SI Joint Pain: Exercises to Focus On (and Avoid)

There is certainly no shortage of pregnancy aches and pains, and sometimes it can be difficult to determine what exactly it is you are feeling and how to address it.  One of the most common pains women experience is sacroiliac (SI) joint pain, but often we may not know that’s what it is, and in turn, could try to do things to remedy the pain that could actually make it worse.  Here are some tips to help you identify if you might have SI joint pain, as well as what to focus on (and avoid) to help mitigate it.

What SI Joint Pain Feels Like

SI joint pain is felt in the backside of your pelvis (around your buttocks), and a tell tale sign is that it’s often felt on one side only.  The pain is typically worsened by weight bearing activity, especially on one leg (like stair climbing, doing the elliptical machine, taking an exercise class, or even long periods walking).  The pain can range from chronic and dull to sharp and shooting, sometimes radiating down your leg a bit.  If you think you may have SI joint pain, speak with your doctor to get a diagnosis.

What Causes SI Joint Pain

Your SI Joint is located in the backside of your pelvis (shown below). When you’re pregnant, a hormone called relaxin continues to increase throughout your pregnancy.  This hormone does what it sounds like it’d do — it softens your joints, ligaments, and connective tissues to allow your body to adapt to your growing baby, and to provide more mobility for childbirth.  While very useful in that sense, the downside of relaxin is that it softens the joints and ligaments that provide stiffness to the pelvis, making the job of the SI joint harder.  That is because the SI joint is tasked with keeping the pelvis in neutral alignment while the growing belly wants to tip it forward.  Many times the pull from your belly combined with the softening effect from relaxin becomes too much and causes the SI joint to give, stretch, and possibly become hypermobile.  This is when you feel the pain.

Moves to manage (or prevent) SI Joint Pain

Many women ask what stretches they can do to manage the pain. If this was muscle pain, there could be stretches that could alleviate it.  However, we are talking about pain in a joint that is likely caused by hypermobility in that joint.  Therefore, the keys to addressing it are to 1) decrease stress on the joint and 2) strengthen the muscles surrounding the joint to provide greater pelvic stability.  You can accomplish this by getting your body into neutral alignment and strengthening your glutes, core canister, and lats.  Here are some moves to help you do that:

  • Get in neutral: Before we get into specific moves, it’s important to mention one critical concept that you should be mindful of throughout your day, and that’s your alignment.  Pregnancy tends to pull your body into an “anterior pelvic tilt” (or excessive lower back arch) like you see below, which places added stress on the SI joint.  Therefore, it’s important to train your body to stand and move in neutral alignment.

  • 360° Breathing: Once you’re in neutral alignment, this is the first and most fundamental move to master to appropriately activate your Core Canister muscles.  Master 360° Breathing, then incorporate it into every single movement from here on out.
  • Pelvic Floor Activations (PFAs): One of the key responsibilities of the pelvic floor muscles is to assist in stabilizing the pelvis.  Therefore, it’s important to target these critical deep core muscles with PFAs.  Note, there is a reason we do not call these moves “Kegels.”  Learn why.
  • Bridges: This is a great movement to target your glutes in a safe and effective way because it keeps your pelvis in a stable position.  You can add challenge by placing a load on your hips.
  • Clamshells: These are also great at targeting the glutes in a safe non-weight bearing way.  Be sure to follow the technique pointers in this video to ensure you get the most out of the movement.
  • Ground Pickup (or Deadlift): The Ground Pickup is essentially a Deadlift, but we refer to it this way because we want you to associate this action with how you pick things up off the ground in your daily life. If you can train yourself to naturally bend over properly (by hinging at your hips and maintaining a neutral spine), each time you do this, you’ll be strengthening your glutes and protecting your lower back and abdominal wall. Once you’ve mastered, increase the challenge by lifting heavier objects.
  • Straight Arm Pull-Downs: This move targets your lats, which help stabilize your pelvis.  You will need a resistance band for it.  We recommend this Theraband variety pack, which includes three bands so you have a few different resistance levels to work with.  You can tie it to something or use this very simple and inexpensive door anchor.
  • Single-Arm Bent Over Row: This is also a great movement to target the lats to help stabilize your pelvis.  It uses the same resistance band as above.  If you need more support for your lower back, try this single arm supported row.
  • Incline Plank: A plank targets the core muscles at the front of your body, training these muscles to help you resist that excessive lower back arch we showed at the beginning.  During pregnancy, however, we must be very careful about managing intra-abdominal pressure and full planks performed with a larger belly will create too much intra-abdominal pressure.  Therefore, beginning in the second trimester, we regress these by performing them at an incline.

Moves to Avoid

Because we are trying to stabilize the pelvis, you should limit single-leg weight bearing activity as much as possible when experiencing symptoms of SI joint pain.  This includes things like the following:

  • Lunges or step-ups: Single-leg lower body moves like lunges of any kind or step-ups/downs place your pevis in a less stable position.  In general, you want to keep your weight evenly distributed over two feet (think squats, deadlifts, floor bridges, etc).
  • Impact: Impact moves like running, jumping, or other ballistic moves will likely aggravate pain given the hypermobility in your pelvis.  Your body will likely tell you these moves are not appropriate.
  • Traditional cardio machines: Machines like the elliptical, Stairmaster, and treadmill all promote single-leg activities, so it is best to avoid these.
  • Crossing your legs when seated: Again, we want to keep your weight evenly distributed, which includes when you sit.  Try to sit tall with both feet flat on the floor.  Also avoid any deep single-leg hip stretches like pigeon pose or figure four.
  • Any move that triggers pain: Sometimes the pain triggers are different for every individual, so try to pay attention to the activities that trigger pain for you.  This can sometimes be tricky because you may not feel the pain until the next day, so you may have to think back to what you did the day prior.
  • (Use caution with) single-leg daily activities: Activities like walking, stair climbing, and getting up and down from the ground are single-leg activities.  Of course, it’s not possible to completely avoid these activities, and we wouldn’t want you to either.  It’s important to keep moving.  You may just want to limit extended periods of walking or stair climbing when pain is severe.  Also, when getting up off the ground, step up on the side that does not hurt.

If pain becomes too bothersome, it’s best to work with a personal trainer who has knowledge of this condition and can design a specific program for your needs, like a PROnatal Personal Trainer.  If pain becomes severe, speak with a women’s health physiatrist (medical doctor who specializes in non-surgical pain rehabilitation) or physical therapist.