Sacroiliac Joint Pain & Sciatica Are More Than A Structural Problem, There Is Likely A Chronic Condition Developing In Your Body

By: Matthew Sabey Smith, DACM, MSOM, Dipl.Ac., LAc., CPT

***Disclaimer: This article is not intended to be used as grounds to claim a cure of any disease. If you are thinking about using an herb, supplement, or therapy of any kind please first consult your primary care provider ***

I’ve Been There…

       Sacroiliac joint pain is something that used to keep me up at night. And we are talking every single night. Not to mention the chronic pain that came along with it during the day. That burning dull ache in the side of my hip that would go to my low back made me want to numb out for a while just to feel nothing. A painkiller was not the route I wanted to take. So maybe you reach for the over the counter NSAIDs or pump in some tylenol or maybe try that Omega 3 supplement your hippie friend suggested and call it a day. 
        Well, when you’re a competitive strength athlete, you are bound to get a little beat up from time to time as your body is adjusting to heavy loads. Musculoskeletal imbalances, shifts in physiological function and everything in between just becomes a part of life as you begin to understand and dive deeper into learning the mechanisms that lead to your strength; or in this case, inhibit it. Something I have encountered time and time again in athletes, clients, and even myself is SacroIliac Joint Pain, also commonly referred to as SI Joint pain or for some this becomes sciatica. Sciatica is when there is pain that runs down the leg due to a disruption present in the sciatic nerve. It commonly only affects one side of the body and can have a number of causes like compression, disc herniation, or stenosis just to name a few (Mayo Clinic, 2021). 

What Is The Root Cause Of All This?

       While there are many causes, it is not out of the question for other factors to be at play that lead to this condition over time. My question became, “what is the root problem creating all this?” The reason I write both about SI joint pain and sciatica together is because they actually have a lot in common, and I am also here to say there is something you can do about it. Dare I say, there are also ways to prevent it as well. (Insert “GASP!”) So, let’s keep it simple for a minute. Typically when there is pain in this area, there is a lack of hip alignment. Your hips can get thrown off for a number of reasons. Many would point out if you are a side sleeper, if you sit on your wallet, or if you slump to one side sitting or standing, cross one leg over the other etc. The mechanisms are endless and sometimes it can be as simple as an adjustment to realign your hips again.

There Is More To The Story

       But what about when that isn’t the whole story? Why was there a relaxation to allow our hips to get misaligned? Now say in the scenario you get your hips aligned every week from someone like the chiropractor. It probably makes you feel better and truthfully it probably really is helping with your healing process (I can speak from first hand experience and also when speaking to personal friends who are chiropractors). When something is out of place, it is important to put it back. Makes sense right? But what do we do to prevent it? We could sleep different, walk different, sit different, but in a scenario where none of that keeps us aligned (because we have repetitive patterns in life), we need to dig deeper. Now truthfully, I utilize chiropractors often, I have had wonderful success combining methods together and I must say, chiropractic care has been a big part of it, but not all of it.

I Just Wanted Answers

       You see, when I was in my early twenties, spending my full training time as an Olympic Weightlifter, I had this endless dull ache in my right hip. It never seemed to go away, but I would at least get some relief when I was actively moving. Certain exercises would really set it off which meant I had to gear up to be in pain for weeks to “train through it.” But there was a lot I didn’t know about when it came to the cause of my pain outside of simply a structural imbalance. It turns out, there was more to the story; a lot more to the story.
       At this point I was in pain pretty much all the time. No matter what I did, my day usually ended with my massage my muscles with some hard trying to break up “scar tissue and tightened fascia.” While this actually was likely true, there was a deeper reason it was tight. I just did things like I thought everyone else did. I would roll out, warm up, lift, cool down and go about my day. Stretching was something I heard was good for me so I threw some of that in there too but it was kind of this extra casual thing. As I investigated further I found that my Quadratus Lumborum or “QL” was often tight on the same side my hip hurt. So I found it interesting how my pain seemed to move between my low back, my hip and sometimes down my hamstring. The reason this pain was occurring was due to something no doctor would have been able to tell me other than, tight muscles and fascia, “you should probably take it easy and try stretching.”

I Dove Into Traditional Chinese Medicine 

       So now we fast forward, and here I am out of my chronic sacroiliac joint pain. So what made the difference? To tell you the truth, it was more holistic than I would have ever realized. As I went through my doctoral training in traditional Chinese medicine (TCM for short), I came across a podcast that got my gears turning. (It was an episode on the Qiological podcast if you are curious.) It was talking about the connection between the kidney channel system and sciatica. This thought led me down a rabbit hole of investigation and further observation, not only for myself, but for folks I worked with.
      Since then I have taken note both in myself and in clients and it turns out I have found several common underlying triggers that tend to dictate an expression of sacroiliac joint pain. But, before I explain that, let me teach you a bit about TCM and pain first. 

Understanding Pain As Stagnation

       In traditional Chinese medicine we refer to pain as stagnation. Essentially this means that when something is “stagnant,” it creates a disruption in the body. Pain is your body saying, “danger danger” which is why it exists, it is a survival response. So, using an example of muscular pain with traditional Chinese medicine, we want to create more flow of “blood and qi.” To explain this more simply, we want to bring more blood, lymph, and nutrients to an area, relax the tightened muscles and fascia as well as improve the signaling communication with the brain.  This is a reason something like acupuncture, tui na, gua sha, moxibustion, cupping etc are so effective over time because it is actively healing the present and underlying condition. But this is also something that takes time, it requires upkeep and nurturing to truly heal from anything.

The Gallbladder and Urinary Bladder? NO! I Said My Hip Hurts!

       Back to the case of sacroiliac joint pain however, I have found that this usually breaks down to a relationship between the Gallbladder channel and the Urinary Bladder channel (The Gallbladder channel runs down the side of the leg and up the ribcage and the Urinary Bladder channel runs down the back of the leg and continues up the back). What does that mean and why does this matter? It means I was able to trace back my symptoms that related to these “channels” and it always seemed to explain the pattern of why myself or someone else was experiencing pain relating to their sacroiliac joint when laboratory scans showed that there was seemingly nothing wrong. The most common thread between the clients was either liver qi stagnation or a deficiency in kidney qi. 
     So… what does that mean and how does it relate to sacroiliac joint pain or even sciatica? Well, this is a  common thread that allows the hips to become misaligned. In TCM we explain things in meridian (aka channel) systems. To make it simple, there are “meridians” that we learn that run throughout the body that have certain acupuncture points. Each of these meridians and points have common symptoms associated with them. They are very specific which is why a well trained Doctor of Acupuncture and Chinese Medicine needs at least 5 years of schooling after 4 years of undergraduate schooling.
       Conveniently, in TCM each organ is paired with another. For the sake of our understanding here, we are going to reference how the Kidney pairs with the Urinary bladder and the Liver pairs with the Gallbladder. This is where it gets interesting to see the relationships. A couple common symptoms of liver qi stagnation include side pain, vertex or temporal headaches, upper back/neck pain, waking up to urinate between 1-3am, PMS symptoms, commonly feeling frustration or having outbursts of anger. In a simple way we can also refer to these in an umbrella term as stress. 
Ok, stick with me now.

Endocrinology & Chronic Stress

       It is well known that chronic stress is not healthy for any of us, you can see it in research anywhere (Kanczkowski, W., et al., 2017). But where does the kidney/urinary bladder system fit into all of this? Well, let’s use endocrinology to help us out in relation to an actual kidney! A common hormone many have heard of is cortisol. Cortisol plays many important roles in the body but many associate its imbalance with stress. In short when we become stressed the adrenal cortex follows the direction of the hypothalamus-pituitary-adrenal axis to produce more cortisol (Thau, L. et al., 2021). If the stress is not regulated then cortisol will continue to produce which can lead to chronic disease. So how does this relate to the kidneys again? The adrenal cortex sits directly on top of the kidneys within the adrenal glands. Now if we also combine chronic stress with caffeine consumption, now we are asking our body to produce even more cortisol (Lovallo, W. R., et al., 2005)! Do you see a pattern yet? Chronic stress over time creates more work for the kidneys over time, thus decreasing its ability to function properly.

An Understanding of the Root Cause Can Lead To More Predictable Symptoms

       The urinary bladder pairs with the kidney in TCM. So by treating the kidney, we help the pain that follows the Urinary Bladder channel. And by treating the liver, we help the pain that follows the Gallbladder channel. If we use channels to relate to structure, when one organ system does not function normally, it’s channel suffers. As a result it is another channel that needs to pick up the slack. This is why the Gallbladder channel and Urinary Bladder channel have this relationship in sacroiliac joint pain. When one suffers (exhibits symptoms that relate to it), the other channel needs to do more work to maintain structure and alignment! (For Practitioners: This is why tight muscles and ashi points are so easily found along one of these channels in a patient with sacroiliac joint pain or sciatica) So what is the big conclusion from all this?
       From a TCM perspective it can easily be explained that when there are no structural issues present, sacroiliac joint pain or sciatica could be as simple as too much stress in your life (in a very very simplified way of explaining it). This is why I use both TCM and biomedicine to explain this. Remember, this is something I used to deal with on a daily basis for several years with no known patterns I could find. I never knew why some days were better than others. But, these symptoms were at their worst during the most stressful time in my life and it turns out, I had a lot of the symptoms that related to liver qi stagnation which led to my kidneys becoming overly taxed. 

What Ultimately Brought Me The Relief & Prevention I Was Looking For

       So here is how I made my sacroiliac joint pain go away and continue to prevent it from coming back. 

1. I began a daily practice of mobility in the form of yoga. Even 5 minutes helped me stretch the areas that were tight around my hips, back and legs (yes that included the QL too!)
 2. I avoid using caffeine for workouts when possible and instead limit its use only for big workouts or competition time.
 3. I make sure I get enough consistent sleep, if you are sleeping less than 7 hours per day, you are likely deficient in recovery and sleep (Hirshkowitz, M, et al., 2017) (Colten, H. R., & Altevogt, B. M., 2006).
 4. I utilize acupuncture and herbs to support my kidneys and liver function which take care of both musculoskeletal imbalances as well as the psycho emotional aspects of liver qi stagnation and kidney qi deficiency.
 5. If the pain ever comes back, I analyze if I am worn out, stressed and/or over-tired (over a period of at least several weeks). If the answer is YES, I go back to the beginning and get a chiropractic adjustment to place my hips back in alignment, and increase my acupuncture treatments to restore normal function to the muscles and associated neuron pathways.

It Is About The Marathon, Not The Sprint

       This may sound like a lot of work but it was lifestyle changes that needed to occur in order to truly heal from my chronic pain. As soon as I decided I wanted to be out of pain, I was ready to make whatever changes were necessary to become free of it. This was a marathon, not a sprint. This is not something that will happen overnight. It is important to recognize how the human body is endlessly interconnected. It is impractical to ignore signs and symptoms while expecting them to mysteriously go away. If you catch it early and implement simple changes in the beginning, you save yourself from spending a lot of money, experiencing a lot more pain and sacrificing your quality of life in the long run.  

References:

Colten, H. R., & Altevogt, B. M. (2006). Sleep disorders and sleep deprivation: An unmet public health problem. Institute of Medicine. 

Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., Hazen, N., Herman, J., Katz, E. S., Kheirandish-Gozal, L., Neubauer, D. N., O'Donnell, A. E., Ohayon, M., Peever, J., Rawding, R., Sachdeva, R. C., Setters, B., Vitiello, M. V., Ware, J. C., & Adams Hillard, P. J. (2015). National Sleep Foundation's sleep time duration recommendations: methodology and results summary. Sleep health, 1(1), 40–43. https://doi.org/10.1016/j.sleh.2014.12.010

Kanczkowski, W., Sue, M., & Bornstein, S. R. (2017). The adrenal gland microenvironment in health, disease and during regeneration. HORMONES, 13(3). https://doi.org/10.14310/horm.2002.1744 
Lovallo, W. R., Whitsett, T. L., al'Absi, M., Sung, B. H., Vincent, A. S., & Wilson, M. F. (2005). Caffeine stimulation of cortisol secretion across the waking hours in relation to caffeine intake levels. Psychosomatic medicine, 67(5), 734–739. https://doi.org/10.1097/01.psy.0000181270.20036.06

Mayo Foundation for Medical Education and Research. (2020, August 1). Sciatica. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/sciatica/symptoms-causes/syc-20377435#:~:text=Sciatica%20refers%20to%20pain%20that,one%20side%20of%20your%20body. 

Thau L, Gandhi J, Sharma S. Physiology, Cortisol. [Updated 2021 Feb 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538239/

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Health & Human Performance  Coach, Doctor of Acupuncture and Chinese Medicine, Professor, and competitive strength athlete, Matthew Sabey Smith DACM, MSOM, Dipl.Ac, LAc., CPT is the owner and founder of Strength Smith Training Systems LLC. With an extensive background in integrative holistic health, training and coaching, Dr. Matt uses his knowledge to help individuals improve their training, boost their recovery and maintain optimal balance as they chase their athletic, fitness and health endeavors.

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