Pain at the sacroiliac joint is a common problem that affects 25% of people with low back pain. See the diagram below. I will help you to figure out if your pelvic floor dysfunction is causing Sacroiliac Joint Pain (SIJ).
Causes of SIJ pain
Sacroiliac joint (SIJ) dysfunction can be caused by many things. Most commonly an injury directly to the SIJ can cause pain and dysfunction in this area.
An injury to the back can also cause SIJ dysfunction. There are many muscles that connect to the pelvis and this can affect its function. If muscles that connect to the pelvis are tight, weak, or dysfunctional it can cause the SIJ to become compressed and painful.
When the SIJ is compressed the ability to stabilize the pelvis with single leg stance, squatting, lifting, running, and walking can all be affected. Often with SIJ dysfunction, these tasks can be difficult and or painful.
Where the Pelvic Floor comes in
One muscle group that is often impacted with the SIJ is the pelvic floor or the levator ani. The levator ani is a group of muscles that runs from the pubic bone to the tailbone like a sling or hammock. See the diagram below. This group of muscles is responsible for supporting all of our internal organs and maintaining continence (keeping urine and stool inside the body). This group of muscles, like any other group of muscles, can become weakened or tightened and shortened due to injury, trauma, or disuse. When this group of muscles becomes dysfunctional we often see incontinence (inability to keep urine or stool inside), sexual dysfunction, or pain in this area of the pelvis.
Where is the Dysfunction?
It is also common that dysfunction in the pelvic floor or levator ani muscles can contribute to SIJ dysfunction. When these muscles are tight or short they add compression to the SIJ in addition to causing bladder, bowel, and sexual dysfunction. Common symptoms associated with a tight or shortened levator ani are pain with sitting, pain with intercourse, pain with a vaginal exam, pain with tampon insertion, urinary or fecal incontinence, leaking gas by accident, pain or clicking at the SIJ, difficulty standing on one leg, or pain with walking, lifting, running, squatting. Conversely, when these LA muscles are weak and not providing enough compression/ stability at the SIJ there is urinary or fecal incontinence, leaking gas by accident, pelvic organ prolapse, pain or clicking at the SIJ, difficulty standing on one leg, or pain with walking, lifting, running, and squatting.
The Role of Levator Ani
The levator ani plays an integral part in your internal organs’ health as well as provides stability to your pelvis and spine with activity. Together with the muscles of your abdomen, the muscles that control your breathing, and your deep back muscles, they make up your anticipatory core.
When working well, these muscles will contract together a split second before other muscles in your body when performing a task. They are called the anticipatory core because they anticipate that your body is going to move and they work to stabilize your spine and pelvis before you move. For example, when you lift your arm to grab a glass out of the cupboard, your anticipatory core contracts first before the muscles in your arm! This is a very important function in a healthy spine and pelvis. It is important that all the muscles of the anticipatory core are working together to stabilize your spine and pelvis with daily tasks, otherwise, your spine and pelvis can become a source of pain and dysfunction. Parsing out which muscles are dysfunctional and contributing to your SIJ pain can be a challenging task.
A physical therapist that is skilled in spine, pelvis, and pelvic floor dysfunction can help you get to the root of your problems to improve your ability to stabilize your pelvis, maintain continence, improve your sexual function, and help you live the best life you are able. Pelvic floor dysfunction & sacroiliac joint pain can go hand in hand. Need help in this area? Reach out to our skilled therapists at Freedom Physical Therapy Services.
I’m considering Sacrocolpopexy, can this cause tension to the SIJ and potentially cause pain?
Pelvic floor dysfunction can indeed contribute to sacroiliac joint (SIJ) pain, a common issue in low back pain cases. SIJ pain can result from direct injury or muscle-related problems affecting the pelvis. Muscles linked to the pelvis can influence SIJ function, and issues like tightness or weakness in the levator ani muscles, part of the pelvic floor, can exacerbate SIJ problems. Dysfunction in the pelvic floor can lead to incontinence, sexual issues, and pelvic pain. These factors often intersect, causing discomfort, affecting posture, and hindering daily activities. Skilled physical therapists can assess and address these interconnected issues to improve pelvic and SIJ function.
I’ve hand 3 years of debilitating SIJ dysfunction and receive SIJ RFA every 6 months. I recently had a histo with prolapse repair but chose not to have the sacrocolpopexy due to my dysfunction. Unfortunately, the prolapse is back and this time I’m having the sacrocolpopexy. I’m so very nervous that this will cause more problems than I already have and in the event that I do have SIJ surgery, how will that effect my prolapse? Thank you for any wisdom. Nikki
The SIJ joint dysfunction is heavily disregarded by the Orthopedic Surgeons and they prefer to relate to the intervertebral disc pressure and nerves pinching. Why?? It seems the solutions for SIJ dysfunction are way easier and simple than the ones offered for Discopathy like surgery and medication.