SI Joint Pain - 6 movements for managing during pregnancy

A common issue experienced during pregnancy and postpartum is Sacroiliac (SI) Joint pain, in which women experience pain in their pelvis, buttocks and low back, usually on one side only. Although symptoms are similar to sciatic pain, it is a different issue.

SI Joint pain is caused by hormones, primarily relaxin, released during pregnancy that are preparing joints to loosen and make way for the baby to give birth. The SI joint connects the pelvis to the spine, and when relaxin loosens the joints, it can cause them to become unstable, which in turn causes other muscles in the body to compensate for the instability. Factors like weight gain and a growing uterus also contribute to this instability. 

Through Pilates, there are two main areas of focus for managing SI Joint Pain. The first is by increasing strength and conditioning areas of the body that can help relieve pressure on the SI joint pain. The second is through releasing the pelvic floor, which can be thought of as a sling of muscles that hold up your bladder, uterus and rectum and the piriformis. 

Let’s first look at the strengthening and conditioning we can practice to manage SI Joint Pain by relieving pressure on the SI joint. 

During pregnancy, the growing baby stretches the abdominals so much that it places additional pressure on the SI joint. During pregnancy I recommend that my clients start to think of their "back core" as becoming their entire core. The back core includes deep core stabilizers like the multifidi, erector spinae, and quadratus lumborum and superficial mobilizers like the glutes and lats. Let's look at two exercises that can help us condition and strengthen the back core during and after pregnancy.

1. 360 breathing with Hug the Baby is amazing because not only does it allow you to strengthen your deep core transverse abdominals, it also conditions the back core by using the breath to open your back and expand your intercostals, which are the muscles between your ribs. Back body expansion keeps the thoracolumbar fascia and deep spinal stabilizers moving rhythmically instead of staying braced, which reduces the compensatory gripping and uneven pressure distribution that contribute to SI joint pain. 

2. Bird Dog helps strength both the back and deep core without adding much intra abdominal pressure, helping us reduce contributions to diastasis recti. Because we focus on keeping the pelvis still during the movement, it helps strengthen the body bilaterally and reduces joint instability.

   

The lateral abs also help keep your pelvis level, so conditioning them can help prevent a pelvis that hikes or tilts unevenly and puts extra stress on the SI joint.

3. Modified Side Plank and Kneeling Side Bend work together to condition the lateral abs, giving your pelvis the support it needs to stay balanced instead of relying on one side to compensate for the other.

It’s common for Pilates teachers to give blanket safety protocol to their pregnant students, once of which includes avoiding working the abductors. This advice stems out of fear of tightening the pelvic floor. While I wouldn’t want to do a full 50 minute Pilates session focused on adductor strength, I also don't recommend letting the adductors atrophy. We want to keep them conditioned, which means strong and flexible. 

4. Side lying bottom leg lift is a lovely movement for strengthening the adductors during pregnancy.

   

Yet another change occurring in your pregnant body that can contribute to SI joint pain is glutes that become less and less engaged and the hip flexors and low back take over as a result of your center of gravity shifts forward with a growing baby.

5. Clamshells are my favorite for strengthening the glutes during pregnancy. There's a reason clamshells are your PT's favorite exercise! They train the exact stability the pelvis needs while asking the glute to fire.

We also want to think about releasing muscles that commonly become too tight as they overcompensate for the ever-changing pregnant body. The pelvic floor is commonly overly tight during pregnancy since its load is increasing as the baby and uterus grow.

6. Pelvic Floor Release with a Pinky Ball is how I like to help release this sling of muscles. A tight pelvic floor isn't a stronger one, it can make it harder for baby to move down and out, which can increase the likelihood of tearing. A few minutes most days, and your pelvic floor will be much happier!

SI joint pain can really feel like an inconvenience during pregnancy and it's tough that there's not a super easy way to avoid or fix it, but these movements can certainly help manage the pain and if you're lucky, possibly avoid it.