Q I’ve received seven months of treatment for a sacroiliac joint sprain, but every time I start running again it reappears. Many people have told me just to put up with the pain, but I’m sure this isn’t the right thing to do.

A First, here’s some general advice about running ‘through’ pain. You’re right in thinking that running with pain is not a good idea, as the body uses it as a warning that you are doing an activity that it can’t handle. In a very small number of instances, though, you can run with aches – but only if you’ve been told it’s okay by a medical professional, and they carefully monitor your progress.

In your instance, I’d advise against running. It sounds as if you were originally diagnosed with a ligament strain of the sacroiliac (SI) joint, but I would have expected that to have cleared up, or at least improved a great deal, by now. I suspect that a more probable cause of your continuing problem is ‘kinetic dysfunction’ of the SI joint – simply put, it isn’t aligned or moving correctly. If you don’t get this addressed, the pain won’t go. The key to treating this problem is accurate analysis and appropriate treatment such as manipulation or mobilisation. These will help to restore normal function to the joint.

That said, there are a few other problems that could cause this pain. Ask your specialist to check for posterior hip instability, lumbar spine problems, adverse neural tension and mechanical instability of the SI joint itself. If the joint is found to be unstable, you may be offered ‘sclerosant’ injections, which will shorten the ligaments and add stability to the joint. But with a full investigation and treatment programme, I’m sure you’ll be back running soon.

—Andrew Caldwell, chartered physiotherapist