What happens when the SI joint is out of alignment?

Hey everyone,

So here’s a common symptom of SI joint dysfunction that I hear people describe just about all the time.

It’s this feeling of a deep pain coming from the area around your SI joints. Like a stuck feeling.

A feeling that you ought to just be able to move a certain way, or stretch just the right amount, and things ought to pop back into place.

But the problem is that nothing you do actually resolves the problem. Maybe you tried a few exercise videos off of Youtube, and you thought you felt better for a moment, but ultimately, nothing really seems to take the pain away.

To me, this kind of pain sounds like your SI joints may be out of alignment.

What does that mean?

To understand the joint being out of alignment, we first have to back up and remember what, exactly, makes up the SI joint.

The SI joint, or sacroiliac joint, is where the hip bone (or ilium) meets with the sacrum (the base of the spine).

When the SI joint is out of alignment, this means that the hip bone has moved out of place, relative to the sacrum.

It’s important to remember that, when this happens, the hip bone is really only moving out of the correct position by a few millimeters. It isn’t even far enough to show up as abnormal in an x-ray.

The problem is that it’s still not the correct position for your body.

Even just those few millimeters can still have a big impact on your overall movement patterns.

The hip bone was designed to rest against the sacrum in a particular way. When it’s out of alignment, that puts a lot of stress on things like the cartilage and the ligaments– which they weren’t designed to handle for long periods of time.

So that’s what starts to cause the pain you feel, and the feeling that something is “stuck”– it’s because it is stuck.

Impact on movement patterns

If the SI joint is out of alignment, it can also cause difficulty walking. For me, sometimes it would make it feel like it was hard to move one of my legs.

This is because the SI joint is supposed to move a tiny bit when we walk. Even though most of our range of motion comes from the hip socket itself, our body is expecting to get a few degrees of movement out of the SI joint as well. If that SI joint locks up, our hip bone doesn’t rotate when we go to take a step. That means, ultimately, that our leg doesn’t swing out in front of us as far as our body was expecting, leading to that “stuck” feeling.

When the SI joint locks up, it can also cause pain in other places, such as the feet and knees.

This is because, when our leg isn’t able to hit the ground at the angle it was designed to, it ends up placing additional stress on places like the feet and knees.

I hear from many, many of you wondering if foot pain in particular can come along with SI joint dysfunction– the answer is yes.

For me, that pain would disappear almost immediately once my joints were put back in alignment. That’s because, technically, I didn’t have a foot problem. I had a problem in my pelvis, that was causing me to use my foot differently. Once I fixed the root of the problem, the secondary issue went away.

Correcting your alignment

This brings me to what is perhaps the most important part of knowing about the SI joint being out of alignment– knowing how to correct it.

For a few years, I went to a chiropractor for this, before realizing it was too rough on my body. I then switched to the Muscle Energy Technique, which I learned from a really knowledgeable physical therapist, and started doing a lot better.

Regardless of which type of adjustment you’re using, the goal of any realignment technique is to help get that hip bone get back into the proper position, relative to the sacrum.

Again, we’re only talking about a joint that can move by a few millimeters. However, in the same way the joint being out of alignment by just a tiny bit can cause all kinds of problems, you’ll likely experience significant relief once you’ve aligned things correctly again.

Which pattern of misalignment do you have?

Unfortunately, something which even many physical therapists may not be aware of is that there’s more than one way for the SI joints to be out of alignment.

“Out of alignment” is a pretty generalized term, which simply means the hip bone has moved out of place, relative to the sacrum. But that term alone doesn’t tell you which way the hip bone has moved.

Instead, there are specific terms that can be used to further clarify exactly where the hip bone has moved, compared to the sacrum. These terms refer to specific, known patterns which each must be corrected in precise ways.

I’ll describe these terms in more detail in future posts, but just to give you an overview, these terms include things like:

• upslip: the hip bone has moved straight upwards, relative to the sacrum
• anterior/posterior rotation: the hip bone has rotated forwards or backwards, relative to the sacrum
• inflare/outflare: the hip bone has moved either inwards towards the center of the body, or outwards away from the sacrum

If someone is going to correct your alignment– or if they’re going to teach you self-corrections– it’s really crucial that they explain to you exactly which of these patterns you have, and what their rationale is for diagnosing these patterns. (More on this later!).

Different types of adjustments:

The last topic I’ll address in this post is the fact that there are different approaches a practitioner can use to correct a misaligned SI joint. Some types of adjustments, such as chiropractic adjustments and some of the techniques used by a PT, may involve the practitioner moving your hip bone back in place with their hands.

Others, such as the Muscle Energy Technique, allow you to gently contract your own muscles, and use that muscle contraction to bring your joint back into the correct position. This definitely requires the proper training, but can be incredibly helpful once you know how to do it!

For more info:

Be sure to check out my Correcting Your Alignment page!

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Illustration credit: Mikael Haggstrom/Gray’s