This article helps to provide all the information you need about how to sit with SI joint pain. As an individual is performing their daily activities, the ligaments in the Sacroiliac joint allow the transfer of forces between the trunk and legs. However, while experiencing Sacroiliac joint pain, these same daily activities might become difficult due to increased tension enforced on the ligaments. Something as simple as sitting may become painful and may lead to further irritation.
What is Sacroiliac Joint Pain?
When trying to understand how to sit with SI joint pain it is important to understand what sacroiliac joint pain is. One of the most common types of lower back pain is Sacroiliac Pain. This type of low back pain may be caused by sports injuries, traumas, pregnancy, or even spinal surgery. (1)
What Causes SI Joint Pain?
The causes of Sacroiliac joint pain may be divided into two further types: Traumatic and Atraumatic Causes. (2)
· Fractures in the Pelvic Ring
· Fall onto the back causing soft tissue injuries
· Motor vehicle accidents causing an indirect injury
· Heavy Lifting and Repeated Torsion (3)
· Increased Load in expecting females (4)
· A discrepancy in leg length
· Lumbar Fusion leads to accelerated degeneration of the Sacroiliac joint
· Prolonged Seated position causing chronic pain in the lower back
Anatomy of the Sacroiliac Joint
It is important to understand the anatomy of the sacroiliac joint when asking how to sit with si joint pain. Every individual has a total of two sacroiliac joints in their body, one on either side. It is found at the junction of the Ilium and Sacrum. The sacrum is a flat and wide done, which is found between the tailbone and lumbar spine. The ilium is also known as the hip bone.
In healthy individuals, the movement of the SI joint is a minimum due to the thick ligaments which hold it together. A sudden injury to the joint or repeated stress and minor traumas may lead to the joint becoming painful. Some individuals may also experience the pain radiating to their lower back and buttocks.
Symptoms of Sacroiliac Joint Dysfunction
Individuals who experience SI pain report it as being deep-seated in nature and radiating to the thigh or knee. The pain originating from the Sacroiliac joint may be often confused with other disorders and may be diagnosed as radicular pain. Individuals frequently complain of experiencing pain while sitting down, lying on the side, or even climbing stairs. (5)
Diagnosis of Sacroiliac Joint Dysfunction
The diagnosis of SI joint dysfunction often begins with a thorough history and examination conducted by the healthcare professional. The movement and pain associated with such movement are an area f particular focus during the examination. The doctor may also perform neurological tests with a focus on deep tendon reflexes, motor activity, and Babinski signs of both the legs. Since differences in the leg length is also a common cause of this pain, the length of both the legs is measured during the examination.
This is often followed by radiographic imagining, which may include X-rays, CT scans, MRIs, and image-guided injections.
· A plain x-ray might help locate the origin of the pathology causing pain and any obvious changes in the Sacroiliac joint.
· A CT scan is a much more accurate assessment of the bony architecture of the joint.
· MRIs may be beneficial for the detection of inflammatory conditions like Spondyloarthritis. However, this may not be beneficial for the detection of non-inflammatory causes of Sacroiliac joint pain. (6)
· Image-Guided Injections are the recommended method for accurate diagnosis of Sacroiliac Joint Dysfunction. This helps the doctor assess the factors which may lead to relief and inflammation of the symptoms of this condition. The injections during this diagnostic procedure are directed towards the lower portion of the joint, and it is inflated only by injecting 1-2 ml of infiltration. (7)
Treatment Options For SI Joint Pain
The plan for SI joint pain relief starts in a similar way to the other lower back or hip pain treatment plans. An orthopedic doctor, chiropractor or physiotherapist may recommend different joint exercises and spinal stabilization methods for the lower and upper body. During the physiotherapy session, belts may be provided to the patient, which they can also use at home to perform at-home exercises. This may be particularly beneficial for pregnancy-induced SI joint dysfunction. (8) This management may also include the recommendation of Non-steroidal anti-inflammatory drugs or other forms of pain killers. However, these might only be effective for symptoms relief. If there is a certain activity or movement that triggers the pain, the patient may be advised about the correct posture and counseled to alter the particular sports or everyday activity. Other treatment interventions that may be indicated include Prolotherapy, extra and intra-articular steroid injections, radiofrequency treatment, chiropractic adjustments, physiotherapy, and even surgical manipulations. (9)
The structures in and around the SI joint have a poor blood supply, which is why they can struggle to heal on their own. It is the oxygen and nutrients in our blood supply that help to heal these structures.
Prolotherapy involves the injection of a regenerative solution into these structures to provide a direct supply of what is required to heal and repair.
As the treatment is helping to treat the root cause of the issue, it is deemed to be a permanent fix.
The steroid injections may help control the inflammation in the joint and relieve the painful symptoms associated with the inflammation. These injections may be injected intraarticularly or extra articularly. Experts recommend the steroid injections either extra articularly or in a combination of the two.
The radiofrequency treatments for Sacroiliac joint pain include radiofrequency denervation and pulsed radiofrequency. The denervation by radiofrequency therapy is commonly focused on the lateral nerve branches that supply the Sacroiliac joint. However, this procedure is only able to cause denervation of the nerve at the back, not those found anteriorly. On the other hand, pulsed radiofrequency is another form of this treatment that does not completely destroy the nerves. Due to the pulsatile nature of the radiofrequency being directed at the nerves, it creates an electric field around the site of pain. This leads to an alternation of pain transmission, particularly through fibers like A -Delta and C fibers.
Extreme cases of pain, which may not be managed through more conservative approaches, may be referred for surgery. However, previous studies have shown the surgical treatment for Sacroiliac joint pain to be mostly ineffective. A study conducted by Schutz and colleagues showed that out of the individuals who went for surgery, 82% were unsatisfied, while 65% opted for a reoperation. (10) However, some experts recommend the new triangular implant technique due to its increased effectiveness and better results. (11)
Exercises and Physiotherapy
The physiotherapist may recommend a number of chair exercises that may allow the individual to sit more comfortably and conduct their everyday activities more conveniently. They may also explain the difference between good posture and bad posture and recommend the correct sleeping position. The exercises may include:
· Backbend: Backbend or seated backbend may be practiced to improve the stiffness in the lower back. This may be done by sitting at the edge of the chair with both the hand touching the lower back and feet pressing flat against the floor. After this, the individual is to push against their lower back and inhale deeply. The exhalation is by arching the back and looking towards the ceiling. The individual may practice this at least five times per day.
· Torso Stretch: Torso Stretch may be recommended as a way to promote mobilization of the spine. This is practiced by sitting in a chair while both feet flat against the ground and placing a tight hand on the back of the chair. This is followed by slowly turning the body towards the arms and staying in that position for 30 seconds. The individual may then repeat this on the other side.
· Hamstring Stretch: This is a seated version of the hamstring stretch, which helps the individual to loosen their hamstrings. This may also improve the overall balance and relieve the Sacroiliac pain. The individual may conduct this exercise by sitting in a chair with both heels pressed onto the ground while the toes are facing upwards. They are then recommended to slowly reach for their feet until a gentle stretch is felt at the back of the legs. This position is to be held for at least 30 seconds.
How to Sit With SI Joint Pain
When an individual sits down, an increased tension is experienced by the ligaments in their Sacroiliac joint. This increased tension may present itself in the form of a painful sensation, which makes it very hard to sit down.
The instructions which may be recommended by experts to make sitting easier include keeping the hips neutral as an individual sits down. This prevents excessive stress from being imposed on the ligaments associated with the Sacroiliac joint. This is done by keeping the hips leveled and preventing them from rotating to one side. They should also prevent the position of legs that may lead to asymmetry of the hips, like sitting with crossed legs or keeping one leg over the other.
Sitting on a Chair
Hence, an individual with Sacroiliac Joint pain may sit on a chair with their chest up and their shoulder blades down. The knees should be kept slightly apart and should not be crossed. The chair should have a pad or cushions that help support the lower back as well.
Sitting on the Floor
Sitting on the floor is also referred to as the tailor’s position. The recommendations for sitting in the Tailor’s Position are similar to sitting on a chair. The individual should try to keep their hips neutral in order to reduce the stress on the ligaments of the Sinoatrial joint. As an individual sits down, their sit bone should be held firmly across the floor. The legs should be crossed in such a way that both the feet are under the thigh of the opposite side. Moreover, the chest should be kept up, while the shoulder should be relaxed.
Use a Standing Desk
A standing desk is another option for individuals who are required to sit across their laptop in the office for a long period of time. Hence, if sitting down is causing pain, it is recommended to switch between sitting and standing positions and take frequent breaks. However, standing does not always mean the individual has to take a break from their work. Instead, they may use a standing desk and continue working. The desk should be adjusted so that it is at an elbow height. The face should be between 20 to 28 inches from the screen. Moreover, the angulation of the screen should be such that the eyes are facing the upper part of the screen. This can be done by rotating it upwards by 20 degrees.
Frequently Asked Questions
Does sitting make SI joint pain worse?
Sitting can lead to the worsening of Sacroiliac joint pain. This is particularly true in situations or routines where they are required to sit for a long time, as seen in office workers or those on long flights. This is because sitting can unlock the Sacroiliac joint, making the sacrum less stable in holding the upper body’s weight.
How can I get immediate relief from SI joint pain?
Individuals may be recommended NSAIDs like Naproxen Sodium or Ibuprofen to get immediate relief from mild to moderate SI joint pain. In addition, the anti-inflammatory action of these drugs may help reduce the swelling in the SI joint and the pain on movement associated with this swelling.
What should I avoid if I have SI joint pain?
Individuals with SI joint pain should avoid positions like sit-ups, twists, beginning the knees close to the chest, or where the knees are straight, but the waist is bent. They should also avoid extensive exercise routines and running. In addition, sports like Aerobics, ice skating, and golfing can cause the frequent shifting of weight from one leg to another – so they should be avoided as well.
What aggravates SI joint pain?
SI joint pain, which stands for Sacroiliac joint pain, is aggravated by activities that involve running, gardening, and shoveling snow. This is because these activities require repetitive rotational movements of the SI joint, which can cause irritation or inflammation of the joint. This may also be associated with irritation of the surrounding nerves – leading to pain.
Will my SI joint pain ever go away?
Sacroiliac joint pain usually resolves within a few days. Some severe cases may also require a few weeks to a month. However, contrary to acute SI joint pain, Chronic SI joint pain may last for more than three months. The individual should consult a health professional regarding the dos and don’ts during the healing periods and what measures can be taken to accelerate the healing.
What is the best sleeping position for SI joint pain?
Individuals with SI joint pain are recommended to keep their bodies in a neutral position as they lay down to sleep at night. For example, while sleeping on the back may require a pillow should be kept underneath the knees, sleeping on the side requires a pillow to be kept between the knees.
References on how to sit with si joint pain:
- Cohen S. P. (2005). Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment. Anesthesia and analgesia, 101(5), 1440–1453. https://doi.org/10.1213/01.ANE.0000180831.60169.EA
- Chuang, C. W., Hung, S. K., Pan, P. T., & Kao, M. C. (2019). Diagnosis and interventional pain management options for sacroiliac joint pain. Ci ji yi xue za zhi = Tzu-chi medical journal, 31(4), 207–210. https://doi.org/10.4103/tcmj.tcmj_54_19
- Slipman, C. W., Whyte, W. S., 2nd, Chow, D. W., Chou, L., Lenrow, D., & Ellen, M. (2001). Sacroiliac joint syndrome. Pain physician, 4(2), 143–152.
- Raj MA, Ampat G, Varacallo M. Sacroiliac Joint Pain. [Updated 2022 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470299/
- Chou, L. H., Slipman, C. W., Bhagia, S. M., Tsaur, L., Bhat, A. L., Isaac, Z., Gilchrist, R., El Abd, O. H., & Lenrow, D. A. (2004). Inciting events initiating injection-proven sacroiliac joint syndrome. Pain medicine (Malden, Mass.), 5(1), 26–32. https://doi.org/10.1111/j.1526-4637.2004.04009.x
- Cohen, S. P., Chen, Y., & Neufeld, N. J. (2013). Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment. Expert review of neurotherapeutics, 13(1), 99–116. https://doi.org/10.1586/ern.12.148
- Le Huec, J. C., Tsoupras, A., Leglise, A., Heraudet, P., Celarier, G., & Sturresson, B. (2019). The sacro-iliac joint: A potentially painful enigma. Update on the diagnosis and treatment of pain from micro-trauma. Orthopaedics & traumatology, surgery & research : OTSR, 105(1S), S31–S42. https://doi.org/10.1016/j.otsr.2018.05.019
- Nilsson-Wikmar, L., Holm, K., Oijerstedt, R., & Harms-Ringdahl, K. (2005). Effect of three different physical therapy treatments on pain and activity in pregnant women with pelvic girdle pain: a randomized clinical trial with 3, 6, and 12 months follow-up postpartum. Spine, 30(8), 850–856. https://doi.org/10.1097/01.brs.0000158870.68159.d9
- Kamali, F., & Shokri, E. (2012). The effect of two manipulative therapy techniques and their outcome in patients with sacroiliac joint syndrome. Journal of bodywork and movement therapies, 16(1), 29–35. https://doi.org/10.1016/j.jbmt.2011.02.002
- Schütz, U., & Grob, D. (2006). Poor outcome following bilateral sacroiliac joint fusion for degenerative sacroiliac joint syndrome. Acta orthopaedica Belgica, 72(3), 296–308.
- Dengler, J., Kools, D., Pflugmacher, R., Gasbarrini, A., Prestamburgo, D., Gaetani, P., Cher, D., Van Eeckhoven, E., Annertz, M., & Sturesson, B. (2019). Randomized Trial of Sacroiliac Joint Arthrodesis Compared with Conservative Management for Chronic Low Back Pain Attributed to the Sacroiliac Joint. The Journal of bone and joint surgery. American volume, 101(5), 400–411. https://doi.org/10.2106/JBJS.18.00022