How to tell the difference:
A common mis-diagnosis made in the musculoskeletal realm is whether people are experiencing pain generated from their low back or their Sacroiliac joint (SIJ). So what’s the big deal? The Primary difference are the treatment approaches taken for each. If I have a patient who is experiencing low back pain, I am often focusing on the low back and core for manual therapy, mobility & strengthening exercises. If someone is experiencing SIJ pain, I am focusing on the glutes or buttock muscles as my treatment approach. Sometimes people can be experiencing a bit of both and this often happens as SIJ dysfunction is left untreated for a period of time.
Many of you may be asking, “So How can I tell which I’m experiencing before I even see a therapist?” The first question I ask someone when performing an evaluation is to describe the type and location of the pain. If the person points to their low back, regardless of where the pain is located, I’m going to be thinking it is more a true Low back pain patient. If someone runs their hand from their pelvic/hip region in the back down to there buttocks, I’m thinking more SIJ. Also, I ask what type of pain. For SIJ patients, I commonly hear the description as, “pinching, aching, constant when standing/moving.”
We are all creatures of habit, and we tend to wait until the pain gets so bad that we are having difficulties functioning. When I ask someone how long they have been having the pain, I rarely hear, “less than a month.” Most of the time people have been experiencing pain on and off for >6 months to a year. I really encourage my patients to seek therapy if they are unable to find relief in a span of a month so the problem does not spread to other body regions. Always remember that the body will get the motion and strength it needs one way or another, even if it means using another muscle/joint that was not intended to carry out a particular function to perform for that region. This can lead to a longer and more difficult treatment approach.
If you have been experiencing pain that runs from the low back down into the buttocks, please seek a therapist that can help instead of trying to strengthen on your own. All of my SIJ pain patients are out of alignment when I first see them, and they must be put back into correct alignment through manual therapy or muscle energy techniques prior to beginning strengthening, or the problem could get worse. Treatment for patients who have more acute (>1 month) of pain can range from 2x/week for 4-6 weeks while patients who are in the chronic category are typically being seen for 2x/week for 8-12 weeks. Always seek help and do not assume the pain will just go away because people who have this issue are actually experiencing a true muscular imbalance that needs to be addressed with therapeutic exercises designed to target those weak muscle groups. *Disclaimer alert* squats and gym exercises will not fix this problem! Please reach out if you have any questions about SIJ or Low back pain.