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Fragile Low Back with SI Joint Pain

Want to skip ahead?
Here’s a link to my post about
getting relief on your own.

How People Describe This Pain Pattern

These people complain of sharp pain in the low back that feels like it will  “go out,” as well as pain in the sacroiliac joint. This pattern is a combination of trigger points in two different muscles that become activate together. On the one hand, multifidi create an intense, fragile feeling in the vertebrae. On the other hand, the quadratus lumborum creates an unstable back with hip pain.

Sometimes, the stiff low back bothers them more, and the SI joint is achy.  At times, the low back problem is sharp and debilitating. In other cases, the low back is stiff, and the SI joint is more bothersome. For example, this person will tend to squat or reach to one side to pick up something off of a coffee table or chair instead of bending forward at the waist.

Morning Back Pain

It usually bothers people more intensely in the morning and can make going to the bathroom at night a real problem. In severe cases, these people have trouble getting out of bed in the morning and may crawl to the bathroom. Likewise, staying seated or for a while, such as long car trips or a conference, is a common complaint.

How You Activate and Intensify This Pain Pattern


This condition commonly occurs just after performing a task that involves teetering forward at the waist, including:

  • cutting grass
  • washing dishes
  • raking leaves
  • vacuuming
  • scrubbing a floor.

It can also come from bending forward and reaching out awkwardly as when someone stacks dishes in the back of a low cabinet, especially when they twist while reaching out.


Also, once aggravated, sitting in a slumped position at a desk or in a car aggravates this condition. As well, people often wake with debilitating pain, especially when they sleep in the fetal position.

The Musculoskeletal Anatomy Behind Your Pain

Anatomy – Throacic Outlet

The anatomy of these structures is important to understand the syndrome. This post walks through the structures one at a time.

This muscle is a small, complicated muscle with three different sections that generate a lot of pain and instability in the low back. Take a look at this post on the anatomy of quadratus lumborum.

Anatomy – Throacic Outlet

The anatomy of these structures is important to understand the syndrome. This post walks through the structures one at a time.

Multifidi and rotatores are interspinous muscles that manage tension and balance between vertebrae.

Getting Relief on Your Own

Clinically Proven
Self-Care Strategies

This post has strategies for getting relief on your own. Explore how to change your activities, stretch, and other strategies that relieve the pain associated with this trigger point.

This trigger point is in the center of the low back, just above the crest of the hip. Focus your icing and twists in that area. Often, it’s a little stiffer in the muscle along that side of the spine. Notably, It often releases with a little click.

Therapy Notes for Massage and Bodywork

Better Bodywork
Through Shared Expertise

This post has techniques, tips, treatment routines, and anatomy illustrations to improve the bodyworker’s approach.

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Tony Preston has a practice in Atlanta, Georgia, where he sees clients. He has written and taught about anatomy, trigger points, and cranial therapies since the mid-90s.

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*This site is undergoing significant changes. We are reformatting and expanding the posts to make them easier to read. The result will also be more accessible and will include more patterns with better self-care. In the meanwhile, there may be inconsistencies in formatting, content presentation, and readability. Until we get older posts updated, please excuse our mess.