Is Your Sacroiliac (SI) Joint Out of Alignment?!

The truth about SI pain and what you can do.

Stefi Cohen, DPT
July 10, 2023 • 2 min read

If your PT has ever told you that your “S.I. joint is out of alignment,” or if your chiro has ever told you “your hips are rotated” and “need to be reset,” then you need to read this.

It blows my mind that rehab professionals are STILL giving their patients and clients these BS explanations in the setting of sacroiliac joint pain. They poke around for a few minutes and come away with this complex and scary diagnosis. They tell you your hips are uneven and that it may become a bigger problem in the future, BUT that they can help FIX you.

SI joint pain is very real-- trust me, I’ve been there. It’s that sudden, aching pain just below your belt line that strikes when you go to sit down, stand up, or take a step forward. It also tends to start on one side and may mischievously switch to the opposite side, which can drive you crazy. Especially when you’re in the middle of a training session.

What is the SI Joint?

If you put your hands on your hips and then slide your thumbs down a couple inches, you’ll land on your “SI joint,” or sacroiliac joint. It’s where your hip bone or ilium meets your sacrum. The sacrum is the bone commonly referred to as the “keystone” of the pelvis, as it closes the pelvic girdle circle posteriorly and helps transmit forces between the lumbar spine and the lower extremities [1][2][3].

The cool thing about the sacrum is not just that it is made of 5 fused vertebrae and looks like a prehistoric trilobite fossil, but that it is a perfectly shaped triangular wedge to fit between your hip bones like a tetris block.

When you add in thick layers of multiple ligaments and muscle attachments-- like the glute max, piriformis, erectors, and pelvic floor-- you get a combination of mechanical, inert, and contractile stability that results in a WHOPPING maximum range of motion of 3 degrees or 2 millimeters at this planar/syndesmotic joint. PTs and chiros have pretty good hands, but we have yet to prove that they can reliably assess this miniscule degree of SIJ mobility [4][5].

So if your hips aren’t out of alignment and your sacrum isn’t crooked, why does your SI joint hurt? Your pain experience is completely individual, so it’s hard to give you an answer without conducting a full-on assessment.

How to Help With The Pain

But, if you don’t have any underlying conditions, there are a few things you can do at home that might bring you some relief. Obviously, if they aggravate your symptoms, discontinue them and get assessed by a qualified professional.

These “muscle energy techniques” probably aren’t “re-aligning” anything; just giving the involved joints and muscles a different stimulus that can help blunt that pain signal. Try them out and let me know how they go.

Supine isometric hip flexion with contralateral isometric hip extension. 3-5 rounds of 5-10 second holds per side, gradually increasing contraction strength as tolerated.
Seated isometric hip abduction, followed by seated isometric hip adduction. 3-5 rounds of 5-10 second holds per side, gradually increasing contraction strength as tolerated.
Frog pump bridge. 3-5 rounds of 10 reps with 5-10 second isometric holds at the top, gradually increasing contraction strength as tolerated.