July - August 2003 Vol. 14, No. 4 | Contents
TRAINING SI Joint Pain by Aaron Haydu, D.C.	The low back can undergo significant stresses when playing a game as competitive and demanding as racquetball. Low back pain is a common cause of complaints following a vigorous match or tournament, due to the repetitive bending, reaching, and stretching required. Occasionally, low back pain is not caused from the low back but from a large joint in the pelvis called the sacroiliac (SI) joint. This pain can be differentiated from low back pain with a good physical exam and needs to be treated properly in order to avoid further complaints. The SI joint is a large joint in the pelvis that connects your tailbone (sacrum) to your pelvic bones. Its irregular shape and strong ligaments allow it to be a source of stability for the connection of the leg to the trunk. The joint has very little mobility but instead acts as a stabilizer of the pelvis and helps distribute impact forces from the legs. In low back pain that is worse with walking and after athletic activities, the SI should be considered as a possible source of the pain.  Initially, the low back and hip should be examined and ruled out first as a primary cause of the symptoms. Often the pain is caused by minor excessive forces or movements (such as those encountered in athletic activity) that can place a shearing stress on the protective cartilage. The joint is also capable of sustaining strain and sprain injuries that can be quite painful and debilitating, especially with walking and moving the affected leg. Individuals who have a short leg of even a few millimeters have been shown to develop SI pains as well.  Avoiding the injury involves strengthening the core muscles of the body (those from below the chest to above the knee). Abdominal training and leg flexibility are crucial, as are balance and coordination activities. Evaluation for chronic pain from the joint may reveal arthritis and nutritional support or joint injections maybe valuable. Also, if a leg length discrepancy is at fault, a lift for the inside of the shoe can correct the imbalance and allow for more effective distribution of the forces in the pelvis. Often the joint has become fixated, and requires manual treatment or manipulation to restore normal movement.  As with all joints, maintaining good joint health requires three key things. First, the joint must have healthy, strong, and flexible muscles acting on it. Second, the joint surfaces must be mobile. And thirdly, the body must be able to control the joint effectively with good balance and coordination. There are a number of exercises that can help this joint specifically and your chiropractor or trainer should be able to direct you toward keeping this joint healthy and happy.
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