Piriformis syndrome

The Untold Truth About the SI Joint (And Why Most Fixes Fail)

The sacroiliac joint—or SI joint—is one of the most misunderstood areas in the body. And yet, it plays a massive role in your ability to move, feel good, and stay injury-free.

If you’ve ever looked for SI joint exercises or ways to relieve SI joint pain, chances are the info you found was generic, over-simplified, or just wrong. And that’s a problem.

A dysfunctional SI joint can prevent you from gaining strength, limit your mobility, and leave you stuck in a loop of recurring pain or injury.

Let’s fix that.

What Is the SI Joint (And Why Should You Care)?

The SI joint connects your sacrum (the base of your spine) to your ilium (your pelvic bones). You have two of them—left and right—and together they form the foundation of your pelvis.

Think of your pelvis as the floor of your body. If the floor is off, everything built on top—your spine, shoulders, legs—becomes misaligned.

Here’s the kicker: SI joint issues are often asymptomatic. You might be struggling with shoulder pain, knee discomfort, or tight hip flexors—and never realize the source is pelvic instability rooted in the SI joint.


Why Standard Fixes Don’t Work

Most practitioners don’t fully understand the SI joint. Some even claim it’s not a real joint or that it doesn’t move. That’s not just wrong—it’s dangerous.

The SI joint is a total joint:

  • It has a capsule
  • It contains synovial fluid
  • It has proprioceptors (tiny sensory “computers”)
  • It’s stabilized by key muscles and ligaments

When this area is off, you don’t just lose movement—you lose the ability to communicate with your body.


A Deeper Look: Movement and Dysfunction

Physiologically, the SI joint has one primary movement axis—called the oblique axis. It helps the sacrum and ilium move together smoothly as you walk or bend.

But when dysfunction sets in, the joint can fall into 20+ different pathological movement patterns, leading to all sorts of compensations, from a false leg length discrepancy to upper-body pain.

If your treatment or exercise doesn’t account for these patterns, you’re just treating symptoms—not the cause.


My Journey With the SI Joint

I’ve been in the health and fitness field for 30 years. I started out like most trainers—using standard methods like PT and corrective exercises. But when I injured my own back (L4-L5 disc bulge with sciatic pain), those traditional approaches didn’t help.

That’s when I found osteopathy. It opened my eyes to how the body truly works: as a holistic, interconnected system.

And the SI joint? It was central to the whole picture.


How I Assess and Work With SI Joint Issues

When someone comes into my studio (or online), one of the first places I assess is the SI joint—no matter what pain they report.

Why? Because if the foundation is off, everything else will be too.

Here’s my general approach:

  1. Assessment – Identify which part of the SI joint is involved (lesser arm, greater arm, apex, base, etc.).
  2. Ligament Reboot – Using manual therapy (like TLS and pumping) to reactivate proprioceptors and restore communication.
  3. Fascial Work – Addressing deeper fascial chains that are often involved but ignored.
  4. Specific Exercise – Not just general glute or core work, but targeted movement based on what your body needs.

Muscles involved include:

  • Piriformis
  • Glute Max (deep + superficial)
  • Glute Med
  • Obturatorius
  • Iliopsoas

But again, it’s not just about muscles. It’s about chains. You have to treat the whole system.


Don’t Google “3 Moves for SI Joint Pain” (Please)

Generic exercises might help a little—or they might make things worse.

Why? Because SI joint issues are specific. The dysfunction could be from one of many regions within the joint or even a combination of them. Without proper assessment, you’re guessing.

And in the body, guessing is a great way to stay stuck.


Want to Learn More?

I share more like this every week—so subscribe, share, and join the conversation. If you’re ready to go deeper:

Don’t let a misunderstood joint hold back your potential. Fix the foundation—so the rest of your body can finally thrive.

it’s not just working out, it’s building a foundation for a better life.

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Piriformis Syndrome Treatment: STOP Foam Rolling!

Diagram showing piriformis muscle and sciatic nerve path

Click to watch the full video

If you’ve struggled with pain deep in your glutes, you may have heard the term piriformis syndrome. Many people confuse it with sciatic nerve pain, and unfortunately, one of the most popular “solutions” — foam rolling with a tennis ball often makes the problem worse.

This article will clarify what piriformis syndrome truly is, how to distinguish it from sciatica, why aggressive rolling can be harmful, and what safe, effective treatment really looks like.

The piriformis is a small muscle deep beneath your glute max. It runs from inside your pelvis to your thigh bone’s greater trochanter. It’s crucial for external rotation of the hip and interacts with your pelvic floor muscles including the obturator internus, coccygeus, and levator ani, affecting pelvic balance, posture, and organ support.

The piriformis exits the pelvis via the greater sciatic notch, sharing a delicate passageway with the sciatic nerve itself. Depending on individual anatomy, the nerve may run above, below, or even through the muscle, which helps explain why piriformis dysfunction is often confused with or causes sciatic-type pain.

Osteopathic Manual Therapy

It’s vital to distinguish between true sciatica (usually from lumbar spine issues) and piriformis syndrome. Positive results on the straight leg test often indicate nerve root issues from the spine, while the FAIR test (flexion, adduction, internal rotation) and outward foot rotation when lying supine may reveal piriformis-specific problems.

Should you stretch or strengthen the piriformis? In reality, most people need both. The piriformis often becomes both tight and weak. Its action is external rotation — stretching involves internal rotation, and strengthening involves careful, supported external rotation. Always address these needs within the context of whole-body, fascia-oriented chains.

Why is foam rolling a bad idea? The piriformis is layered among sensitive fascia and ligaments with the sciatic nerve dangerously close. A tennis ball cannot target it accurately and risks compressing nerves and delicate structures, often raising inflammation and aggravating your symptoms.

Instead, sustainable treatment for piriformis syndrome demands:

  • Professional diagnosis (to exclude spinal causes)
  • Targeted stretching and strengthening, done within the body’s connected chains
  • Skilled therapy to restore fascial and joint balance
  • Avoiding movements and modalities that could worsen irritation

The underlying theme is restoring overall structural balance and function not just “treating one muscle.” If you rebalance how your pelvis and hips work, pain and dysfunction often resolve naturally.

If you’re currently frustrated by piriformis syndrome and repeated failed attempts at relief, it’s time for a change. Respect your body’s architecture and fascia, and choose precise, guided exercises and therapy.

Ready for Relief?

If you’re ready to move beyond pain and get clear on lasting solutions, Book a free consult. On your call, we’ll pinpoint what’s holding you back and build a personalized plan to get you strong, mobile, and pain-free.

it’s not just working out, it’s building a foundation for a better life.

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