Low back/Si Joint Pain

Medical Q&A [Moderated]
1

Hello Barbell Medicine,

I’m writing you with the hope that you can give me some advice to help me fix my lower back. I am 21 years old, 6’8" 230lbs, and have just gotten into strength training after playing college basketball. However, about 6 months ago I tweaked my lower back (si joint) while squatting. I unfortunately have to admit the injury occurred while doing 5/3/1… even worse, this was the first program i ran… please don’t blame me entirely for this, I was an stupid, uninformed newbie and have since smartened up and gotten on starting strength like all beginners should. However the pain keeps coming up every so often when i squat. I have tried everything… switched from high bar to low bar, experimented with front squats, ssb squats, different stance widths, oly lifting shoes to help mobility, you name it. I sacrifice weight for technique (almost to a fault at times) and never lift when my ego. I am still very much a beginner and am not very strong (currently squatting around 200lbs for 3 sets of 5)

I tried going to physio and i kid you not, the first thing the guy told me was that i should never do squats, deadlifts, or presses, especially because i’m tall, because they’re bad for the joints. He said I should focus on “functional exercises like leg press or battle ropes” and “if i insist on squatting i should do it in the smith machine because its safer”. I received no feedback on what he thought the injury was or how i can rehab it. After this advice I walked out of his clinic and did not come back.

The pain is around my sacrum and is feels more severe towards my si joint on my left side. The pain is triggered most when bending over, standing after sitting for long periods of time (getting out of the car or standing up after class), and when squatting and deadlifting. Switching to low bar has made squatting feel better but I still feel an instability around my sacrum and the occasional sharp pain at the bottom of the squat (i do focus on bracing and staying tight throughout my core). I have continued to train through the pain but nothing has made it better so far and at its worst it hurts so much that I cannot get through a set of 5 for squats. If there is any advice you could give I would love to here it!

Thanks!

2

Have you ever posted a form check to the BBM FB group? Let’s start there.

In the absence of traumatic injury, it is highly, highly unlikely that you have any significant instability of the SI joint.

3

To echo Austin’s sentiment, the sacroiliac joint is held together by some of the strongest ligaments in the body. Pelvic fractures around the sacroiliac joints happen much more frequently than actual sacroiliac joint disruptions secondary to definitive injury to those SI ligaments. These pelvic fractures are typically the result of high energy violence, such as a high speed/high energy motor vehicle accident.

Here is a helpful overview of the SI joint https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3512279/pdf/joa0221-0537.pdf

Hopefully this information will provide you some comfort in knowing that perfoming squats with the load you stated is not sufficient enough stress to cause damage/instability to your SI joint.

The more you know…

4

Thanks, JHG.