What is the Sacroiliac Joint?
The SI or Sacroiliac Joint is one of two joints in the pelvis that connects the sacrum, or lowest part of the spine, to the large pelvic bone, the ilium. The two sacroiliac joints, on either side of the pelvis, connect the spine to the pelvis. The coccyx, or tailbone, is connected to the sacrum, but has no connection to the pelvis, and can be easily injured or bruised from a fall.
The SI Joint moves with a slight gliding action as we flex and walk. Sometimes walking, sitting, standing, or lying can cause pain in this joint and refer into the back, buttocks, and thigh. This radiating pain is sometimes confused with sciatica or low back pain.
Pain in This Area
Generally, pain in the sacroiliac area can be distinguished from pain in the low back or sciatica based on the location of symptoms and whether or not the symptoms felt are localized or radiate into the buttock or leg. Classic symptoms for sciatica inlcude: pain in the lower back, buttock, and/or various parts of the leg and foot that can sometimes be severe. Numbness, muscular weakness, tingling and difficulty in moving or controlling the leg can also occur. Typically, the symptoms are only felt on one side of the body.
Sacroiliac joint dysfunction, can be described as pain in the SI, low back, hip or groin. The pain is typically worse with standing and walking and improved when lying down. Inflammation and arthritis in the SI joint can also cause stiffness and a burning sensation in the pelvis. It can be difficult to identify the exact cause of pain, therefore, you may need to see a physician or physical therapist to help idendify the source.
Cause of SI Dysfunction
Although SI joint dysfunction has similar symptoms and does affect the sciatic nerve, it is not caused by a pinched nerve root. SI joint pain is normally caused either by overuse, wear and tear on the cartilage in the joint, or from underuse were it becomes tighter and less mobile causing pain when we do need to mobilize it for activity.
Pregnancy is also a big risk factor for sacroiliac joint dysfunction caused by instability. Due to the increased amount of circulating hormones that cause ligamentous laxity in the body, pregnant and postpartum women often experience pain in their hips, low back and SI joint.
The goal then of SI joint exercise is to perform range of motion and stretching exercises helping to mobilize and stabilize the joint ligaments.
Exercises to Help Decrease SI Pain
Stretching Exercises for the Pelvis These stretching exercises will help a stiff pelvis, or those who have decreased mobility and motion through the hips and pelvic girdle. For those that are hypermobile, continue on to strengthening and stabilizing exericses.
Knee to chest stretch: Exhale as you engage the abdominal muscles gently drawing one knee at a time to the chest, hold for a 2 count, then release. Do this 8-10 times with each leg.
Knee Sways: Lying on your back with your knees bent and together with your feet flat on the floor, gently sway the knees side to side. The lower back should remain fairly still on the mat. As you improve you will be able to let the knees sway further to the floor feeling the lower back and hips peel off the mat. Do this for 4-8 times each side.
Piriformis Stretch: Lying on your back with your knees bent, and spine in neutral, cross your leg with your ankle resting on the opposite thigh. Grasp the “under” leg and pull it towards you. Hold this stretch for 20-30 seconds, then switch legs.
Strengthening and Stabilizing Exercises for the SI and Pelvic Girdle.Pelvic stabilization exercises should be performed to strengthen muscles that support a joint that may be too loose. This is important because the extra motion can cause wear and tear on the joint cartilage leading to degeneration and arthritis.
Knee Stirs: Start lying on your back with your spine in neutral (tailbone and lower ribs in contact with the mat, natural curve in the lumbar spine), and hands on your hip bones.
Exhale as you fold one knee up to a 90 degree angle from the hip so the shin is parallel to the floor. Feel the head of the thigh bone sink into the hip socket. Keeping the pelvis stable and hips level circle the knee feeling the head of the femur rotate in the hip socket. Circle clockwise and counterclockwise 4-8 times each direction for each leg.
Clam Shells: Start lying on your back with knees bent and squeezed together feet flat, place your hands on your hip bones and keep them still or level with the ceiling. Use your fingers to feel for a muscle contraction of your lower abdominal muscles just below your hip bones.
Keeping your spine neutral with tailbone down and middle ribs pressed into the mat let your knees fall apart until you feel a gentle stretch in the groin, as you exhale draw them back together feeling the deeper pelvic floor and lower abdominal muscles working. Keep the buttocks relaxed. Do this for 6-10 repetions.
**Variation: Drop just one leg at a time toward the floor making sure the opposite buttock stays in contact with the mat and the hips stay level. This should be done very slowly and controlled. Make sure to feel for a good contraction on your lower abdominal muscles.
Jane Fonda’s: Start side-lying, with your hips and shoulders stacked, spine in neutral. You can bend the bottom knee to increase your stability.
Exhale as you lift the top leg, making sure to keep the knee straight. Leading with your heel towards the ceiling will help you activate your gluts and hip abductors. Slowly lower the leg back down. Repeat this 8-12 times for each leg.
For more information on pelvic floor exercises that can save your back, click here.