposition, the result is sacroiliac pain.

In fact, you don’t have to be a construction worker, an athlete, or a new mother to develop a sacroiliac problem. Simple postural strain – sitting for long periods of time, for example – can stress these joints, especially if you are sitting in a tilted position. A classic example is sitting with a thick wallet in one back pocket.

Finding the Problem
Sacroiliac pain usually affects one side. The pain can travel down the buttock and thigh (sciatica), or it can remain in the lower back/hip area. It often becomes worse when standing after a long period of sitting. Climbing stairs and walking with long strides tends to aggravate sacroiliac problems. Looking in the mirror, the sacroiliac patient may notice their beltline being noticeably higher on one side than the other.

Unlike lumbar vertebra problems and disc herniations, sacroiliac problems are not usually identified on x-ray, CT scan, or MRI reports. The best way to check the sacroiliac area is still by a good physical exam of the joint motion and related muscle function.

Getting Past the Problem
A combination of chiropractic adjustments and simple exercises usually does the trick. There are several clinical papers detailing the benefit of the chiropractic adjustment for new mothers and athletes with sacroiliac pain.

A particular compelling study describes 16 female long-distance runners with sacroiliac injuries. Chiropractic adjustments were included in their rehabilitation. Not only did these runners recover quickly, but seven of them scored “personal best” performances upon recovery.

Of course, as mentioned above, ordinary people doing ordinary things certainly develop sacroiliac problems. Helping these people is part of a chiropractor’s normal day at the office.

Helping Yourself
When sacroiliac pain first appears or becomes aggravated, applying ice for 20 minutes can take the edge off the inflammation. Instead of ice, you can use frozen peas or cold gel packs. Remember to protect your skin with a thin towel or t-shirt. Ice treatment can be repeated every two hours you are awake.

When the pain is more manageable, try a “core brace.” While standing tall, tighten your abs, glutes, and Kegel muscles (the muscles you would contract if you wanted to stop urinating in mid-stream). Look up slightly. Hold for at least a count of 5, for at least 5 sets. As conditioning allows, you can build up sets or hold the brace during brisk walking. For more advanced sacroiliac exercise, you can get guidance from a doctor of chiropractic or a physical therapist.

The sacrum (upside-down triangle in the middle) and the two ilia
(flared bones to the left and right) form the left and right sacroiliac
joints. Image: courtesy of Dr. Masarksy

About the Author
While serving as a medical specialist (MOS 91-B) in the U.S. Army Reserve, Dr. Masarsky earned his Doctor of Chiropractic degree from New York Chiropractic College in 1981. He is in the private practice of chiropractic in the Virginia suburbs of Washington DC with his wife and partner, Dr. Marion Todres-Masarsky. For research citations related to this article, contact Dr. Masarsky at Also visit his practice’s website, and YouTube channel.

Sources for this article:
Mayo Clinic, Sacroiliitis:

Tousaint R, Gawlik CS, Rehder U, Ruther W. Sacroiliac Dysfunction in Construction Workers. J Manipulative Physiol Ther, 1999; 22(3): 134-138.

Ruhe A, Bos T, Herbert A. Pain Originating from the Sacroiliac Joint is a Common Non-Traumatic Musculoskeletal Complaint in Elite Inline Speedskaters – An Observational Study. Chiropr & Manual Ther, 2012; 20(5).

Hoying M, Alcantara J. Improved Outcomes in a Woman Experiencing

Chronic Post-Partum Low Back Pain. Journal of Pediatric, Maternal, and Family Health Chiropractic, 2017 (3): 128-132.

Peterson CK, Muhlemann D, Humphreys BK. Outcomes of Pregnant Patients with Low Back Pain Undergoing Chiropractic Treatment: A Prospective Cohort Study with Short Term, Medium Term and One Year Follow-Up. Chiropractic Manual Therapy, 2014; 22: 15.

Grimston SK, Engsberg JR, Shaw L, Vetanze NW. Muscular Rehabilitation Prescribed in Coordination with Prior Chiropractic Therapy as a Treatment for Sacroiliac Subluxation in Female Distance Runners. Chiropractic Sports Medicine, 1990; 4: 2-8.

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