Sacroiliac Joint Dysfunction



Well, firstly, dysfunction means “not working properly”. This is a general term which refers to any number of problems (irritation, compression, misalignment, laxity etc.) which can cause a joint not to function as well as it should. 

The sacroiliac joint (SIJ) is an L-shaped joint between the sacrum, which is a wedge-shaped bone at the base of the spine (ending in the coccyx) and the larger, wing-shaped bones of the pelvis (which incorporate the hip joint). 


The term sacroiliac joint (SIJ) dysfunction most often refers to excess compression of the joint (usually as a result of local muscle spasm creating uneven forces over the joint) which causes the joint to become painful. 


Pain from the SIJ can present as low back pain, buttock pain or sciatica. 

In some cases, there is no pain in the area at all, but an injury occurs elsewhere as a result of altered biomechanics (for example, a hamstring strain on the side of dysfunction). 

For a long time, it was thought that the SIJ was fused and therefore did not move; as a result, SIJ pain is still often assumed to be referred from the lower spine. However, research has shown that this joint does have a small amount of movement and can most certainly give rise to pain. 

Physiotherapists who have undergone specialised training in this area are able to identify and treat a number of different types of SIJ dysfunction. 

If you are experiencing any of the following, the cause could be SIJ dysfunction:

  • recurrent low back pain
  • groin pain
  • buttock pain
  • hip pain
  • recurrent hamstring or calf strain

Milkwood Health are specialists in this area - we could be your answer!

A sense of self...

Have you ever had a sense that the health practitioner telling you what was going on with your body was a little off the mark? Did you suppress that thought and heed their advice, telling yourself “He’s the expert: what do I know?”

Have you ever persisted with a prescribed exercise, even though you suspected it was aggravating your symptoms?

Why didn’t you speak up? Were you afraid of offending the practitioner, or being branded a “difficult” patient? Were you worried you might sound ignorant?

Any therapist worth his salt will welcome questions of any sort - and remember: he/she probably knows a lot less about your field than you do.

I think I speak for most of my colleagues when I say this: physios, chiropractors, osteopaths and the like generally choose a career in this field because we genuinely want to help people. At the same time, we like to be challenged, and what better challenge than the incredibly complex mass of connections, tissues, systems and emotions that is the human body? 

Humans have been studying themselves for centuries and we are still only at the tip of the iceberg. So, listen up folks: WE DON’T KNOW EVERYTHING ABOUT YOUR BODY! WE DON’T EVEN KNOW A LOT!!

Physiotherapists know a lot about the structure and function of many of your body systems - the musculoskeletal system in particular - and we know a little about how the brain works. This does not necessarily mean we know your body better than you.

If you go to see a physiotherapist (or other bodyworker), you will get a much better result if you go with the view that the pair of you will work as a team to nut it out together. If your practitioner talks down to you or seems to brush over your story,  diving into treatment without hearing you properly, FIND A NEW PRACTITIONER. Arrogance has no place in the realm of health care. 

After two decades, I still learn something about the body every day - and each time, I am learning something about the body in the room with me at that moment. A body that is part of a person with a brain and a heart, connected to a whole network of other people, animals, plants, spaces. Part of a community. 

Bigger than me. Bigger than them. Most certainly bigger than their left shoulder or lumbar spine. 

I think what I’m trying to say is:

Ask the question. Voice the doubt. Challenge me. Please.

4 ways to get the most out of your physiotherapy session:

1. Ask for clarification if there’s anything you don’t understand. If you don’t know why you’ve been asked to do something, you’re much less likely to do it.

2. Voice your concerns if you have reservations about a technique or exercise. If the therapist can’t explain why they are doing something, they’re not giving you 100% of their attention.

3. Do mention that old injury or other niggle you think is irrelevant. It’s all relevant. The more information we have, the better.

4. Tell your story. Anything that has happened to you has happened to your body. This extends beyond physical injuries to personal trauma, stressors and life events.


Can stress be a good thing?

Leonard Bernstein once said: 

“To achieve great things, two things are needed: a plan, and not quite enough time”.

Stress gets a bad rap these days: it always seems to be seen in terms of its negative health benefits, which are well documented. However, stress serves a purpose: historically, it got us out of life-threatening situations, and the stress response remains a vital part of the human make-up. The main stress hormone, adrenaline, is essential for life. It plays an important part in the regulation of our vital organs and enables us to react quickly in times of danger: have you noticed how your reaction time is much quicker if you step onto the street and a cyclist hurtles past, compared to on the tennis court?

If we didn’t get stressed, we’d most likely never be on time and would get very little done - it’s a great motivator!

The problem arises when chronic stress sets in: we tend to fill our weeks up with hundreds of tasks and bite off more than we can chew, resulting in a state of hypervigilance. In this state, we buzz around and rarely allow ourselves time to slow down or pause, which is when adrenaline levels would normally drop and allow our parasympathetic nervous system to kick in and take care of the everyday “house-keeping” such as digestion and tissue repair.

Have you noticed your back aches more at the end of a busy/stressful day, or you get a stomach ache if you don’t pause and sit down to eat lunch?

Stress is part of the “yang” of life - we just need to learn to balance it out a bit better with a good dose of yin.



Mindfulness - what does it mean?

Mindfulness seems to be a buzz word at the moment - everyone is talking about trying to squeeze a half-hour of 'mindfulness' into their busy days. Isn’t it a little contradictory, though, racing about like mad, spending the obligatory 30 minutes “quietening the mind” and then racing back off at full speed to work our way through our list of tasks for the day?

While this can certainly be a useful tool, true mindfulness is about being in the moment while you go about your day, no matter what you are doing. I’m yet to meet anyone who can achieve this all the time, but I don’t think working towards this necessarily means spending four months of the year with Monks in Tibetan high country.

Mindfulness is about being aware. Being mindful does not mean staying calm and unaffected all day, but rather noticing when we feel anger or frustration (or whatever) and perhaps pondering why for a second. The act of noticing our mood or emotion often seems to dissipate those feelings enough to prevent that downward spiral into what we think of as 'having a bad day' - which is really just a perception that the world is against us. We notice the frowns and not the smiles when interacting with others. We feel the traffic is worse than usual or the kids are being “difficult”, when really it is our internal state that makes it seem so. 

Regretfully, I rarely make the time to sit down and meditate or listen to a relaxation recording, but I do find stepping back from a situation, taking a deep breath and reminding myself of the bigger picture (I love my kids, I love my job and I love my husband: what do I have to be grumpy about?) helps me to be a little less reactive and a little more proactive.