Dealing With SI Joint Pain Part 1: What Exercises Help and What Should You Avoid
The sacroiliac (SI) joint, located at the base of the spine, plays a crucial role in connecting the sacrum to the pelvis. It acts as a shock absorber, transmitting forces between the upper body and the legs during various movements. It is often overlooked as a source of low back pain and when the SI joint becomes irritated or inflamed, it can cause severe discomfort and impaired mobility.
The most common symptoms of an irritated SI joint include:
Lower back pain, particularly in the dimples above the buttocks. SI joint pain often presents as a dull or sharp ache in the lower back, typically on one side. The pain may radiate to the buttocks, hips, or thighs.
Pain in the hip, groin, or buttocks, often felt on just one side
Pain when climbing stairs or straightening up after bending forward
Discomfort when sitting for long periods
Pain that worsens with walking, standing, twisting, or transitioning between positions
Radiating pain down the leg rarely past the knee
Causes and Symptoms of SI Joint Pain
The sacroiliac joint can be susceptible to dysfunction and inflammation for a variety of reasons. Some of the most common causes of SI joint pain include:
Pregnancy: Changes in weight, posture, hormones, and pelvic mechanics during pregnancy and childbirth often put extra strain on the SI joints, leading to pain. SI joint dysfunction is a very frequent cause of back pain in pregnant women. Let's break down these factors in more detail:
Pregnancy Alignment Shifts: The body's alignment shifts during pregnancy, tilting the pelvis forward into an anterior pelvic tilt. This shift, combined with a change in the body's centre of gravity, can cause the two bones at the SI joint to rub against each other, resulting in pain.
Hormonal Changes: Pregnancy hormones, including relaxin, soften joints, ligaments, and connective tissues to accommodate the growing baby and provide flexibility for childbirth. However, this softening can lead to increased joint mobility and reduced stability, potentially causing SI joint hypermobility and pain.
Increased Body Weight: As pregnancy progresses, the added weight increases the forces exerted on the pelvis, exacerbating the above issues.
Injury or trauma: Stress or injury to the joint from an abrupt movement, fall, or motor vehicle accident can damage the ligaments supporting the SI joint. Sports that involve twisting like golf, football, and hockey commonly lead to SI joint sprains and inflammation.
Arthritis: Osteoarthritis of the SI joint may develop over time from normal wear and tear. Rheumatoid arthritis can also affect the joint and is associated with inflammation.
Leg length discrepancy: Having one leg longer than the other alters pelvic alignment and weight distribution, which increases stress on the SI joints. This asymmetric mechanics can cause pain.
Muscle imbalances: Weakness or tightness in core, pelvic, hip, and leg muscles can impair proper stabilization of the SI joint, leading to strain and pain. Abdominal muscle separation after pregnancy is one example.
Is your low back causing your Sacroiliac Joint pain?
Your lower back can contribute to SI joint pain due to their close functional connection. Stiffness or issues in the lower back can lead to SI joint dysfunction. When the lower back isn't moving properly, it can alter the biomechanics of the SI joint, causing discomfort and pain. This is because the SI joint and lower back work together to support the spine and pelvis.
The SI joint pain you experience may not always directly originate from the SI joint itself; it can be referred pain from the lower back. Dysfunction in the lower back can create stress on the SI joint, affecting its stability and causing discomfort in the lower back and hips.
To determine if your lower back is contributing to SI joint pain, you can perform a self-assessment using a ball to target specific areas in your lower back. If pressing on a spot in your lower back reproduces your pelvic pain, it suggests that the lower back is involved in your SI joint discomfort. Addressing both lower back and SI joint mobility through appropriate exercises and consultation with a healthcare professional can help manage and alleviate SI joint pain effectively.
Assessment and Exercise
Practical assessment and exercise to help individuals determine if their lower back is contributing to their SI joint pain:
Choose a Ball: To begin, you will need a therapy ball, spikey massage ball, tennis ball, or a similar object that you are comfortable lying on top of.
Lay down on your back with your knees bent and your feet flat on the floor. Place the selected ball at the base of your rib cage, set the ball just off to one side of your spine (never place a ball directly in the middle of your spine).
Gently let the ball roll out across that one side, allowing it to press into any specific triggered areas of your lower back.
Once a triggered spot has been identified, remain there, take deep breaths, letting the ball apply pressure to the identified area.
Once the tension in the tissue has released you can move on and hunt out any other triggered areas.
Continue downward on that same side of the spine, move the ball down one segment at a time and repeat the process. Look for areas that feel important and spend enough time on each spot for it to release.
Compare the sensations on one side with the other. Note any differences in stiffness, tenderness, or tightness.
Please note that if you’re a currently pregnant you must not carry out this exercise whilst laying on your back. Alternatively, you can perform the exercise against a wall or hard back chair.
If you are experiencing significant pain or discomfort, it is essential to consult with a healthcare professional for a proper diagnosis and a tailored treatment plan. Addressing both hip and spine mobility can help individuals manage and alleviate SI joint pain effectively.
effective exercises for sacroiliac joint pain relief
Diaphragmatic Breathing
Starting Position:
Visualization: Picture the diaphragm as a dome-shaped muscle separating the chest (ribcage) from the abdomen, even though it's not physically felt.
Awareness: Stand or sit upright and place a scarf or band around the lower ribcage, gently pulling both ends to draw attention to the diaphragmatic area.
Inhalation
Focus: Direct your attention to the back and sides of the ribcage where the lungs are situated.
Breathing In: Inhale through your nose, visualizing your lungs expanding like slowly inflating balloons, feeling the scarf tighten.
Avoid Force: Do not force inhalation; it should be natural.
Diaphragm Action: Simultaneously, the diaphragm descends into the abdominal region, expanding the ribcage outward.
Exhalation
Expelling Air: Exhale through your mouth, sensing air gently leaving from the depths of your lungs.
Diaphragm Rising: Feel your diaphragm rising as you engage your deep abdominal muscles, gradually closing the ribcage.
Avoid Tension: Refrain from puffing cheeks or pursing lips to prevent tension in the neck, jaw, and face.
Benefits: Diaphragmatic breathing enhances breath control and posture, facilitating ease of movement and overall well-being.
Static Kneeling Hip Flexor/Quadriceps Stretch:
Kneel with front leg bent at a 90-degree angle.
Internally rotate back leg.
Draw abs in and Squeeze buttocks, while rotating pelvis posteriorly.
Slowly move your hips forward until a mild stretch is achieved in the front of the hip.
Raise stretch side arm up and over to the opposite side.
Hold side bend position and slowly rotate backward.
Hold for 20-30 seconds.
Switch sides and repeat.
Inner Thigh Stretch:
Sit on the floor with legs bent and knees wide, feet together. You can place a small pillow under each knee for comfort.
Keeping back straight, gently press knees toward floor using both hands on top of thighs. Avoid forcing the stretch.
Hold for 30 seconds, feeling a mild stretch of the inner thighs. Relax and repeat.
Hamstring Stretch:
Sit near the edge of a chair. Extend one leg straight out in front of you, with a flexed foot place your heel on the floor, keep the knee slightly bent.
Keep the other foot flat on the floor. Maintain a neutral spine by avoiding rounding or arching the lower back.
Hinge forward at the hips, keeping the back straight. Reach down the extended leg as far as you can without pain.
You should feel a gentle stretch down the back of the thigh. Hold for 30 seconds, breathing deeply.
Repeat on the other side.
Pelvic Clock- Semi Deflated Mini Ball
Performing the Pelvic Clock with a deflated mini ball is an effective exercise for SI joint dysfunction and overall core strength. It helps with natural pelvic movement and differentiation in the spine, sacrum, and pelvis.
Lie on your back with your knees bent and your feet flat on the floor. Position a semi deflated mini ball under your sacrum.
Inhale deeply.
Exhale while performing a deep crunch, tilting the pelvis forward (6 o'clock position).
Hold for 5 seconds.
Inhale again.
Exhale while tilting the pelvis back (12 o'clock position).
Hold and repeat the process.
SI Joint-Specific Tilt (11-1)
Similar setup with the Pelvic Clock.
If you have pain on the right, tilt slightly to the right (11 o'clock position) during the crunch.
If you have pain on the left, tilt slightly to the left (1 o'clock position) during the crunch.
Follow the same breathing strategy as in the previous exercise.
Focus on tilting toward the painful SI joint.
Lower Trunk Rotation
Lie on your back with knees bent and feet flat on the floor.
Tighten your stomach and push your lower back into the floor.
Gently rotate your legs to one side as far as you can, then do the same to the other side.
Repeat 10 to 20 times.
One Knee to Chest Stretch
Lie on your back with legs straight out in front.
Bring one knee up to your chest and grasp the back of your thigh.
Pull the knee toward your chest to stretch your buttock muscle.
Hold for 15 to 30 seconds, then return to your original position.
Repeat three times on each side.
Both Knees to Chest Stretch
Lie down on your back with knees bent and feet flat.
Tighten your stomach muscles and push your lower back into the floor.
Pull both knees to your chest and hold for five seconds, then relax for five seconds.
Repeat this 10 to 20 times.
Knee Pull with Isometric Resistance
Start by lying on your back.
Pull one knee up toward your chest.
Cup your hands around the knee.
Push the knee away from you while providing resistance with your hands (isometric exercise).
Hold for several seconds, exhale, and repeat.
Leg Pull Apart with Belt
Place a belt around the legs near the knees.
Lie on your back.
Attempt to pull the legs apart against the resistance of the belt (isometric exercise).
Create an outward motion without actual leg movement.
Knee Squeeze with Stability Ball
Place a stability ball between your knees.
Squeeze the knees together, pushing against the ball (isometric exercise).
Attempt to touch the knees without allowing actual movement due to the ball.
Floor Bridge
Lie on your back with knees bent, arms against your body, and palms against the floor.
Squeeze your buttocks and raise your hips off the ground to bring your body into a straight line.
Hold for five seconds, then slowly lower yourself to the ground again.
Repeat eight to ten times.
Single Leg Extension
Lie face down, ensuring your pelvis and spine are in a neutral position. Rest your forehead on your hands. Straighten your legs, positioning them hip-width apart.
Inhale deeply and elongate your spine.
Exhale and gently lengthen one leg away lifting it an inch off the mat. Concentrate on extending your leg away from the hip socket.
Inhale again as you lower leg, all the while maintaining abdominal engagement.
Lift the leg only as high as you can while ensuring your pelvis and spine remain stable.
Repeat ten times, alternating legs.
Yoga Exercises for SI Pain Relief
Many yoga poses offer beneficial stretches for SI joint pain relief. These poses can strengthen the sacroiliac joint and reduce discomfort, as well as prevent future problems. However, it's crucial to perform these poses correctly to avoid exacerbating the issue. If you're uncertain, consult a local yoga instructor or studio for guidance and always remember to seek expert advice from a physiotherapist
1. Cobra Pose
Lie on your stomach with your legs stretched back, tops of your feet on the floor.
Spread your hands on the floor under your shoulders, elbows tucked in.
Lift your upper body off the floor, holding for five seconds, then lower it back down.
2. Locust Pose
Lie on your stomach with arms alongside your body, palms up.
Lift your head, upper body, arms, and legs away from the floor.
Hold for 15-30 seconds, then release.
3. Bow Pose
Lie on your stomach with arms along your body, palms up.
Bend your knees and bring your heels as close to your buttocks as possible.
Reach back and grab your ankles, being careful not to tense your back muscles.
Lift your feet and upper body, holding the pose for 15-30 seconds, then relax.
Dealing with sacroiliac joint pain During Pregnancy and Beyond
If you are experiencing sacroiliac joint pain while pregnant, check out Part 2 of this article for safe and effective exercises that can provide relief during pregnancy. Click [HERE] to jump to Part 2: Effective Exercises for Sacroiliac Joint Pain Relief During Pregnancy.
For those dealing with lingering SI joint pain during postpartum recovery, Part 3 outlines safe and beneficial Pilates exercises to aid in recovery after childbirth. Click [HERE] to go to Part 3: Effective Pilates Exercises for Sacroiliac Joint Pain Relief Postpartum.
With proper assessment, targeted exercises, and lifestyle adjustments tailored to the stage of pregnancy or postpartum, sacroiliac joint pain can often be effectively managed. The key is choosing the right activities and exercises to strengthen and stabilize without overstressing the SI joint. By following the guidance in Part 2 and Part 3, you can develop an appropriate exercise routine to keep your SI joint happy and healthy.
Exercises and Activities to Avoid
While the above exercises are excellent for preventing and managing SI joint pain, certain movements and activities should be limited or avoided, especially when experiencing pain:
Lunges or Step-Ups: These single-leg lower body exercises place the pelvis in a less stable position. Focus on exercises that evenly distribute your weight over both feet.
Impact Exercises: Running, jumping, and other high-impact activities can exacerbate pain due to pelvic hypermobility. Avoid these movements when experiencing SI joint pain.
Traditional Cardio Machines: Machines like the elliptical, Stairmaster, and treadmill promote single-leg activities and should be avoided.
Crossing Legs When Seated: Maintain even weight distribution by sitting with both feet flat on the floor. Avoid deep single-leg hip stretches.
Any Pain-Triggering Moves: Be mindful of activities that trigger pain, as these can vary among individuals.
Single-Leg Daily Activities: Activities such as walking, stair climbing, and getting up and down from the ground are single-leg activities. While it's not possible to entirely avoid these activities, limit extended periods of walking or stair climbing during severe pain. When rising from the ground, step up on the side that doesn't hurt.
Prevention and Lifestyle Tips
Preventing SI joint pain and maintaining the health of the sacroiliac joint are essential for promoting overall well-being and avoiding potential discomfort. Incorporating simple lifestyle adjustments and adopting good practices can significantly reduce the risk of SI joint pain and improve joint function.
1. Maintain Good Posture
Practicing good posture is crucial for maintaining proper alignment of the spine, including the SI joint. When sitting, standing, or walking, try to keep your shoulders back, chin parallel to the floor, and abdomen engaged. Avoid slouching or hunching forward, as this can place unnecessary strain on the lower back and SI joint.
2. Practice Proper Body Mechanics
Whether lifting heavy objects or performing daily activities, using proper body mechanics is essential for protecting the SI joint from injury. When lifting, bend your knees and keep your back straight, avoiding twisting or jerking movements. Engage your core muscles to support your spine and use your legs to lift, rather than relying solely on your back.
3. Stay Active and Exercise Regularly
Regular physical activity and exercise are essential for maintaining joint flexibility, muscle strength, and overall joint health. Low-impact activities such as walking, swimming, or cycling can be particularly beneficial for individuals with SI joint pain. Be sure to incorporate exercises that specifically target the SI joint and surrounding muscles.
4. Maintain a Healthy Weight
Excess body weight can place additional stress on the SI joint and contribute to pain and discomfort. By maintaining a healthy weight through a balanced diet and regular exercise, individuals can reduce the burden on their joints, including the SI joint.
5. Avoid Prolonged Sitting
Sitting for extended periods can place increased pressure on the SI joint and lead to stiffness and discomfort. If your job or lifestyle involves prolonged sitting, take breaks to stand, stretch, and walk around regularly. Consider using an ergonomic chair with proper lumbar support to maintain better posture while seated.
6. Avoid High-Impact Activities
High-impact activities such as running or jumping can put significant stress on the SI joint. If you have a history of SI joint pain or are at risk for developing it, consider engaging in lower-impact exercises or consulting a fitness professional to create a joint-friendly exercise routine.
7. Listen to Your Body
Pay attention to your body’s signals and avoid pushing yourself through pain or discomfort. If you experience SI joint pain or any discomfort, take a break and allow your body to rest and recover. If the pain persists or worsens, seek guidance from a healthcare professional.
8. Supportive Footwear
Wearing supportive and comfortable footwear can contribute to proper body alignment and reduce stress on the SI joint. Choose shoes that offer adequate arch support and cushioning, especially if you spend extended periods on your feet.
9. Strengthen Your Core Muscles
A strong core can help support the spine and SI joint, reducing the risk of injury and discomfort. Incorporate core-strengthening exercises into your routine, such as planks, abdominal crunches, and yoga poses that target the core muscles.
The sacroiliac joint plays a crucial role in stabilizing the pelvis and lower spine. When this joint becomes irritated or inflamed, it can result in significant pain and mobility impairment. There are several potential causes of SI joint dysfunction, from pregnancy and childbirth to trauma, leg length discrepancies, and muscle imbalances.
The good news is that with proper assessment, targeted exercises, and some lifestyle adjustments, many cases of SI joint pain can be effectively managed and relieved. Exercises that strengthen the muscles surrounding the SI joint, improve pelvic and lower spine mobility, and promote stability are beneficial. Yoga poses like Cobra and Locust can also provide helpful stretches.
However, individuals should avoid activities that exacerbate SI joint pain like high-impact exercises, deep single leg stretches, and prolonged sitting or walking. Listening to your body and seeking guidance from a physical therapist or healthcare provider is key. With a proper exercise routine, healthy lifestyle habits, and mindfulness of body mechanics, the sacroiliac joint can be kept happy and healthy for the long term.
For those experiencing SI joint pain during pregnancy, Part 2 outlines safe exercises to relieve symptoms without overstressing the joint. If SI joint pain lingers postpartum, Part 3 provides beneficial Pilates exercises to aid recovery. The key is choosing safe pregnancy and postpartum activities that strengthen the surrounding muscles and promote mobility without further irritation. By developing an appropriate exercise routine tailored to your needs and stage of pregnancy or postpartum, you can keep your SI joint happy and healthy for the long term. With mindful body mechanics and professional guidance, SI joint pain can often be successfully managed through strategic exercises and lifestyle adjustments.