The Route of SI Pain

In the quest to nail down exactly where pain is coming from, people have a tendency to drive themselves absolutely insane trying to pinpoint WHERE the pain is coming from.

Questions flood SI joint Facebook daily. Does anyone else have pain down their leg, in their foot, down the side of their leg, outer hip, groin.  The list goes on and on. Is it a progression, is it more damage, does SI joint dysfunction cause these sensations.

I get it. I’ve been there. I totally understand. 

Because I understand, let’s go through some more anatomy and basics of how the body works.
I will also remind you that pain that has lasted longer than 3-6 months is rarely a single tissue that can be identified and “fixed”.  If you want to read more on how pain does work, read here.

Buckle up, here we go.

Pain travels on nerves. Nerves serve to power certain muscles and give sensation to certain parts of your skin. These are called dermatomes (skin) and myotomes  (muscle). 

It’s important to understand the fact that we can trace these patterns from a specific spinal level to the body part where you are feeling pain. They don’t really change. So if you have been told you have sciatica the sciatic nerve does not go to the front of your leg. 

You may have sciatic-like pain, and you may have pain in the front of your leg, but the sciatic nerve is NOT the CAUSE of that. That’s a different nerve pattern distribution.

What do we know about the pain patterns of the SIJ?

A doctor by the name of Joseph Fortin decided to see what pain referral patterns come from the SIJ. He set up a little study, taking people with no SI pain and injected irritants into the joint to see where they hurt. 

The results.. Pain was felt 10 cm from the posterior superior iliac spine ( where you point when you say it hurts.) towards your feet and about 3 cm out to either side. That means mostly in the buttock and down into the mid thigh.   

This is where pain generated by the joint is felt.  

You can check out the research here and here

But Amy, you say, I feel pain in more places than that – does that mean it isn’t my SIJ.

No, that’s not what I am saying. Your SIJ can hurt as can the surrounding structures. Let’s just stop blaming the joint for every pain we feel in every part of our body, ok. 

I refer you back to the complex anatomy of the SIJ – it shares all the muscles and nerves of the hips and low back, so it is not unusual for someone to have been handed a diagnosis of SIJD without following diagnostic procedures, which I wrote about here.  If one is looking for solutions to solve the offending tissue, this can be a very expensive and long lasting search. 

Are you frustrated yet?  I would understand if you are. Part of the point of this series is to show you this is not as simple as finding a single tissue causing your pain. It’s why I keep imploring you to stop looking for the single offensive portion of anatomy when your scans come back with nothing significant and there are no sprains, no fractures, or tumors.

There is no clear answer as to why. But there are clear paths out of the mind numbing pain. 

We will get to those, I promise.

Let’s keep going down this path of trying to trace the path of pain, shall we.

The next guy that gets tons of hype is the piriformis. This is a muscle that runs from the anterior ( front) portion of the sacrum to the hip. It’s job is mostly to externally rotate the hip. ( think of dancers turning their feet and legs out) – that’s what this muscle and a bunch of his friends do. No one ever mentions this muscle has 5 other friends in the same area that do the same thing, kinda makes you wonder why doesn’t it? 

The poor piriformis gets blamed for a lot. The sciatic nerve runs underneath this muscle and anatomists have found 4 different variations on how the muscle and nerve can exist in our bodies. 

We are told tales that it is tight trying to stabilize the SIJ. Which is a cool story, i guess, except it can’t do that. Can’t really understand why people keep saying it though. Does it get tight, sure does. Why? Well same reason other muscles get tight, they are guarding the part of your body with pain. Sometimes it really is that simple. 

As an aside, it always amazes me that people will roll it, stick thumbs in it, inject it with botox, use medications, stick needles in it, hell, I had mine ultrasound to death, use electricity on it…. Yet no one really wants to try relaxation techniques to relax a muscle. Kinda crazy when you think about it isn’t it?

We complain and fret and freak out that this piriformis muscle is too tight and we cross hell trying to find a solution, yet we ignore some of the simplest forms of relaxing a muscle. Jut some food for thought.

Anywho, back to pain pathways. 

The sciatic nerve is formed in the lower spine by the combination of motor and sensory fibers from spinal nerves L4 to S3. These spinal nerves belong to a larger group of nerves in the lower spine called the lumbosacral plexus. (more big words).

This is why it’s so very important to follow a diagnostic flow chart before getting lost in the weeds! L4 – S3 make up what we call  the sciatic nerve. The reality here is pinpointing the exact cause of your pain is not as simple as you think. If you have pathology anywhere along these places in your imaging – well, no need to keep looking or to blame the poor SI joint. The muscles this nerve pathway gives power or motor control to. Please take note these are all on the back of the leg. ( Hamstrings, calf and foot.)

Fine, I believe you, I don’t need to know the exact reason for my pain, but I’d like to get out of it. What do I do?

So glad you asked!  Here are a few of my favorite movements to try when pain pops up in these places. Here are nerve glides, don’t listen to the explanations, just follow the movement!