What is the difference between SI Joint inflammation and dysfunction?

In the video above, Dr. Ty, a spine surgeon who operates on the SI joint using the Zyga implant, describes a very important concept for people suffering from SI joint dysfunction to understand.

SI Joint Dysfunction vs. Inflammation

SI Joint Dysfunction is “an umbrella term for an abnormality within the joint.”  Although this umbrella term can include inflammation in the joint, Dr. Ty explains that most often when clinicians use the word, they are using it to refer to “either an abnormal motion or an abnormal position of the SI joint.”

Now, when the SI joint is out of place, this means that the ligaments that are supposed to hold it in place are not doing their job, and have become slightly stretched out.

This is what Dr. Ty means by the term “ligamentous laxity”– ligaments that are lax, or loose.

The overlap between SI joint dysfunction and inflammation occurs here, at the ligaments:

“When ligaments become loose, they can become inflamed, and this is typically what we refer to as SI joint inflammation.”


This has been a question that I’ve really thought about a lot in the past few years.  I always considered the main problem with my SI joints to be that they were constantly rotating out of place and then getting stuck that way.  (This would be in the first category Dr. Ty describes: SI Joint Dysfunction, an abnormal motion or position of the joint).

However, many of the interventions that were suggested to me by various physicians all seemed to be targeting a problem that was caused more by inflammation.

I actually haven’t written about this previously because it wasn’t super helpful, but I did see an orthopedist once who offered to do a lidocaine injection into my SI joints.  This is supposed to be one of the gold standards for diagnosing SI joint pain.  The idea is that if the injection helps, then it really was your SI joint causing pain, versus something similar like the lower back.  (UPDATE: I did write about that appointment here).

However, I really questioned the orthopedist on this and explained that my level of pain really seemed to be dependent on the position my SI joints were in.  When they were out of place (or stuck) I had pain, but then as soon as my chiropractor put them back into place, the pain went away.  (This was before I learned to adjust them myself, an important part of my story).

I asked him, if the pain goes away as soon as my joints are put back into place, is the lidocaine injection really going to make that much of a difference?

He had to admit no, not really.  I asked him a bunch of questions, and determined that the lidocaine injection would help more with an inflammation-based problem that was not so dependent on the positioning of the joint.   He said that, based on the way I described my symptoms, it was not really clear whether or not the lidocaine shot would help.

He still was more than willing to do it– I think it is drilled into the head of every doctor who treats the SI joint that lidocaine injections are the first step.  However, I personally decided it wasn’t worth it for me, since I’d had a bad response to a cortisone shot in my knee once and ended up in even more pain, simply from having fluid injected into a joint that was already inflamed.


So I really appreciated this video because I think it helped to sort of clarify what went on for me back then.

As I noted during my post about my second visit with a physiatrist, it seems that most physicians that treat the SI joint without actually performing surgery are more comfortable with the idea of SI joints that are hypermobile or inflamed, but not necessarily getting stuck in the wrong place.

I believe this is the main reason why MD’s were never really able to help me– I was only really helped from people who had been trained in directly addressing the positioning of the joint, such as chiropractors and PT’s.

(Now, there are MD’s who do deal with the positioning of the SI joint, however these are generally surgeons, who are operating in order to fix its positioning and stabilize it in a good place).


This is definitely a complicated concept, and possibly one of my most complicated posts yet, but I hope it is useful to you guys!

I know it’s always helpful for me to write all my thoughts out and link to related resources, as I try to generally tie everything together in order to come up with a better understanding of this joint.

So I hope you enjoyed reading it as well!  Any comments or questions, feel free to drop me a line or leave a comment below.


A note on SI joint surgery: I have not written a ton on SI joint surgery yet, because thankfully, I have not had to learn much about it in order to heal my own problems.

However, there are a few different surgical options which are being developed.  I am not well educated enough on any of them to make a pronouncement yet.  So, if I share resources that are produced by the various companies behind these devices, it is in the spirit of collecting information, and because I’m interested in what the doctors who perform these procedures have to say.  Like everything I share here, of course, it’s important to simply take what is useful to you, and of course, consult your own doctor with questions about your next steps!


7 thoughts on “What is the difference between SI Joint inflammation and dysfunction?

  1. lorie says:

    So if naproxen helps with my pain, and I feel I can adjust the SI joint by lying on my bed and popping it back into place, where does that put me in the stream of getting permanently better? I haven’t had a shot, have only been to the PT and chiro, but besides my overall strength returning and being able to do more, the basic pain in that specific spot keeps returning. (Though I do feel pretty good most of the time.) And my lower back keeps stiffening up and there’s a lack of curving right above the sacrum. It’s been almost 9 months, with just the PT and chiro. I think I’m ready to see if I can be referred to a doctor. The pt is trying to discourage me from that, and encourage me to do breathing exercises.


    • Sunlight in Winter says:

      Hi Lorie, well the first thing I would say is that no PT should EVER try to discourage you from seeing a doctor! It is absolutely your right to see whoever you want. I’m glad that it sounds as though you’ve been making some progress but frankly, I am a little skeptical of this PT based on that alone. It is not within the scope of their training to say whether you should see a doctor or not.

      I think sometimes people get a bit of an ego about their ability to help you, but it shouldn’t be about them, it should be about you! So I think you should go ahead and make an appointment! I am quite sure that after 9 months, you will be able to get a referral (and it sounds as though one is in order!). Maybe the doctor won’t make any changes to your current treatment plan, but at least then you’ll know. There is a certain type of specialist called a physiatrist that you may want to see. https://sijointsaga.com/2017/09/29/sacroiliac-joint-doctor/

      With that being said, if you’ve had improvement with the treatment you’ve had, then yes, I think that is a good sign that you will be able to continue getting better. I don’t know if you’ve seen this post for me, but I personally found I got a LOT better once I stopped receiving chiropractic adjustments and learned to adjust the joint myself using the Muscle Energy Technique from a physical therapist. That is something to keep in mind as well. Every PT you see will probably have different suggestions for you, so don’t be afraid to look for a second opinion there as well! I think I may have heard of the breathing exercises you’re referring to, but they were not a part of my recovery at all. Please don’t ever think you are stuck with the first PT you happened to see!

      I hope this helps– feel free to let me know if you have any more questions!


  2. Sue says:

    Hi I’m Sue,
    I’ve had back pain off and on for about 8 months. I went to a wedding and was dancing and the next day my back was killing me. I went to the chiropractor and he adjusted me for about a month. He said one leg was longer than the other. I was on muscle relaxers and I ibuprofen for about a month and a half. I then was seeing a personal trainer while still seeing the chiropractor. He worked me too hard so I decided to see a PT. She told me to stop seeing the chiropractor. I’ve been going to her for about 4 months now. She has never adjusted me. I think I’m working a little too much with her too. I’m 58 and my muscles aren’t that strong. I’ve had one episode of inflammation that was bad enough to take ibuprofen. She then said that I will never fully heal and will always have a number 3 pain score and if I do too much will have inflammation. She said that I have degenerated si joints. She taught me one move to help my one joint but I want to be able to adjust them like you do. Should I get another opinion?


    • Sunlight in Winter says:

      Hi Sue, yes to me, getting another opinion is always worth it! You can always decide afterwards which person you want to continue working with. There really is such a range in skill level and training out there among PT’s— maybe someone out there will be better able to help you. It sounds like you want to find a PT who’s trained in Muscle Energy Technique — if you check out my Physical Therapy page, I have a bunch of tips on how to find a good PT there https://sijointsaga.com/physical-therapy/ Hope this helps!


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