SI Joint Pain Exercises

Your sacroiliac (SI) joints are located where your lower spine and pelvis meet. These joints stabilize your spine when you walk, bend, climb stairs, and lift heavy objects. 

Sacroiliitis is a medical condition that causes pain and inflammation in one or both sacroiliac joints. It can cause discomfort in the buttocks and lower back, and the pain may radiate down one or both legs. Prolonged standing, sitting, and climbing stairs can aggravate symptoms. Sacroiliitis can occur due to various underlying causes, including injury, infection, autoimmune disorders, and pregnancy.

Luckily, following a consistent exercise routine can help alleviate symptoms of sacroiliitis. Even after just five consecutive weeks of consistent exercises, you should notice a marked improvement. (1) 

If you suffer from SI joint pain, you should consider engaging in the following types of exercises:

• Stretching exercises: You should engage in stretching exercises that target the SI joint. These exercises can enhance flexibility by relaxing tense muscles in your hips, back, or buttocks that may exert undue pressure on your SI joint.
• Resistance training: Resistance exercises strengthen ligaments and supporting muscles around your SI joint, including your core, glutes (buttock muscles), and thighs.
• Low-impact aerobic activities: Activities like walking or swimming can improve circulation and help heal soft tissues in the SI joints by providing them with oxygen and nutrients.

Below is a review of targeted exercises that have been shown to relieve SI joint pain. If any of these movements worsen your SI pain or cause new discomfort, you should stop immediately and contact your healthcare provider.

Strength: Pelvic Tilt

Activating your core is crucial when performing exercises to stretch and strengthen your lower back. However, it can be challenging and uncomfortable to activate these muscles if you're experiencing lower back pain. One easy exercise to start with is the pelvic tilt. 

Here are the steps for performing the pelvic tilt:

1. Lie down with your feet flat on the ground and your knees bent.
2. Tighten your abdominal muscles, press your lower back down, and tilt your pelvis upwards.
3. Hold this position, count to five, and release. 
4. Return your spine to a neutral position.
5. Repeat this exercise at least ten times.

Stretch: One Knee to Chest

Starting your exercise routine with gentle movements is a great way to prevent injuries and assess your pain level. Resting your SI joints by lying on your back in the supine position provides ample back support and releases tension, which helps with misalignment. 

Follow these steps to perform this stretch:

1. First, lie down with your feet flat on the ground and your knees bent.
2. Slowly and carefully bring one knee towards your chest, ensuring not to push past any pain. 
3. Pause briefly and release the knee, returning your foot to the floor.

 Skipping a leg is perfectly acceptable if you start to experience pain.

Stretch: Both Knees to Chest

If you're up for a challenge, you may attempt the double knee-to-chest stretch, but be aware that this exercise can be uncomfortable if you haven't started strengthening their abdominal muscles.

Here is how to perform this exercise:

1. Begin by lying down on your back with your knees bent and your feet resting flat on the ground.
2. Bring one knee towards your chest.
3. Bring your other knee to your chest while holding the first knee in place.
4. Grab both legs below your knees and gently pull them towards your chest.
5. Hold this position for up to two seconds before slowly lowering each leg.

Lowering one leg at a time is crucial to ensuring your safety. Putting too much stress on the joint at once may exacerbate your SI problem unless your abdominal muscles are strong.

Stretch: Spinal Twist

Consider transitioning from the prone position to a gentle spinal twist.

Follow these steps:

1. Begin lying on your back with your legs straight.
2. Raise your knees and bend your legs, creating a 90-degree angle. Then lower both legs, in that position, to one side of your body while ensuring your shoulders are flat on the ground. Move gently and be mindful of any discomfort. 
3. Pause for a few seconds before returning your legs to the center position.
4. Return to the lying position.
5. Perform the identical movements on the opposite side.

For additional support, try placing extra pillows or blankets where your knees will land when you twist. 

Strength: Bridge

After your warmup exercises, you can perform strength-building exercises to help stabilize your SI joints. The first low-impact exercise is called the bridge. Incorporating this exercise can help strengthen your glutes, lower back, abdominal muscles, and hips.

Here's how to perform the bridge exercise:

1. Start by lying on your back with your knees bent and your feet flat on the floor. Keep your palms facing down and your arms by your sides. 
2. Squeeze your glutes and ensure your shoulders remain against the ground. Gradually lift your hips.
3. Pause and hold your hips in the air for five seconds.
4. Carefully lower your hips back to the floor while squeezing your glutes.
5. Repeat these steps eight to ten times or stop if you experience pain in your SI joint or knees.

Strength: Inner Thigh Squeeze

This exercise may help reposition a misaligned SI joint by engaging the adductor muscles, a group of muscles located in the inner thigh region. Adduction, which involves bringing the thigh closer to the body's center, can be performed by crossing the affected leg in front of the other while standing or lying down.

Here is how you can do this exercise while lying down:

1. Start by lying down on your back with your feet resting on the ground and your knees bent.
2. Place a softball or a rolled-up pair of socks between your knees.
3. Gently squeeze for a count of five, then release slowly.
4. Do approximately three to five repetitions.

Stretch: Outer Hip Muscles

This exercise stretches your outer hip muscles and realigns your SI joint. It's a one-legged movement that can be less intense than the inner thigh squeeze and may help relieve chronic tension.

Follow these steps to perform this stretch:

1. Start by lying down with your feet resting on the ground and your knees bent.
2. Rest your ankle on the knee of your other leg.
3. Reach your hands underneath the supporting knee.
4. Using your core muscles, gently lift the supporting knee off the floor as high as possible without pain.
5. Hold the position briefly before setting the leg back down on the floor.
6. Repeat up to five times on one side before switching to the other side.

Pay attention to your body and discontinue the activity if you feel pain.

Stretch & Strength: Cat-Cow

The cat-cow exercise is a commonly used yoga pose that can help stretch and strengthen the back, hips, and abdominal muscles. However, if you're experiencing knee pain or are recovering from a knee injury, you'll want to avoid it since it puts pressure on the knee.

Here's how to do it:

1. Start on all fours with your chin up, your eyes looking ahead, and your back straight.
2. Slowly arch your back upward as you bring your chin toward your chest, holding the pose for two to five seconds.
3. Slowly return your chin to its original position and bring your eyes forward as you arch your back downward, holding the pose for two to five seconds.
4. Repeat this sequence eight to ten times. 

Stretch & Strength: Backbend Yoga Poses

These yoga exercises can be effective for overly mobile SI joints because they help strengthen and stabilize the back of your pelvis. However, be careful not to compress your lower back. If your back feels tight or achy after you've performed the poses, you've gone too far.

Cobra Pose

1. Begin by lying belly down on the ground, with your legs straight.
2. Spread your hands on the floor directly under your shoulders while tucking your elbows close to your body.
3. Push on the floor with your thighs, feet, and pubic bone, and raise your upper body off the floor.
4. Hold for five seconds. Lower your body back down. 

Locust Pose

1. Assume the prone position by turning your palms face up and extending your arms alongside your body while lying on your stomach with your forehead touching the ground.
2. Bring your big toes together to rotate your thighs inward.
3. Lift your head, upper body, arms, and legs away from the ground, keeping your lower ribs, abdomen, and pubic bone in contact with the floor. 
4. Lift your arms parallel to the ground and elongate your spine while gazing slightly upward.
5. Hold for 15-30 seconds, then lower your body back to the ground.

Bow Pose

1. Lie down on your belly with the palms of your hands up and arms extended alongside your body. 
2. Bring your heels towards your buttocks as you bend your knees. Then, grasp your ankles with your hands, ensuring your knees are not wider than your heels.
3. Gradually lift your upper body and feet while being mindful not to strain your back muscles.
4. Pause and hold the pose for up to 30 seconds before releasing and relaxing.

Stretch & Strength: Triangle Pose

The triangle pose is a stretch-strengthening exercise that can benefit you even if you're not very flexible. By strengthening your lower back, hips, core, and thighs, this exercise can help stabilize your SI joint.

Here's how to do it:

1. To begin, stand with your arms by your sides and your feet positioned a bit wider than the width of your hips.
2. Extend your left arm upward towards the sky.
3. Carefully, bend at the waist and bring your right hand towards your left ankle. Aim for your calf or knee if you can't reach your ankle.
4. Return your body to a standing position, keeping it straight.
5. Repeat the exercise by reaching your left arm towards your right ankle.
6. Repeat these steps five times, or stop if you feel weakness or pain in your SI joint or knees.

It's important to keep your knees slightly bent to avoid buckling.

For more techniques and exercises to help with SI joint pain, be sure to check out  Functional Anatomy of the Pelvis and the Sacroiliac Joint: A Practical Guide by John Gibbons.

Low-Impact Aerobics

For maximum benefits, you should engage in aerobic exercise for at least 30 minutes, 5 times a week. While the goal is to increase your heart rate, it's important to exercise within your comfort zone if you suffer from SI pain. Several aerobic exercises, like those listed below, can be easily adapted to your pace and pain level.

Walking

Compared to running or jogging, exercise walking is kinder to the sacroiliac joint and is simple to incorporate into a daily routine. While walking is easier on the joints, it's important to make sure that you're increasing your heart rate.

Elliptical Running

An elliptical machine offers an aerobic workout that simulates running or jogging but puts less pressure on the sacroiliac joint, as there is no direct impact. It also includes handles to work out the upper body and various resistance levels to strengthen lower body muscles.

Stationary Cycling

Like an elliptical machine, a stationary bike allows you to engage in aerobic exercise without an impact on the joints or the danger of biking on uneven surfaces. Stationary cycling is less likely to aggravate the SI joint than biking outside is.

Swimming or Water Aerobics

Water aerobics is a beneficial way to engage in low-impact aerobic exercise without overburdening the SI joint because of the natural buoyancy of water. In addition, the resistance provides a gentle workout for the muscles. Physical therapy programs may recommend specific water aerobics exercises, water walking, or swimming strokes as part of the treatment.

If you have SI joint pain, knowing your limits is essential. While some muscle tightness is expected, it's important not to push through the pain. If you find performing the exercises mentioned here challenging, consider speaking with your healthcare provider about getting a referral for physical therapy.

Exercises to Avoid

If you are experiencing sacroiliac joint pain, you should avoid certain sports and movements that can worsen your condition. Activities to avoid include:

• Golf
• Weightlifting
• Basketball
• Football
• Biking for extended periods of time
• Tennis
• Abdominal crunches
• Sit-ups
• Tennis

Generally speaking, you should avoid any activity that involves physical contact, quick twisting and turning movements at the hips, or lifting heavy weights or objects.

When to See a Healthcare Provider

If you cannot perform the SI joint stretching exercises without experiencing pain or have not noticed any improvement after three weeks, it's important to speak to your healthcare provider. 

If you don't notice an improved range of motion after three weeks or experience increased pain, numbness, or tingling that goes down one or both legs, you should go get a medical evaluation.

Natural Treatments

Natural remedies like ice and heat therapy, acupuncture, massage therapy, and improving your posture can offer relief. In addition, adding certain supplements to your diet can help alleviate discomfort and promote healthy joints. 

Some supplements you should consider include:

• Turmeric: A potential natural remedy for SI joint pain is turmeric, which has anti-inflammatory properties that could help alleviate discomfort. In the Journal of Medicinal Food, one study determined that turmeric can help reduce osteoarthritis-related inflammation and pain. (2)
• Omega-3 Fatty Acids: Some studies show that omega-3 fatty acids could help mitigate inflammation and alleviate SI joint pain. In the Journal of Nutrition, Health and Aging, one study found that omega-3 fatty acid supplements decreased levels of inflammatory markers in people with chronic low back pain, which may be associated with SI joint pain. (3)
• Boswellia: Boswellia is a natural supplement known for its anti-inflammatory properties and has been utilized to alleviate joint pain. According to a study, Boswellia reduced pain and stiffness and enhanced joint function in individuals with osteoarthritis. (4)
• Chondroitin and Glucosamine: These components are naturally present in cartilage and act as a cushion between the bones that form joints. Supplements containing chondroitin and glucosamine have been shown to alleviate pain associated with cartilage degeneration, with chondroitin improving joint function and glucosamine reducing stiffness. (5)
• Collagen: Collagen is an essential protein involved in maintaining the structural integrity of cartilage. As you age, the amount of collagen decreases, which increases the risk of degenerative joint disorders like osteoarthritis. Some studies indicate that collagen supplementation may help alleviate joint pain, while others suggest it can reduce muscle soreness.(6)

Consider Healthycell's Joint Health & Mobility product. This product contains potent extracts and lubricating nutrients, including curcumin, omega-3, chondroitin, glucosamine, collagen precursors, and hyaluronic acid, to help with joint performance, comfort, and range of motion.

If you're still struggling to find relief, corticosteroid injections might be the best treatment for you. To learn more, check out SI Joint Injections.

About the Author

Dr. Giampapa is a world-renowned medical doctor, inventor, and surgeon specializing in anti-aging medicine. He recently received a nomination for the Nobel Prize for his groundbreaking stem cell research, as well as the Edison Award for the Healthycell nutritional supplement for cell health. He was also awarded the A4M Science & Technology award for his development of the BioMarker Matrix Profile – the first computer program to measure aging. 

References

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5808006/
2. https://whttps://www.ncbi.nlm.nih.gov/PMC5664031pmc/
3. https://europepmc.org/article/med/16531187
4. https://whttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7368679/
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6035477/
6. https://www.sciencedirect.com/science/article/abs/pii/