What is SI Joint Pain and How Do I Fix it?
Pregnancy can be a real pain in the butt…literally!
Sacroiliac (SI) joint pain can be difficult to diagnose, but it can be successfully treated. In this blog post, I'll tell you why this is, and explain how to take the burden off your back and hips with helpful tips so you don't have to keep asking your partner for the back and butt rubs.
Let's dive deeper into SI joint pain as it relates to pregnancy and postpartum.
What is the sacroiliac (SI) joint?
Your sacroiliac joint is where your two hip bones (ilia) meet your tailbone region (sacrum) — which explain the name sacroiliac joint.
The SI joint is a very strong joint structure and it has thick ligaments that support it. It’s also very jagged like a jigsaw puzzle. Because of these features, the SI joint is usually very difficult to knock out of place. For people who aren’t pregnant, it usually takes a major fall or accident to experience issues here. But when you’re pregnant, that’s not the case. Let’s dive into why that is.
Why does the SI joint cause issues during pregnancy?
There are a few reasons why women tend to experience SI joint pain. It can start pretty early in pregnancy – typically in the first trimester and progressing as your belly grows.
A big reason for this is because of the hormone fluctuations women experience during pregnancy. One of the hormones that is produced in the body during pregnancy is called relaxin. Just like the name sounds, it causes the ligaments and connective tissue around the pelvis to relax and soften, which helps prepare your body for a baby to come down and out of the birth canal.
In the meantime, that means your pelvis is less stable, which can compromise your SI joint and cause some serious aches and pains.
The weight you gain during pregnancy also plays a part. As you gain weight in pregnancy, your feet rotate outward to increase your base of support. This pregnancy waddle (yes, that’s actually the medical term for it) causes your hip muscles to shorten and become less effective. Less effective muscles place more pressure on joints.
On top of everything, traumas from labor and delivery can also cause SI joint pain postpartum. And most of the time, it does not correct itself after your baby arrives.
Symptoms of SI Joint Pain:
SI joint pain can vary in sensation, but typically individuals experience pain, numbness and/or tingling that can start in your butt and radiate down the back of your thigh.
Pain created at your SI joint can be very intense for some, but for others it might be more of a dull, constant ache. Women that experience this pain typically have a decreased tolerance to standing, walking or sitting. They constantly feel the need to change positions and find it hard to get comfortable. During walking, some individuals feel a “catching” or “clicking” of the hip.
How To Fix SI Joint Pain:
STEP ONE: GET SOME HELP
First, you need to correct the alignment of the SI joint and make sure your low back is moving well. To do this, you will need help. Your SI Joint is complicated and not one you can fix on your own.
I would suggest finding a good PT in your area (try searching here and here). If there are any in your area, give them a call and ask if they have ever worked on SI joints prior to scheduling your appointment. Not every PT works on this, so be picky!
You can also schedule an Expecting and Empowered Online Wellness Session for a one-on-one session with our very own women’s health physical therapists.
This will temporarily alleviate your symptoms. But, don't stop here.
My own experience…
I have adjusted and realigned numerous SI joints and pubic bones in the clinic, but my pregnant patients always seem to come back. So, be cautious with spending too much time and money on PTs, chiropractors, massage therapists etc., because the root of the problem is typically muscle strength.
During my first pregnancy, I saw a chiropractor twice a week and a PT once a week from 19 weeks on. It helped but was definitely more of a short-term fix. During my second pregnancy, I started having pain at 15 weeks, but was able to start testing the Expecting and Empowered Pregnancy workout program (now available in the Expecting and Empowered app!) at 20 weeks. The pain was completely gone by 25 weeks! Even better, I followed the Pregnancy program to a tee during my last pregnancy and had no pain.
Nothing worthwhile is ever easy. It will take time but it is really best for you and your little one if you can operate comfortably. It is never too late to start! You want to prep your body for delivery and postpartum so even if you are at 37 weeks, you can still start now.
STEP TWO: FIX THE INSTABILITY
The root of SI joint pain is instability. This means that strength training is a must. During pregnancy, your core — which consists of your abdominals, pelvic floor, diaphragm and back muscles — becomes compromised. You should focus on waking these muscles back up as soon as you can, especially if you’re starting to feel pain.
Often there will be asymmetries from one side of your body to the other. What tends to happen during pregnancy is that one side of your latissimus dorsi (lats) and the opposite butt cheek will become weak.
Testing for Instability…
A hypomobile SI joint is complex to fix because you must be very specific to which side you are “treating.” You will need to rebalance the joint, which means strengthening the gluteus maximus on one side and the latissimus dorsi on the opposite side. You likely fall in this category if you have a combination of weak hip extension on the right and weakness on the latissimus dorsi on the left, or vice versa.
Note: You’ll need a partner for both of these tests.
Hip Extension Test (second test in video):
Lean forward over a table, enough so that your hips are on the table. You can hold onto the table but you are not allowed to use your arms to generate force.
Leading with your heel reaching toward the ceiling, lift one leg about 12 inches off of the ground. You should be able to hold this while your partner pushes down on the back of your leg just above the knee.
Repeat on the other side. If either leg gives way, this means you probably have some hip weakness on that side.
Stand in an upright position and hold your arms in an upright “Y” position with palms facing forward.
Test one arm at a time by holding this “Y” position while your partner places pretty significant forward pressure on each arm, as if they are trying to push the back of your hand forward.
You should be able to hold this without breaking. If you are unable to hold this, it means you are weak on that side.
Exercises for a Positive Hypomobile SI Test:
Single Leg Bridge (ONLY PERFORM ON WEAK GLUTE SIDE):
Lie on your back with your arms at your sides, knees bent and feet flat on the floor.
Keep the foot of the weak glute on the floor and lift the other at a 45 degree angle.
Engage your abdominals and slowly lift your hips off the ground into a bridge position, keeping your back straight.
Hold briefly, then lower yourself back down to the ground. Repeat for 3 sets of 5-8 repetitions.
Bridge with March (ONLY PERFORM ON WEAK GLUTE SIDE):
Lie on your back with your arms at your sides, knees bent, and feet flat on the floor.
Slowly lift your hips off the floor into a bridge position, keeping your abdominals engaged the entire time.
Lift the foot of your strong leg off the ground, keeping your knee bent.
The goal is to do this without letting your pelvis tilt to either side
Only lift your leg 2-3 inches off the ground. Repeat for 3 sets of 8 repetitions.
If you are pregnant, place your upper back on the edge of the couch or a stability ball.
Standing Lat Pulldown with Resistance Band (ONLY PERFORM WEAK LAT SIDE):
Anchor a resistance band high above you. Stand facing the anchor, and grab both ends of the band with your weak side hand, holding the ends shoulder height to start. Make sure your arm stays straight.
Pull your weak arm straight down towards your hip. Think about pulling your elbow down and back towards the opposite butt cheek — even though you’re still keeping your arms straight and pulling straight down.
Return to the starting position and repeat. Make sure your back stays straight throughout the exercise and do not allow your shoulders to shrug. Repeat for 3 sets of 8 repetitions.
Adding stability back into an unstable system means that your nagging pain will decrease or be eliminated, making it more comfortable to sleep, walk and sit.
What I would most highly recommend is doing the Expecting and Empowered Pregnancy Workout Program in the Expecting and Empowered App for a balanced program that will help you tackle and avoid other common pregnancy issues as well.
What else can I do to fix my SI joint pain?
SYMMETRY with your everyday movement:
Avoid crossing your legs. Crossing your legs (or any other asymmetrical lower extremity movement/positioning, for that matter) places more pressure on the joints, which equals more pain.
Sit down to take your shoes off.
Do not push objects with your legs (moving a box across the floor with your foot).
Do not sit with legs crossed under you.
SYMMETRY during exercise:
The Expecting and Empowered Pregnancy App Program was designed to avoid asymmetrical movements (i.e. lunges) after 20 weeks of pregnancy. We want to make it less likely that you will be one of the 33% of women that experience pelvic girdle pain during pregnancy (Albert 2000).
There is still a ton of leg and core strength in the guide, but it transitions to using both sides symmetrically during movements. You’ll see a lot more exercises like squats and RDLs instead of lunges or single leg RDLs.
Tips for SLEEPING:
This condition can make sleeping uncomfortable and not as restful. If you’re sleeping on your side:
Place a pillow between your legs up into the thighs, starting at your pubic bone and down toward your knees.
Make sure that both knees are bent (do not sleep with one leg straight and the other bent).
Use a pillow to support your baby bump if pregnant.
When getting in and out of bed, try using the log roll technique.
Focus on Instability, Even if You Need Help
Temporary stability can be created by using a SI belt (aka a Serola belt) until you can strengthen this area. Wearing an SI belt can help if you experience SI joint pain. This is our favorite - which you can find in our Amazon storefront here.
If it is more painful to wear the brace, it means that your SI/pubic bone is poorly aligned and you are trying to hold your hip bones and sacrum in the incorrect position. Or you may have the belt on wrong — wearing it too high can actually cause the problem that we are trying to correct. Squeezing the “wings” of the hips high gaps the SI joint at the bottom. OUCH.
Proper placement of the belt is right above your greater trochanter, which is the large pointed part on the side of your hip. You can locate this by rotating your leg like you are squishing a bug and hold your hand over your hip. You should feel a bone rotate as you do this.
Place the bottom of the belt directly above it. Then take the two side straps and place them like a butterfly, pulling the main part of the belt tight and then reach back for the two additional side straps.
For more help, you can also watch this video to learn about proper placement. You could also try using a Sacroiliac Belt to provide some relief - here is one we recommend.
Keep moving, but be mindful.
Movement is the fountain of youth. Joints love movement. Movement pumps synovial fluid through the area, which is basically like WD40 but for your joints. Walking is great for this condition. Just be sure to monitor how much you’re walking because too much walking can also aggravate it.
As we mentioned, you’ll want to avoid deep asymmetrical movements such as lunging, cleaning in a half-kneeling position, etc. I advise patients to pretend that they are wearing a mini skirt, meaning avoid allowing your legs to become more separated than you would if you had a mini skirt on. For example, while getting into the car, sit your butt down and then move your legs together into the car, instead of one leg in at a time.
Thank you so much for taking the time to read this post. If you found it helpful, share with your mama friends that are in need of help too! They don't have to be pregnant for this blog post to help, as this info is for anyone suffering from SI or pubic bone pain issues. Since this problem doesn’t usually correct itself postpartum, it’s important to start on it early. But also know that it’s never too late. Happy healing mama!
Krystle Howald, PT, DPT