Hey everyone,
I believe knowledge is power. So many of us have seen countless medical professionals, and still struggled to get answers.
I’ve been through myself, and have gotten just about the full range of responses from the different medical pros I saw. Whether that’s primary care doctors, pain management specialists, neurosurgeons, PTs… I left no stone unturned.
And the incredibly difficult reality here is that most doctors and PT’s actually don’t learn about the SI joint in their original schooling. Because it’s such a new topic, and isn’t actually included on their licensing exams, medical and PT schools don’t necessarily teach about it.
Over time, I’ve identified four major types of responses you’re likely to encounter:
Perspective 1- Hasn’t heard of SI joint dysfunction at all
This happened more commonly back in 2011 when I was first injured. Believe it or not, there are medical professionals out there who haven’t heard of SI joint dysfunction. Why?
Historically, this condition has been tragically underrecognized, along with the genetic hypermobility disorders that so often play a role. I have even had doctors as my coaching clients, and they’ve confirmed they learned absolutely nothing on this topic in medical school.
Thankfully, I do think awareness has been growing, and I haven’t been hearing as many stories from my current clients about finding doctors who’ve never heard about this topic at all. You’re much more likely to find someone in one or the other categories.
Perspective 2- Believes in “SI pain” aka Sacroilitis
The next school of thought is frustrating because it’s so close. It’s almost what we need.
People in this school of thought – doctors, PT’s, and others- do believe that the SI joint can cause pain. In this perspective, the joint can become inflamed, due to degeneration and/or arthritis. They’ll often give a diagnosis of sacroilitis, which literally means “inflammation of the SI joints.”
However, the distinction with this school of thought is that they don’t believe in the concept of the SI joints going out of alignment. Rather, they attribute the SI “pain” to some abnormal movement on a microscopic level, but don’t believe the joints can go out of alignment.
That’s why you’ll have doctors who offer you a cortisone infection and refer you to PT to strengthen the muscles. The thought is that these treatments will bring down the inflammation in the joint, and then strengthening will stop the abnormal movement, and stop the pain from coming back.
These concepts are not wrong, per se. But the issue is that this perspective overlooks one of the most important aspects of SI joint dysfunction— which I’ll address in the next section.
Perspective 3 – Understands the concept of SI joint alignment
So… this is the school of thought that changed my life, and what I believe is truly necessary to help most people with SI joint dysfunction.
This school of thought builds upon the previous… but it goes a step beyond to acknowledge that sometimes the joint can become “stuck” out of alignment. This means that the hip bone is not in the proper position, relative to the sacrum, or base of the spine.
When these bones are out of alignment, it’s very subtle. It won’t show up on an X-ray or an MRI. But it is enough to dramatically alter the way you move and feel.
Usually, it’s physical therapists, as well chiropractors and osteopaths, who are most likely to understand the significance of the joint being out of alignment, because they’re in the specialties which work hands-on with the joint. But there are some doctors who understand as well, although it’s unlikely they’ll be trained to do hands-on corrections themselves.
The thing I can say is that anyone who truly understands the significance of SI joint alignment will also urge the importance of correcting it right away.
Each I’ve the practitioners I’ve seen over the years who truly was able to help me brought it up from the very beginning of our work together. It always comes up on Visit 1, because that’s how crucial it is.
That’s because these practitioners know something I also found to be true in my own experience- if your SI joints are out of alignment, there is really no substitute for correcting them. Alignment affects everything, and once your joints are lined up properly, everything gets easier again.
Perspective 4- Thinks SI pain is a protective mechanism generated in the brain
So, I debated whether or not to include this perspective in here, but because I know any of you are going to encounter it, I decided to include it here.
After everything I said, there is also a category of medical professionals that have heard of SI joint dysfunction… and don’t believe the SI joint can move enough to cause pain, on any level.
Rather, they’ll think it has to do with an over-sensitization of the nervous system. Essentially, the brain is going a bit haywire in an attempt to protect the person, so it will create the sensation of pain as a warning.
This is a tricky topic for me because I actually do believe this type of “protective mechanism” pain can happen. In fact, treating pain from this perspective was hugely helpful to me personally at a different point in my life, before I ever injured my SI joints. And it’s possible it may be happening in some people having pain in the SI area.
But if you are having SI pain, the bottom line is that it really does need to be fully investigated.
Many of the people who come to me for help have already had this idea mentioned to them by previous medical professionals, and it didn’t move the needle for them.
It’s so disappointing for me to hear that pain science is being misused in this way, because in the right contexts, it can be life-changing. But it’s not meant to be a way to try to “talk” people out of their pain, without acknowledging the underlying cause.
If your SI joints are out of alignment, nothing is going to fix the issue other than correcting the alignment itself. Everything else is secondary to that.
Moving forward: What we need in the future
Ultimately, I’d like to see the medical profession develop more of an awareness of joint alignment, and the genetic hypermobility conditions which so often play a role in conditions like SIJD.
Skeptics who think the SI joint can’t move will often quote studies that talk about how strong the ligaments that hold the joint together are.
My response to that is, well, if you’re going to tell me how strong the ligaments are, while overlooking the fact that up to 20% of the population has a genetic mutation that means their body forms connective tissue differently… clearly you don’t know everything.
Moving forward, I hope those of us who’ve struggled with SIJD can help to raise awareness and create a shift within the medical profession. Just because we can’t see a joint moving (or not moving) doesn’t mean it can’t create pain. Sometimes a very subtle misalignment – particularly in a place like the pelvis, aka the foundation of your entire spine – can play a very big deal.
Especially if you’re one of the people whose body codes for connective tissue differently.
I do think things are changing
Awareness of SI joint dysfunction has grown by leaps and bounds. Things are already so much better than when I first got injured.
We just need to keep going.
My Sacroiliac Joint Saga 