SI joint pain? Here’s what to do (and what not to do)

Will doing a handful of sacroiliac, or SI, joint exercises a few times a week prevent your lower back pain?

This may seem reasonable, since that’s where the joint is located, but like anything related to health and fitness, it’s not that simple.

Pain and dysfunction in the SI joint is common in some athletes, pregnant and postpartum women (thanks to ligament-relaxing hormones), people with unequal leg length and certain genetic conditions that cause cartilage loss and inflammation.

But Glenn Babus, DO, president of Healthcare Associates in Medicine, PC in New York, New York, believes that the time we sit may be the biggest culprit of SI joint pain.

“When I first started, I didn’t see as many sacroiliac problems as I do now. It has grown a lot in the last 15 to 20 years,” he says.

“I see all these people who are sitting at the computer, or they’re sitting for hours and not moving at all,” Babus continued.

In a classic example of “move it or lose it,” disused SI joints become more vulnerable to subsequent injury even during seemingly innocuous activities such as weekend hikes and everyday activities such as bending, reaching, and lifting.

That being said, SI joint exercises and increased daily activity are not a universal prescription for relieving SI joint pain (or any chronic pain, for that matter).

If you suspect you may be dealing with sacroiliac joint dysfunction, see a medical professional.

What is the SI joint?

The two SI joints connect the sacrum (the lower, triangle-shaped part of the spine above the tailbone) to the right and left iliac bones, which are wing-shaped protrusions arising from the pelvic girdle.

Reinforced by ligaments, each SI joint has a limited range of motion and, according to the Weill Cornell Brain and Spine Center at NewYork-Presbyterian Hospital, serves to absorb impact and provide stability when transferring weight from the upper body to the lower body, such as when standing up from a seated position or walking

What exercises should you avoid for SI joint pain?

While medical doctors and physical therapists may recommend SI joint exercises and movement therapy to deal with sacroiliac joint dysfunction, there are certain activities that, generally speaking, should be avoided by anyone with SI joint pain.

Jessalyn G. Adam, MD, CAQSM, a board-certified physician specializing in primary care sports medicine with orthopedics and joint replacement at Mercy Medical Center in Baltimore, Maryland, advises only against any activity that causes pain.

“Running, jumping, or things where you’re loading one side of the body can be painful,” she says.

Babus recommends that people with SI joint pain avoid sit-ups, heavy lifting, contact sports, and exercises that bend and twist the hips, such as golf and tennis.

Common “weekend warrior” activities can also be harmful.

“Excessive biking or long rides can actually do more harm than good by putting extra stress on the sacroiliac joints,” he adds.

SI joint exercises to prevent injury

Adam and Babus agree that a strong core is key to preventing SI joint pain and sacroiliac joint dysfunction.

In addition to incorporating more walking (and less sitting) into your day, try adding these core-strengthening exercises to your fitness routine.

side plank

Side plank  Planks for beginners

  • Lie on your right side on your right elbow and forearm, with your legs straight and stacked. Your shoulder should rest on your elbow with your left hand on your hip.
  • Engage your core, flex your glutes, and lift your hips off the floor until your body forms a straight line from head to heels.
  • Hold for a moment, then switch sides and repeat.

bird dog

  • Get down on all fours with your hands directly under your shoulders and your knees directly under your hips.
  • Keeping a flat back, engage your core and simultaneously extend your right arm in front of you and your left leg straight behind you. Keep your left leg flexible.
  • Pause, then return to the starting position.
  • Do equal reps on both sides.

clamshell

Woman doing clamshell exercise

  • Lie on your left side with your head resting on your left arm, your legs and hips stacked, and your knees bent 90 degrees.
  • Bring your knees forward until your feet are in line with your hips and place your right arm flat in front of you by your left elbow. This position begins.
  • Keeping your feet together, engage your core as you slowly lift your right knee without tilting your pelvis or lifting your left knee off the floor.
  • Hold for one second, squeeze your glutes, and then lower your knees to the starting position.
  • Do equal reps on both sides.
  • Make it harder: Loop a small resistance band around both legs just above your knees.

The SI joint is stretched to reduce discomfort

Stretching can help ease SI joint pain, but Babus has a few caveats. “Stretching alone is not enough. You have to increase your core strength,” he says.

Additionally, he recommends dynamic stretches (such as hip swings) and caution against stretching around cold SI joints—always warm up first.

Hip swing

Best stretching exercises for daily flexibility

  • Stand tall with your right arm on a wall, rail or other stable object at your side for balance and shift your weight onto your right leg.
  • Keeping your torso straight and your core engaged, swing your left leg forward and backward, starting with a small range of motion and gradually increasing the height of each swing.
  • Continue for time, and then switch legs and repeat.

Seated Figure 4

Andrea Rogers Seated Stretch Figure 4 |  Figure 4 is enlarged

  • Sit on a chair or bench and bring your right ankle out to rest on your left knee.
  • With your chest up, back flat and right ankle bent, reach your waist until you feel a stretch in your right hip and lower back.
  • Hold for a while and then repeat with the other leg.

Twisting of the spine

  • Lie on your back with your legs extended and then draw your right knee towards your chest.
  • Extend your right arm to your right side and place your left hand outside your right knee.
  • With your right shoulder on the floor and your gaze on your right arm, reach your left hand across your body to help bring your right knee to the floor until you feel a deep stretch in your hips and lower back.
  • Hold for a moment, and then switch sides and repeat.

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