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Lower Back Pain That Won’t go away and Sacro-iliac Joint Dysfunction

Back Pain


Do you have consistent lower back pain that won’t go away? Even after numerous diagnoses and multiple treatments, do you still continue to suffer? Back pain can often be the result of an underdiagnosed condition known as Sacro-iliac Joint Dysfunction or SI Joint Dysfunction. People who suffer from this condition get a random sharp pain when standing up but feel better after taking a few steps.

Key Symptoms of Sacroiliac Dysfunction Are:

  • Lower back pain after sitting for more than 30 minutes: it is very painful and difficult to stand up and takes you some time to fully be upright.
  • Lower back pain once you start walking from a sitting position: the first steps are painful but feels better as you keep walking
  • Difficulty sleeping: inability to find a comfortable sleeping position due to SI joint dysfunction
  • Lower back pain after a fall (landing on side or buttock)
  • You have been told or feel as if one leg is longer than the other (leg length discrepancy)
  • Sideways walking feeling or tendency to ‘Walk like a duck

What is SI Joint Dysfunction?

SI Joint Dysfunction is just one of many possible sources of back pain. The sacroiliac joint (SIJ) is a very small joint that connects your pelvis to your sacrum. To give you a better perspective, it lies below your lower back and above your tailbone. Although small, the SI joint has an important job. It is required to take heavy loads of force at every step while walking, running, or even bending.

So, Why Does SI Joint Dysfunction Happen?

Dysfunction in the SI joint can occur if your body is out of alignment due to either an old injury, falling, or a jolt that rotates the sacrum so it is slightly facing left or right. SI Joint dysfunction can lead to a functional leg length discrepancy.

If you have been told that your legs are not the same length, you may have been prescribed a shoe lift. In actuality, the shoe lift makes this condition worse and does not correct the underlying SI Joint Dysfunction. If you have been given a shoe lift yet you are still having back problems (shoe lift may worsen problem over time), you may have a SI Joint issue that can be resolved through manual therapy.

How Do I know I Have SI Joint Dysfunction?

One way to tell if you have SIJ Dysfunction is to evaluate if you have lower back pain after sitting for thirty minutes or so. An unstable SI Joint causes pain as it slips or becomes mis-aligned slightly to adjust to your sitting position. Once you get up, this mis-alignment causes pain in the joint which can radiate from the low back down to your knee (most people think this is sciatica). During those first few steps, it begins shifting back into proper alignment, making you feel better after a few steps.

What does the SI Joint do?

The SI Joint is the shock absorber between the spine and the legs. The weight of the upper half of your body gets transferred to your legs through this joint as it links the spine to your hip. It can become unstable over time and as you sit or apply pressure on your sit bone, it can shift slightly, causing pain in the joint and lower back. Many who experience SI Joint dysfunction describe their walking patterns to be ‘duck like.’ If you find your walking pattern has changed, it is time to get this issue checked out. Manual therapy can help with SI Joint and other complications associated with SI Joint dysfunction.

How Can Manual Physical Therapy Help My SI Joint Dysfunction?

Your physical therapist can stabilize your SI joint by addressing the root cause of the issue and any associated conditions that may be present and making your lower back pain worse. Finding the original source is the key to lasting results and can be done by a knowledgeable Physical Therapist who specializes in Manual therapy.

There are 5 muscles involved in stabilizing the SIJ Dysfunction. These muscles must be addressed to stabilize this joint and return it to proper alignment. Once stable, you will see an improvement in pain and increased mobility.

Next, your therapist will work on correcting the root cause of this condition which may be from poor posture or compensation related to another muscle dysfunction. A very common complication with this muscle dysfunction is weakness to your Gluteus Medius, the main stabilizer of your pelvis as you advance your leg forward while walking.

What if I Have Back Pain and Hip Pain?

The Gluteus medius muscle is part of a group of buttock muscles and it is one of the stability muscles of the SI joint along with a few others. When there is a tear in your gluteus medius, it is often a partial tear as opposed to a complete tear (your doctor may be more specific on this). The body will protect itself by tightening up this muscle, resulting in further weakness. Making your gluteus medius muscle more flexible will make it stronger and more efficient, making your SI joint more stable, reduce symptoms and prevent future recurrence.

These two issues tend to co-exist and can be present in cases when patients are suffering from hip pain in addition to lower back pain. This is resolved using the manual therapy treatment approach Joann has developed, built upon and taught within her practice. The first step is recognizing the signs of dysfunction within the body and then addressing the underlying cause.

What if I Have Had surgeries in the Past and Still Don’t Feel Better?

Even if you have had multiple surgeries with no improvement of pain, Manual Physical Therapy may still be a great choice for you. Of many possibilities, an underlying SIJ problem may be to blame. Pain coming from a SI Joint problem and pain from a lumbar disc herniation may overlap. If the herniation gets addressed but not the SI Joint then you will continue to develop symptoms.

Why Haven’t I Been Diagnosed With SI Joint Dysfunction Yet?

Part of the reason SI Joint dysfunction is often overlooked is because it can mimic symptoms related to low back, sciatica or hip problems. For example: low back pain, radiating pain down leg, buttock pain, and side hip pain. It is important to determine the underlying cause of your pain as it will allow us to target the real culprit. Here at Manual Physical Therapy, we assess in detail this joint especially for someone with low back and hip pain.

Unfortunately, SI Joint Dysfunction often gets overlooked by doctors because this rarely shows in X-rays or MRI. In addition, there are only a few proven methods of treatment for this condition. It has become commonplace for physicians to prescribe pain treatments for such conditions to provide temporary relief from symptoms without addressing the root cause. This is helpful in the short term but does not identify the source of discomfort. Manual Physical Therapy provides you with lasting solutions for back pain instead of covering your pain with ‘band-aid’ shots and pain killers.

At Manual Physical Therapy, we ask specific and detailed questions that pertain only to SI Joint problems to provide an accurate diagnosis. If you do have a SI Joint dysfunction, we can treat it through our manual skilled interventions to provide stability and efficiency of that joint that is very important to get you walking and standing without back/hip pain.


Joann Pung

Joann Pung

Founder of Manual Physical Therapy & Concierge Services and leading PT in Bradenton and Sarasota, Florida. Joann has been helping transform people’s lives since she was introduced to Manual Therapy techniques 28 years ago. Since opening up her own clinic in July 2016, her reputation has grown quickly, with patients now driving from areas as far as Punta Gorda and Orlando to see her and some even enjoying telehealth from as far as Denver, Seattle, London and UAE. To help more people, Joann works extensively with her team and spends a vast amount of her time continually training them. This ensures that our treatment approach is consistent and that every patient gets the functional outcome that is most important to them, regardless of who treats them. When not at work, Joann spends her time with Joel, her best friend, husband, and fellow PT who now runs the front desk. She has raised 2 amazing daughters and enjoys spending time with her family, learning new ideas (such a nerd), watching funny videos on YouTube, or planning for the next family trip.
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