Where is my low back pain coming from?
Monique Goss, Osteopath
21st July 2023
Have you ever had a pain in your low back that doesn’t quite feel like the lumbar spine at the dip in the spinal curve? But it’s also not in the front at the hip? It feels like it is more in the back of the body instead of the front but you can’t quite pinpoint the pain. So what is it?
Hip pain? Lumbar Pain?
Or is it the Sacroiliac Joint (SIJ)?
The sacroiliac joint is located in the pelvis, where the sacrum bone (our tail bone before the coccyx) meets the ilium bone of the pelvis (the bit that looks like the elephant ear or wings). (See image below). It is a crucial joint that helps support the upper body and transfer weight from the spine to the legs. Dysfunction in this joint can cause lower back pain and discomfort just like other back injuries. Think of it as the joint near the “dimples” of the lower back.
Let’s compare this to the other joints of the lower body and gain a better understanding of WHERE exactly we are sore or injured in the spine or pelvis.
The lumbar spine is the lower part of the spine (where we get the curve/sway inwards) that consists of five vertebrae located below the thoracic spine and above the sacrum. It is responsible for providing support to the upper body and allowing for movement and flexibility. The lumbar spine is also the largest and most flexible section of the spine, which makes it more prone to injury and wear and tear over time. This is commonly an area of complaint with disc injuries that can create nerve pain or sciatica.
The hip joint is a ball-and-socket joint that connects the pelvis and the femur bone (our thigh). It allows for a wide range of motion of our lower limb and is responsible for supporting the body's weight during standing, walking, and other activities. The hip joint is surrounded by a network of muscles, tendons, and ligaments that provide stability and support to the joint. It is also one of the largest and strongest joints in the body but given the intricate surrounding tissue it uses for support can be injured during sports and other movement based accidents or traumas.
So, what is the difference between hip joint, lumbar and sacroiliac joint pain?
With the hip joint more anterior of the pelvis in relation to the sacroiliac joint in the posterior pelvis, hip pain will more often feel like it's more “in the front” whilst the SIJ pain will feel like it’s more “in the back”. It is important to remember the SIJ is a relatively immobile joint that provides stability and support to the pelvis and spine. While both joints are located in the pelvic area, they serve different functions and have different structures.
Whereas lumbar pain may feel slightly higher and oftentimes more central towards the bony parts of the spinal vertebrae. Quite often lumbar pain can have a distinct direction or directions of movement where it feels better and where it feels worse because of it’s role in spinal motion.
So, what does SIJ pain feel like?
Of course, pain can vary but a sure sign that you’ve sprained or injured your SIJ is that you feel stiff “like an old person” when you move. You might have trouble going from sitting to standing, getting in and out of the car or rolling over in bed. There may be times during movement when you don’t notice your pain at all but when you’ve been still for a while or waking in the mornings after rest it feels the worst.
This joint is important in shock absorption, hence SIJ sprains typically don’t like downward pressure through the joint and your osteopath can do special tests to identify whether this joint is the cause of your pain. This is the type of pain a pregnant person will typically get whilst growing a baby (imagine the awkward way some pregnant people rise out of a chair or squat down to pick something up with a growing belly).
There are many things you can do in your osteo treatment and at home to help with your injury but specific advice from your practitioner is always best to get the most out of your recovery. Remember, every presentation is different and you should never make assumptions about your body without the proper guidance from a professional diagnosis. With this in mind it’s advised to seek help as soon as possible to reinforce the best healing opportunity.
So go on, book with one of our osteopaths to help get guidance on your specific presentation.