SI Joint Pain During Pregnancy
SI joint (SIJ) pain can be a literal pain in the ass - and a really common complaint during pregnancy!
Generally this presents alongside the tailbone, into the glute area, and is usually more painful on one side. Pain can get worse with transitions like rolling in bed, and weightbearing movements like standing on one leg, stair climbing and walking.
Pain usually located around this area on either side.
As we all know, the pelvis goes through a lot of changes during pregnancy. We need the pelvis to move more in preparation for labor. However, these changes are often the contributing factor to the annoying pain felt along the backside.
One of the most effective things you can do to treat and manage SIJ pain is STRENGTHEN AROUND IT. We can't change the natural physiologic effects that need to happen during pregnancy, but we can build some resilience to improve how our body manages daily forces.
Let's dive into strengthening specifics.
First, the posterior oblique sling.
This myofascial connection provides support along the SIJ from the big lat muscle to the opposite glute max muscle via thoracolumbar fascia. Exercises that involve the lats and opposite glutes will automatically create a stabilizing force across the SIJ.
The posterior oblique sling is made up of the lat muscle and the opposite glute max muscle. They connect via the thoracolumbar fascia right over the SI joint. Contraction of these to muscles simultaneously creates a stabilizing force the to SIJ.
Image source: Essential anatomy app
Here are some examples of my favorite exercises to prescribe for the posterior oblique sling:
DB ROW WITH OPPOSITE HIP EXTENSION
On all fours, row one dumbbell up as you simultaneously extend the opposite hip. Think about squeezing the lat and the opposite glute. Exhale as you lift, inhale as you lower back down.
2. BRIDGE WITH BANDED PULL DOWN
Start on your back with your knees bent, anchoring a band overhead. Exhale as you bridge your hips up and pull the band down towards your hips. Inhale as you lower back down.
3. BRIDGE MARCH WITH PULL DOWN
A progression from exercise 2, start the movement by bridging the hips up and holding onto the band from overhead. Exhale as you pull the band down towards your hips.
4. REVERSE LUNGE WITH BANDED PULLDOWN
Step back into a reverse lunge. Hold the band on the same side of the leg that’s going back. Push through the front foot to step back up to stand as you pull the band down towards the opposite hip.
5. STAGGERED RDL WITH BANDED ROW
Put one leg in front with slight bend in knee and the opposite foot slightly back in a kickstand position. Most of your weight is through the front foot. Band is held in the opposite hand. Hinge down and lengthen through the back of the hip. Press through the front foot to push back to a standing position as you row the band back on the opposite side.
Sets and reps can look different for everyone depending on the level of acute pain they are in. As a general recommendation, I would try for 2-3 sets of 8-12 reps (total or on each side).
Second, the deep abdominals.
Connecting with the deep abdominal muscles (transverse abdominus and internal obliques) is helpful for providing increased stability during painful movements. As an initial strategy, I’ll typically recommend “exhale on effort” combined with this deep abdominal draw-in maneuver. For example, if going from sit to stand is painful, try exhaling and drawing in the deep abdominals as you perform the task. It will provide support to the pelvis and help manage painful symptoms.
Here is a video of how to perform a deep abdominal draw-in (sound on to hear the voiceover):
Long story short, SIJ pain is no fun, but we do know that it responds strengthening and increased support. If symptoms are acute, you do have the option of looking into an external support like a Serola belt. This can be a helpful stepping stone to manage pain while you build strength.
I highly recommend being seen by a physical therapist (orthopedic or pelvic floor) to get an individualized assessment if pain is continuing to affect your day to day wellbeing. Just because you’re pregnant, does not mean pain is justified!
