I had a really interesting comment recently from a reader who’d been suffering from low back pain, but wasn’t quite sure what the exact cause was. She’d found relief both from a chiropractic adjustment as well as massage therapy.
However, she wasn’t sure what exactly the chiropractor and massage therapist meant when they referred to the problem they were addressing as her “hips being out of line.”
She asked if I thought it sounded like they were talking about sacroiliac joint dysfunction. My answer was that actually, there’s a few things they could probably be talking about. Here’s what I said:
The sacroiliac joint = the ilium and the sacrum
I find the most helpful way to describe SI joint dysfunction is to get very specific about how the ilium and sacrum are positioned, in relation to each other. Sometimes chiropractors and PT’s will try to simplify their explanations, because they’re assuming you won’t be interested or they don’t have time to go into detail. Make them! You have a right to know!
Here’s my very first video, showing you exactly where the sacroiliac joint is:
Anterior Pelvic Tilt
I think it’s possible that sometimes when people say “the hips” they might be talking about the positioning of the pelvis as a whole, in relation to the lumbar spine. For example, there’s a condition called “anterior pelvic tilt” where both sides of the pelvis are tilted too forward, but that’s a symmetrical problem.
When you have SI joint dysfunction, it’s assymetrical– if one hip bone rotates forward, the other one rotates backward. If you’re like me, this is actually pretty good news– it means only one SI joint can actually get “stuck” at a time.
Anterior pelvic tilt can be caused by muscle tightness, and also weakness, so this is a condition that might be helped by massage (although in the long term, it might be best to go to physical therapy). Here’s an article that explains a little bit more.
The Quadratus Lumborum muscle
A few times over the years, I walked into my chiropractor’s office thinking my SI joints were locked up, however it turned out that something else was going on.
There’s a very major muscle that runs up and down your torso, essentially connecting the bottom of your rib cage with the top of the pelvis. It’s called the quadratus lumborum:
When this muscle gets tight, especially if it’s just on one side, it can pull one of the hip bones up, causing it to sit higher than the other one. This can lead to the feeling that one side of your pelvis is up higher than the other, or that one of your legs is shorter than the other (because actually, your hip socket is being held up farther away from the ground).
This can feel pretty similar to sacroiliac joint dysfunction, in that it’s an assymetrical, left to right problem. Having a stuck SI joint can also lead to the feeling that one of your legs is shorter than the other.
However, this problem doesn’t directly involve the SI joint, although of course, it’s possible to have these two different types of dysfunction occurring at the same time.
When this happened to me, my chiropractors were able to release it almost instantly, by using a specific technique with their Activator tool to get the muscle to relax. (As you know, I have mixed thoughts on chiropractors, but I was pretty impressed by their ability to fix this particular imbalance).
Can you release a stuck SI joint by working on the surrounding muscles?
I personally have never heard of anyone being able to release the kind of “stuck” SI joint I’m talking about (when the ilium is jammed backwards against the sacrum) by working on the muscles.
However, you can achieve a lot of pain relief by releasing major muscles in the area, if it turns out that they are in spasm and contributing to some of your pain. (This is why I also recommend stretching regularly).
It’s also possible that when someone says your SI joint isn’t moving properly, they mean the muscles around it are in spasm and restricting its motion. If this is the cause, then it makes sense that getting the muscles to relax would help. So if you’re able to get relief this way, that’s great! But if muscle work helps, I don’t think your joint is getting “locked” in the sense that I talk about in this post.
Ask healthcare professionals to explain things in specific anatomical terms.
If you’re confused about whether a certain professional is addressing your SI joints or a different problem, I suggest you ask them to explain what they’re doing in more anatomical terms. If they are looking at the SI joint, they’ll be looking at the position of the ilium and the sacrum, relative to each other.
For more reading:
I found this great article written by Dr. Maureen Kennedy, a sport and exercise medicine physician. She talks about some of the same things I talk about in this post. The only thing I would clarify is that she’s talking about the SI joint in the first paragraph under the heading “Rotation means trouble.” In the very next paragraph, she goes on to talking about anterior pelvic tilt, so don’t get confused!
Okay… that’s all for this post! As always, I hope it was helpful! If you have any comments or questions, you can leave them below or email me at email@example.com.