SI joint pain is one of the most common pregnancy-related pains… and one of the most misunderstood. Many people feel it and describe it as “low back pain.” But once you understand what SI joint pain actually is, and where it’s felt, the distinction becomes clear. And that distinction matters, because it changes how you respond to it.
Whether you’re experiencing it yourself or working with a pregnant client, this article will help you identify SI joint pain and walk you through practical strategies to manage it or prevent it in the first place.
Read on to learn:
- What SI joint pain feels like and where it’s located
- What causes SI joint pain during pregnancy
- Exercises to focus on to help manage or prevent symptoms
- Movements to avoid if you are experiencing SI joint pain
- Additional resources to support you
Quick Answer: SI joint pain during pregnancy is felt in the back of the pelvis, usually on one side. It’s most often caused by hormonal changes that loosen the pelvic ligaments, combined with added body weight and weakened glutes. Strengthening the glutes and deep core muscles can help manage or prevent symptoms. Knowing which movements to avoid can also make a significant difference in your day-to-day comfort (or your clients’).
What SI Joint Pain Feels Like
SI joint pain is felt in the back of the pelvis (around your buttocks), often felt on one side only (like in the image below). The pain can range from chronic and dull to sharp and shooting, sometimes radiating down your leg a bit. Often that pain is worsened by weight-bearing activity, especially on one leg (like stair climbing, doing the elliptical machine, taking an exercise class, or even long periods of walking).
What Causes SI Joint Pain
The human body has two SI joints (a left and a right) located in the posterior pelvic region between the sacrum and the ilium bones (hence the name sacroiliac joint).
During pregnancy, the following factors can place added stress on these joints, which can lead to pain:
- Hormonal Changes: Pregnancy hormonal changes – including the increase in the hormone relaxin – can loosen the ligaments of the pelvis, making the SI joint more mobile than pre-pregnancy.
- Insufficient Glute Strength: The glutes are critical in stabilizing the pelvis and, by extension, the SI joints. Due to pregnancy weight gain, the added body mass can become more difficult for the glutes to support, especially during single-leg activities.
- Increased Body Weight: The increased weight as pregnancy progresses elevates the forces going through the pelvis, which accentuates the two issues above.
Because some hormonal changes from pregnancy persist into the postpartum period, SI joint hypermobility or asymmetry may still be present after giving birth. This is why SI joint pain can also occur in the postpartum period.
Exercises to Focus On (to Manage or Prevent SI Joint Pain)
The following techniques and exercises are great for prevention and pain management.
- Neutral Alignment: This first one is not really an “exercise,” but incredibly important in alleviating stress on the SI joint. Unfortunately, the physical and physiological changes of pregnancy can pull the body out of neutral alignment, which could worsen the impact from the causes stated above. To address, practice getting your body — especially your pelvis — into neutral alignment to alleviate stress on the SI joint.
- 360° Breathing: The deep core muscles (diaphragm, transverse abdominis, and pelvic floor) help to support and stabilize the pelvis (and therefore minimize SI joint pain). Begin by practicing 360° Breathing (the #1 most effective core exercise) because it activates these deep core muscles and gets them to work together in a coordinated way. Master this movement first, then practice incorporating it into all the other exercises below (as demonstrated in the video).
- 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 exercises we refer to as PFAs.
- Bridges: As mentioned above, insufficient glute strength can be a key contributor to SI joint pain because the glutes work with your core to stabilize your pelvis. So, targeting them directly is essential. Bridges are a great option because they keep your pelvis in a stable position. Don’t worry, it is fine to be on your back for short durations during pregnancy as long as you feel comfortable.
- Clamshells: These are also effective 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 use this name because we want you to connect it to how you pick things up in your daily life. Training yourself to naturally bend over in neutral alignment (maintaining a straight line between ear-shoulder-hip) strengthens your glutes while also protecting your core. Once you’ve mastered this move, 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: Planks target the core muscles at the front of your body, which can help resist the common anterior pelvic tilt (alignment shift) during pregnancy. As the belly grows, you’ll need to begin regressing full center planks to avoid too much direct downward facing pressure on the belly. Incline planks are a great option. Get more guidance on planks by trimester in this post on planks during pregnancy.
Movements to Avoid (if You Are Experiencing SI Joint Pain)
All the movements above are also great ways to prevent SI Joint pain in the first place. If you or your client are experiencing pain, you’ll want to limit single-leg weight bearing activity as much as possible to keep your pelvis in a more stable position. This includes:
- Lunges or step-ups: Single-leg lower body moves like lunges of any kind or step-ups/downs challenge the stability of your pelvis in a way that can be too strenuous in the presence of pain. Therefore, you want to keep your weight evenly distributed over two feet (think squats, deadlifts, floor bridges, etc.).
- Impact: Moves like running, jumping, or other ballistic exercises will likely aggravate pain given any hypermobility in the pelvis. The body will usually make it clear when 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 when symptomatic.
- Crossing your legs when seated: Sitting cross-legged can pull your pelvis out of alignment, which can aggravate the SI joint. Instead, try to sit tall with both feet flat on the floor.
- Deep single-leg stretches: Deep, single-leg stretches (like “figure four” or “pigeon pose”) can also aggravate the SI joint.
- Any move that triggers pain: Pain triggers can vary from person to person. Pay attention to the activities that seem to cause or worsen pain, keeping in mind that the pain may not appear until the following day.
It’s worth noting that many single-leg activities are simply part of daily life, like walking, climbing stairs, and getting up and down from the ground. The goal is not to avoid these entirely. 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.
Important: The above guidance applies only if you are experiencing pain. You do not need to avoid single-leg activity if you are not in pain. In fact, single-leg strength training is very beneficial during pregnancy and helps with walking, climbing stairs, and moving through daily life more easily while carrying around an additional 25 – 35lbs or more.
Support Garments for SI Joint Pain
If you or your client are experiencing SI joint pain, a compression garment can provide additional pelvic support alongside the exercises above. We recommend the range from SRC Health, which offers high-quality garments designed to wear under and over the bump. Use code PRONATAL10 for 10% off.
Frequently Asked Questions
Can SI joint pain occur after pregnancy, not just during? Yes. Because hormonal changes continue into the postpartum period, SI joint hypermobility may still be present after giving birth. This is why SI joint pain is also common postpartum.
How is SI joint pain different from low back pain? Low back pain is typically felt higher up in the back, around the lumbar spine. SI joint pain is felt lower, in the back of the pelvis around the buttocks, and usually on one side only. The distinction matters because the exercises that help manage each condition are different.
Can I still exercise if I have SI joint pain? Yes, in most cases. The key is avoiding single-leg weight-bearing activity when symptomatic and focusing on the exercises outlined above. Movement is generally encouraged. If pain is severe or persistent, consult your healthcare provider.
Will SI joint pain go away after pregnancy? For many people, yes. As hormone levels stabilize postpartum and the pelvis regains better symmetry, the SI joint typically improves. Continuing to strengthen the glutes and deep core muscles postpartum can support a faster recovery.
Are you a Health & Fitness Professional?
SI joint pain is one of the most common issues you will encounter when training pregnant and postpartum clients. Knowing how to identify it, program around it, and support your clients through it is exactly the kind of practical, evidence-based knowledge that the ProNatal Fitness Certification is built around. If you are ready to train pre & postnatal clients with clarity and confidence, explore our Pre & Postnatal Fitness Specialist Certification.
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Medical Disclaimer: This information is for educational purposes, to be used as general information only. It should not be considered medical advice nor should there be an assumption of a doctor-patient relationship. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment as a result of any information provided in this document.