I have been thinking a lot recently about different ways to classify different types of SI joint dysfunctions. Based on all the reading I’ve done, learning from other people who’ve struggled with this issue, and talking with various medical professionals, I’m starting to think there are 3 main types.
The following types refer both to the nature of the problem, as well as the symptoms, if that makes sense. All of them involve some sort of weakening of or injury to the ligaments that are supposed to hold the joint in place.
Let me see if I can explain…
Type 1. Joint Hypermobility due to a Ligament Injury
Joint hypermobility means that a joint is moving more than it should, in this case because the ligaments are stretched out.
My friend Kelsey struggled with SI joint dysfunction for a few months, at one point in time, however her case was pretty easily resolved compared to mine.
She had stretched out the ligaments in her right SI joint because she was in a car accident where she was rear-ended, while she was stomping her foot down on the break. That impact created too much force for her SI joint ligaments, so it created a lot of pain.
However, Kelsey was able to recover with one course of physical therapy, with the first physical therapist she happened to see. (God, could we all be that lucky!).
Her pain was caused by her right SI joint moving beyond its normal range of motion. Any time you have a joint that’s moving too much, it puts strain on all of the ligaments of the joint (not just the one that may have been initially injured). It also overworks the muscles, which can spasm up to protect the area, and create inflammation.
This, obviously, can be painful.
However, Kelsey never seemed to experience the main symptom that has plagued me, which is my joints moving out of place and staying that way.
Type 2. Hypermobility can lead to hypomobility: Joints that get stuck in an abnormal position
Here’s the thing about hypermobile SI joints. In some people (like me), the hip bones can rotate out of place, in relation to the base of the spine, and then stay that way.
With my SI joint dysfunction, my main symptom was actually never pain. It was that one of my SI joints would get “stuck,” and I wouldn’t be able to fully use the leg on that side. Then that would create pain, but it seemed to be more as a result of having my leg restricted. If I didn’t move, it usually didn’t hurt.
So in technical terms, you have a joint that was hypermobile (moving too much), but once one of the hip bones moves enough that it gets jammed against the base of the spine and doesn’t move anymore, then it has become hypomobile.
From my conversation with the first physiatrist I ever saw, I have come to understand that whether or not someone’s SI joints get stuck actually has a lot to do with the shape of the bones they were born with.
In my physical therapy prerequisite classes, I have learned that there are multiple factors that can affect how stable a joint is, based on its shape. Some people are simply born with more stable joint shapes than others.
Personally, I had the luck to be born with joints that are on the extremely unstable end of the spectrum. (The orthopedist who performed my surgery for compartment syndrome has actually pointed this out about most of the joints in my body). Basically, I’m prone to injury more than other people, because my joint shapes leave me vulnerable.
So basically, it seems that the main difference between someone like Kelsey and me might have less to do with the way we were initially injured, or the types of things we did to recover, but the actual shape of our bones, which obviously neither of us can control.
So if you’re suffering from prolonged SI joint dysfunction, and you don’t understand why you aren’t getting better compared to other people, it’s not your fault. You may be doing everything right. But you can’t help the shape of your bones.
(What you can do, according to my orthopedist and everyone else, is to do everything you can to strengthen your muscles, because that helps to protect the joints).
Type 3. Joint Hypermobility caused by a disease or genetic condition
This is the category of SI joint dysfunction that I am the least familiar with. However, there are conditions known as connective tissue disorders, in which someone is genetically predisposed to have a weakening of their ligaments and other connective tissues.
For example, one of the first places in the body that Ehlers-Danlos syndrome seems to affect is the SI joints.
If your doctor suspects you may have a condition like this, it’s obviously a very important matter to investigate. However, I don’t want anyone to worry unnecessarily that they have it. It is something to talk to your doctor about, and then they will be able to do certain tests (blood work and possibly x-rays, I believe) to see if you have it or not.
If you want to learn more about connective tissue disorders, I really recommend the blog Jelly-Like Joints, written by a highly knowledgeable patient.
So, these are my main three.
What do you think? Do you agree, or have any suggestions? Feel free to chime in below! This is really just a hypothesis I’m working on, so I want to know if I forgot anything.
Thanks for reading!
Here are a few related posts I’ve written previously: