Is Rotation of the Sacrum Causing Your Pelvic Pain?

Pelvic pain can be caused by many things, from falls to pregnancy, and even too much flexibility, but why they have pain is usually the same issue – sacral rotation or what is frequently called SI dysfunction.

What is SI Dysfunction?

This disorder is more common in women than men and basically means that the very unique joints, the sacro-iliac (SI) joints, aren’t setting properly. The sacrum, a triangular bone, fits like the keystone of a bridge in between the two pelvic bones called the ilia. The SI joints are the tiny vertical joint spaces between the sacrum and the ilia. Unlike many joints of the body, they have very little motion, but their ability to move is vital to pelvic stability and positioning. For decades, physicians had a hard time believing a joint with such little motion could cause so much pain, yet we know now that the stability and mobility of the sacrum is the key to spinal integrity.

There are two ways the keystone stays in place. One is called form closure, which refers to the natural shape of the joint and how it fits together (or not). The other is called force closure, which refers to the muscle and ligamentous integrity that holds the structures in place.

Force closure can be improved through very specialized exercises that reintegrate the timing of the deep muscles of the pelvis. Form closure can also be helped, depending upon what’s causing the actual issue in the shape discrepancy.

What causes the sacrum to rotate?

It can be caused by many factors including:

  • poor posture
  • bad lifting techniques
  • changes in the pelvic region and lower spine caused by hormonal imbalances or injuries
  • pregnancy and childbirth can both cause significant changes in the stability of this joint

For those of you who are obsessed with working out, traditional exercises are likely not the answer. If your sacrum is misaligned, strengthening muscles around it with poor pelvic positioning will only reinforce the dysfunction.

Exercises like the old classic “fire hydrant,” where you are in a quadruped position and rotate your leg to the side, may make your hip and butt burn, but they could cause issues in the sacral position over time. Poorly executed hip extension motions may still make your butt look more lifted, but if you overdo it, you’re likely to experience pain.

Having a sacrum that is unstable can cause a lot of pain and discomfort not only in the pelvis but down the legs, into the hips, knees, ankles, and even cause foot pain and problems.

More information around the SI Joint


It’s imperative to understand that the SI joint is different from hinge-type joints. It’s more of a gliding joint that has an axis of rotation uncommon to other joints. Traditional exercises rarely help this issue and it takes a specific protocol to restore the SI joint mobility (which is frequently lost) as well as its force closure integrity with isolated stability techniques.

Treating SI Issues

When someone has SI issues, it’s best to seek out a manual therapist to restore its positioning whenever possible. One of my very favorite practitioners who has had great success is Erik Dalton. On Erik’s website, you can find many articles and more information on this issue. I found this one and have sent it on to many people asking about pelvic pain.

In his article he states, “Frequently, muscle imbalance patterns develop as tissues become strained from overuse, underuse or abuse. In the early stages of a typical SI pain episode, protective muscle spasm arises as the sacrum gets stuck side-bent and rotated between the ilia, usually from a forward-bending and twisting incident. Sustained isometric contraction produces muscle toxicity and weakness causing increased SI ligament loading and overstretching. As the articulating joint surfaces become jarred loose, ligament microtearing creates an inflammatory response.”

If you think you may have an SI issue or sacral torsion or rotation, I’d first suggest you get some hands-on evaluation by a qualified manual or physical therapist. There are key hands-on techniques that work well to give immediate changes – the problem is that your daily life just puts it back where it was unless you are able to do homework to improve the integrity of the stabilization elements around the joint. I have to tell you, there aren’t many therapists who know how to evaluate, treat, and then give homework to remedy this issue. And if it’s done incorrectly, it can actually increase pain.

As a highly trained hands-on neuromuscular therapist, I have helped many people get out of pelvic pain. It was always my goal to create a program that simulates these highly specialized hands-on therapeutic techniques. I have trained dozens of top MELT instructors in what came to be known as MELT NeuroStrength – the highest level of MELT training. Instructors learn how to reintegrate optimal joint motion, erase compensatory patterns, and help people live pain-free.

To find a MELT Instructor trained in these techniques, go to the MELT Finder and look for someone with the badge NS, indicating that the instructor has been trained in MELT NeuroStrength.

Custom MELT Sequences for SI Joint Issues

Finally, I want to share some of the top moves with you on my streaming video site, MELT On Demand. I suggest trying out the MELT Performance Lower Body Sequence to help rehydrate your legs and bring some stabilization to your pelvis. In the video, I’ll show you how to reintegrate the timing of the deep stabilization mechanisms and how to repattern movement once the integrity of joint stability is restored. Not a MELT On Demand subscriber yet? That’s okay! Sign up here to start treating your SI Joint pain today.


Build a practice that restores your body and helps reduce and prevent chronic pain. MELT On Demand’s library and fresh weekly content will inspire and help trigger a transformation in both body and mind.

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