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Thread: Chronic SI joint issue

  1. #1
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    Default Chronic SI joint issue

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    Hi all, I’d like your advice about ongoing pain in and around my right SI joint. This has persisted for a year, and I am reaching the limit of my ability to train through it. I’m 34, male, 5’10”, 195 lbs.

    I read the Blue Book and began lifting last May. Squatting and deadlifting do not make it feel immediately worse. The pain and inflammation ramp up beginning 24 hours after each workout. The pain is in my right posterior hip, in the visible “dimple” where my low back and pelvis meet. It spreads up into the low back and down into the right buttock. I can feel it getting puffy and hot, and it keeps me up at night. It hurts when walking, bending over, and twisting. I have looked through this forum for solutions. Here are some things I have tried to deal with this issue:

    • Form coaching. I attended a squat and deadlift camp last August with Grant and Pete. They gave me advice in lifting more efficiently, but did not say I was doing anything harmful. They told me to train through the injury. I also submitted videos to the Strength Club show with Rusty and Alex K. They told me my squat was fine, and to train through it. Then I hired an online SSC who gave me video feedback on every top set for four months. Again, the feedback was helpful, but did not yield any form adjustments that lessened the pain.
    • Deep tissue massage. Per Rip’s suggestion here, I used a lacrosse ball to release the piriformis muscle and other deep external rotators of the hip. It felt better for a day or so, but the pain came back. I also got a professional massage to the same effect.
    • Chiropractic adjustment. This gave immediate relief, but the pain came back the next time I deadlifted a few days later. Subsequent adjustments showed no benefit.
    • Leg length discrepancy. I got X-rays of my legs and found that my left femur is slightly short by 5 mm. The tibias are dead-even. I now wear a 5 mm lift in all my left shoes. This has had no effect as far as I can tell.
    • Not squatting or deadlifting. This is the only one that works. The pain subsides within two weeks, and goes completely back to normal. I have done this twice in the past year, then gone back to squatting, and the pain quickly came back. Obviously, not lifting is not a satisfying long-term solution.


    Any guidance you might have is greatly appreciated.

  2. #2
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    Quote Originally Posted by napalmkoenig View Post
    Hi all, I’d like your advice about ongoing pain in and around my right SI joint. This has persisted for a year, and I am reaching the limit of my ability to train through it. I’m 34, male, 5’10”, 195 lbs.

    I read the Blue Book and began lifting last May. Squatting and deadlifting do not make it feel immediately worse. The pain and inflammation ramp up beginning 24 hours after each workout. The pain is in my right posterior hip, in the visible “dimple” where my low back and pelvis meet. It spreads up into the low back and down into the right buttock. I can feel it getting puffy and hot, and it keeps me up at night. It hurts when walking, bending over, and twisting. I have looked through this forum for solutions. Here are some things I have tried to deal with this issue:

    • Form coaching. I attended a squat and deadlift camp last August with Grant and Pete. They gave me advice in lifting more efficiently, but did not say I was doing anything harmful. They told me to train through the injury. I also submitted videos to the Strength Club show with Rusty and Alex K. They told me my squat was fine, and to train through it. Then I hired an online SSC who gave me video feedback on every top set for four months. Again, the feedback was helpful, but did not yield any form adjustments that lessened the pain.
    • Deep tissue massage. Per Rip’s suggestion here, I used a lacrosse ball to release the piriformis muscle and other deep external rotators of the hip. It felt better for a day or so, but the pain came back. I also got a professional massage to the same effect.
    • Chiropractic adjustment. This gave immediate relief, but the pain came back the next time I deadlifted a few days later. Subsequent adjustments showed no benefit.
    • Leg length discrepancy. I got X-rays of my legs and found that my left femur is slightly short by 5 mm. The tibias are dead-even. I now wear a 5 mm lift in all my left shoes. This has had no effect as far as I can tell.
    • Not squatting or deadlifting. This is the only one that works. The pain subsides within two weeks, and goes completely back to normal. I have done this twice in the past year, then gone back to squatting, and the pain quickly came back. Obviously, not lifting is not a satisfying long-term solution.


    Any guidance you might have is greatly appreciated.
    A 5mm lift in not something that should really be considered. That is such a small variation that it isn't worth considering as an issue and is well within the range of normal deviation.

    What else is in this area that is not the SI Joint and might be caused by, or exacerbated by, squatting and deadlifting and is not remedied with relative rest?

  3. #3
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    I included leg length in the list of things I had ruled out because large discrepancies can be symptomatic. As you pointed out, this one is small, and I don't think it's the problem.

    Not sure I understand your question. There are many other things in this area (hip joint, L5, nerves, ligaments), but my issue is always remedied with relative rest. It just always comes back when I resume training.

  4. #4
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    Quote Originally Posted by napalmkoenig View Post
    I included leg length in the list of things I had ruled out because large discrepancies can be symptomatic. As you pointed out, this one is small, and I don't think it's the problem.

    Not sure I understand your question. There are many other things in this area (hip joint, L5, nerves, ligaments), but my issue is always remedied with relative rest. It just always comes back when I resume training.
    Not being aggravated and remedied are two completely different things. A bruise, given time to heal, will heal completely and not come back when you resume training. So, you have a condition that does not hurt with activity but is not healed with inactivity....does that make sense?

  5. #5
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    Quote Originally Posted by Will Morris View Post
    Not being aggravated and remedied are two completely different things. A bruise, given time to heal, will heal completely and not come back when you resume training. So, you have a condition that does not hurt with activity but is not healed with inactivity....does that make sense?
    Correct. It's not like a bruise because it does not heal completely. It comes back every time I resume training after a layoff. Even if I start light.

    Activity does aggravate it. The pain and swelling show up the day after every decently heavy squat and deadlift session.

  6. #6
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    Quote Originally Posted by napalmkoenig View Post
    Correct. It's not like a bruise because it does not heal completely. It comes back every time I resume training after a layoff. Even if I start light.

    Activity does aggravate it. The pain and swelling show up the day after every decently heavy squat and deadlift session.
    Sorry, that was a typo. I meant to say, "You have a condition that hurts with activity but is not healed with inactivity"....

    So, in that area, what is a structure that follows this pattern? Meaning, what type of structure feels better with inactivity, does not heal with inactivity, and pain returns almost immediately upon resuming activity despite the lay-off?

  7. #7
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    I watched your video series on low back pain for ideas on how to answer your question. My uneducated guess is that it’s either 1) lumbar spine going through the common age-related degeneration, or 2) a ligament attached to the sacrum was sprained and has not had enough opportunity to heal. Is that on the right track at all?

  8. #8
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    I watched your video series on low back pain for ideas on how to answer your question. My uneducated guess is that it’s either 1) common age-related degeneration of the lumbar spine, or 2) sprain in a ligament attached to the sacrum that has not had enough opportunity to heal. Am I on the right track?

  9. #9
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    Quote Originally Posted by Will Morris View Post
    Sorry, that was a typo. I meant to say, "You have a condition that hurts with activity but is not healed with inactivity"....

    So, in that area, what is a structure that follows this pattern? Meaning, what type of structure feels better with inactivity, does not heal with inactivity, and pain returns almost immediately upon resuming activity despite the lay-off?
    I’ll take a guess. Tendon issue in that area. Erector spinae maybe?


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  10. #10
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    For the most part, bone pain is readily alleviated with rest. Fractures, stress fractures, bony contusions, etc all respond pretty well to rest. Arthritic changes respond favorably to rest but only in the sense that it makes you feel better at rest. Arthritic change related pain tends to be worse with movement after a period of rest, but that pain typically gets better with more activity. You may have heard people repeat the cringeworthy phrase, "Motion is lotion." As cringey as it is, it serves the purpose of convincing people with arthritic changes to continue movement.

    For tendon related issues, the pain tends to be mostly alleviated with rest, but the pain immediately returns when you reintroduce activity. Rest does not bring about the tissue remodeling necessary to rectify a tendon issue. In fact, the majority of tendon related pain is thought to be due to neuro-proliferation of substance P sensitive fibers ingrowing into the tendon. Rest does not prevent this, and a lot of people will notice an increase in pain or irritability in that area when returning to activity after a lay-off.

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