Horizontal position and SI joint area pain

Introduction:

Hello, I’m a 17-year-old intermediate lifter who’s been noticing pain in the SI joint area for quite a lot of time now, and I’ve decided to research it myself because I haven’t met any certified medical doctor in my country that gives me any advice other than to “stop lifting weights”. Therefore I thought I would ask here, I know that it’s rarely possible to diagnose such issues over the internet, but any advice would be great. I apologize if this post might be little long, I’m trying to give as much information as possible.

Problem:

Whenever I bend over with my spine in extended position, I instantly feel the pain in SI area (more precisely in SI joint and PSIS). This pain often occurs on starting-strength style deadlifts and parallel barbell rows, when I’m as horizontal as possible. It also occurs on a very bottom position of high bar squat if i lose tightness or do any rotation.

Wearing a belt slightly above iliac crest has significantly reduced such pain during training, but I was not able to get rid of pain completely.

I took MRI in lumbar vertebrae and there was nothing wrong with vertebral discs.

Question:

How does on get rid of SI joint pain which occurs at horizontal position with extended spine? I can feel it every time I bend over with hip extension.

I try “fascial adhesion release” (cough Chaudhry et al) or at least fibroblast stimulation in connective tissue with foam roller and lacrosse ball in pirfimoris, quadratus femoris, gluteus medius and gluteus maximus every day. It slightly reduces the pain for short period of time, but not by much. I also don’t want to mess with a sciatic nerve so I’m being cautious. In addition, I also stretch and foam roll my hip flexors, tensor fascia latae, quads and lats.

I also thought it was misaligned pelvis, but I think many studies show that SI joint is quite stable.

The closest video related to my problem was the one made by Kelly Starrett who explains that tightness in hip capsule or piriformis might create a large rotational force on SI joint. Maybe that’s why wearing a belt helps?

Is there anything I can do to fix this pain? I’m stuck at 265x5 deadlift just because of sacral pain that occurs during bent over position. Any help would be greatly appreciated!

Thank you very much!

Important information (tl;dr I have kyphosis which causes anterior pelvic tilt):

When I started lifting 2 years ago, I had a postural kyphosis that made me look like I had a hunchback even when standing “upright”, I was sitting and laying all day with improper posture at a very low weight of 60kg (135 lbs) at 180 cm (5’9) and with the growth in height my kyphosis has become apparent, I ended up looking like an anorexic chimpanzee at peak height of 187 cm (6’2).

Eventually I started doing “bodybuilding” type training with all the important compound exercises at the balanced volume for a novice (I wasn’t aware of starting strength linear progression or anything similar by then). My upper back got much stronger with deadlifts, high bar squats and barbell rows, and now at 96 kg (210 lbs) I have no apparent hunchback on the upright position.

But, whenever I try to lean over in a horizontal position, I’m incapable of avoiding a kyphotic posture - for example, I can not deadlift with completely neutral upper back no matter how hard I try to extend it. What’s weird is, that I’m incapable of attaining position where my lumbar vertebrae is obviously flexed (it always remains close to neutral no matter how much I try to flex it), but my upper back rounds even more.

This figure represents my problem accurately:

(image taken from www.edu.xunta.es)

Hence I believe that kyphosis has also caused some kind of anterior pelvic tilt to support my rounded thoracic spine. I think this might be the ultimate cause of the pain.

Hello, sorry to hear about your symptoms. I’m going to assume you are not overly familiar with our work so before we go much further I’m going to recommend a few things for some context.
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https://www.barbellmedicine.com/mobility-explained/

What does your current training look like? If you have went from 135# to 210# in two years I would guess it has been rather regimented as that is a massive change for anyone even if it was from 15 to 17.

Do you think maybe this overemphasis on attempting to avoid a kyphotic posture could be contributing to the issue at hand? Why are you concerned about having a completely neutral upper back?

Hello! Thank you for the response!

I’m actually only aware of the first article, as mentioned in the original post many studies show that SI joint is quite stable, but the video that I linked below (made by Kelly Starrett) seems to contradict this assertion. Second article is very interesting, I’m definitely going to read through it completely.

I didn’t have a very strict training regime, I’ve started with the simple high-volume full body bodybuilding program and then in few months switched to upper/lower split in few months after (keep in mind that repetition numbers in this program mean total amount, e.g 4x8 squats). Unfortunately, I was unaware of strength based linear progression programs by then, although I wish I would start from there.

Also, I was/am eating a lot of food which made me gain a lot of body fat (I went from 900 calorie almost vegetarian “diet” to 3500-4000 calorie protein/carb dense “diet”, obviously with progression). Now before I start LP, I just want to lose some body fat (not looking for abs) so that I don’t end up being obese. Basically, I did a popular “bulking phase” (stupid, I know), but at least I got a lot stronger and bigger.

As for the last question, I think this is relevant to the third interesting article that you’ve referenced? I actually wonder this as well, since I can feel SI joint area pain much more when I try to forcefully extend my upper back in a bent-over position (I feel much more tension in SI joint area compared to the thoracic spine).

I’m trying to have a neutral upper back to follow the common starting strength style deadlifts, they argue that thoracic extension is necessary to sufficiently activate upper back muscles and should be done by any normal lifter to avoid “thoracic laziness”. Obviously powerlifters such as Konstantin Konstantinovs and Larry Wheels are not mentioned here since their primary goal is to lift as much as weight as possible off the floor. But I could perhaps argue that “thoracic laziness” problem could be eliminated by including assistance exercises such as barbell row.

Do you think I should actually try to tighten my abs, glutes and lats during the bent-over position rather than try to extend sacrum (this greatly reduces the tension, although I’m not sure about it’s safety)?

Thank you!