Updated: Sep 22, 2020
Exercises for your Sacro-Iliac (SI) joint
The sacroiliac joint gives a lot of women of child-bearing age and beyond a lot of grief!
The SI joint is really at the hub of the body and it takes a smooth balance of forces from the core, hip, and pelvic girdle to keep the joint healthy and happy.
The pelvic girdle is the intersection of the body, where the ground reaction forces from the lower extremities and the forces of gravity down through the spine cross. A lot can go wonky here, and it’s not exclusive to women or just to women of child-bearing age.
The SI joint is the base of the lumbopelvic girdle.
The spine connects into the pelvis where the sacrum and tailbone (the end of the vertebral column) fit into the two iliac bones. Thus the sacro-iliac joint.
You also have the two femur bones connecting into the iliac bones at the hip, so you can see how things get complicated here.
The SI joint bears the weight of the body. It’s held together mainly by bony congruency, but also via some really tough ligaments and the thoracolumbar fascia.
This is referred to as its form closure.
The muscles that connect to the pelvis in this area are meant to move the joints, referred to as the force closure.
These muscles can easily become dysfunctional (ie tight, tired, painful with trigger points) when they are asked to stabilize more than they should…essentially taking up the slack of weakened ligaments.
The sacrum moves with the rotation of the spine. It does a combination of flexing/extending, sidebending and rotating, so things can get “stuck” in all sorts of goofy ways.
Painful syndromes around the SI joint can include the SI itself, the pubic symphesis in the front, the tailbone, and the low back.
How can you differentiate pain coming from your SI joint vs. your lumbar spine?
The easiest way to tell is if your pain is one sided, and/or notable gets worse on that one side when you transfer load to it like when you lift up one leg to put your pants on.
Common complaints I hear that help me narrow problems down to the SI joint is when people tell me they feel like they are “stuck” or “out of alignment.”
What I want you to know is that “stuck” and “out of alignment” conjure up some extreme images, but it’s a really subtle shift in position. Enough to create muscle spasm or restrict smooth motion, but not so much that you’re going to crumble and fall apart as these terms might suggest. Bottom line, it can be fixed!
SI Joint rehabilitation
You may hear a lot about SI joints being “rotated”, or having one hip higher/more rotated than another. There is clinical speak for anything that doesn’t look or move in perfect symmetry, but again, it’s not as dire as it sounds.
Some people may have muscles or ligaments that are overstretched, leading to trigger points and spasming and a hypermobile joint, whereas others may be more stiff and lack movement. Either way, we need to meet back in the middle.
There are three parts to any SI joint rehab:
Restore the normal alignment and mobility. In the video below I share some basic muscle energy techniques to help with neutral positioning, as well as my #1 stretch to improve mobility around the sacrum. If you are more on the hypermobile end of the spectrum, you may benefit from external supports such as my favorite Serola Sacroiliac Belt
Stabilize via force closure mechanism. This means working the right muscles around the joint. We get into the most fundamental and important stabilizers in this video. Again, sometimes it takes a little time to build muscular strength up to speed, so in the mean time a stability belt can help.
Integrate mobility and stability during functional movement tasks. This is a large part of what we teach you in Physical therapy. Often times it’s not WHAT you’re doing, it’s HOW your doing it. PT’s are experts at analyzing and fixing your movement patterns.
Your own anatomy, history, and dysfunctional movement patterns will determine the true correct course of treatment, so please get yourself to a Physical Therapist if you’re finding you want more answers and more individualized guidance. This is why we exist!