Over the summer & fall a lot of us were focused on activities like hiking, running, climbing, biking, golf, and rowing. All of these activities contribute quite a bit of stress on the sacroiliac (SI) joint, and as a result we’ve been seeing a lot of patients come in with SI joint dysfunction & discomfort. As we continue with all of our winter activities, it’s important that we resolve these issues so we can ski, snowboard, and play outside pain-free. In this video we’ll go over what the SI joint is, how it functions, and corrective exercises you can do to resolve SI joint pain.
SI Joint Dysfunction, Pain & Corrective Exercises
Today’s four blog topics include:
What is an SI joint?
What are the symptoms of a painful and dysfunctional SI joint?
What can we do at JH Backcountry Health to resolve it?
What corrective exercises can help?
What is an SI Joint?
The SI joint is where the ilium (part of the pelvis) ties into the sacrum, which is a small triangular-shaped bone at the bottom of your spine.
The SI joint doesn’t move very much. We get about five degrees of rotation and only about two millimeters of translation. The purpose of this joint is to act as both a torque converter and a shock absorber. Essentially, it converts the forces generated by the lower extremities into manageable loads for the lumbar spine. Often, if we see SI joint dysfunction, we’ll also find hip and/or low back issues.
Painful and Dysfunctional SI Joints
So now that we understand what the SI joint is, let’s break down why it can become dysfunctional and what a painful SI joint looks like. Si joint pain is often misdiagnosed as lumbar spine pain, or misinterpreted as such, because it’s in such close proximity to the lumbar spine. If your pain is general in the low back and slightly lateral to the spine, it could be SI joint pain.
As we see with lumbar or sciatic nerve pain, we might have radiation coming from the SI joint because of the close proximity to the L5 and S1 nerve roots.
What can JH Backcountry Health do to reduce your SI joint pain?
Our goal is to help to improve the mobility of these structures and take pressure off the musculature above and below the SI joint. This means we often stretch muscles of the hips such as the glutes, iliacus, and psoas muscles. We’re making sure that you can properly brace your core so that we’re not irritating the lumbar spine.
Our treatment includes Active Release Technique, manual adjustments, and at the end of our appointments, we get you moving.
Eight Corrective Exercises for SI Joint Pain & Dysfunction
These exercises stabilize and strengthen the core musculature, as well as make sure that you’re getting proper muscle activation in your daily movements, which will help relieve SI joint pain. Do what feels good and avoid doing anything that hurts. If something does hurt, stop and consult your doctor.
Glute Bridge with Hip Abduction
Start lying on your back with your knees bent at approximately 90 degrees and feet flat on the floor. Perform a glute bridge with a resistance band around the thighs just above the knees. Make sure to draw in the midsection. Brace the core in order to press the low back into the ground from the starting position.
Engage the glutes to extend the hips upwards until your back, hips, and thighs are in one straight line. Keep the core engaged to prevent the low back from arching. Press your knees away from one another to resist the inward pull of the band. This will target your lateral hip musculature. Hold for three to five seconds. Lower slowly and repeat.
Glute Bridge with Hip Adduction
This is similar to the previous exercise. This time place a small ball, yoga block, or another lightweight object between your knees. Perform the same glute bridge with good core and glute engagement, keeping the spine neutral, and squeeze the ball or object together between your knees to hold it there throughout the exercise.
Side Bridge (aka Side Plank)
This is another great exercise to work your core, including the transverse abdominis, obliques, glute medius, and glute minimus. Start lying on your side on the floor with your feet stacked, and place your bottom elbow in a straight line directly below your shoulder.
Engage the core and glutes to lift your body into a straight line and hold this position for a few seconds before lowering back down. You can always separate your feet for balance to make this a bit easier.
Posterior Lunge
This is another great exercise that requires more glute activation than a traditional lunge, and will help you work on single-leg stability and hip stability.
Start in a standing position and then step one leg back as you kneel down into a lunge, getting as close to touching the back knee to the floor as you feel comfortable. Make sure to keep your core engaged and trunk upright with a neutral spine. This is a great one to do in front of a mirror so you can watch that front knee and make sure it is not collapsing inwards.
We want that front knee tracking directly over the second or third toe, staying stable and not wobbling around during this movement. Make sure to engage your glutes for stability here. As a regression, you can place your hands on the back of a chair, the edge of a sink, or a countertop for stability and support.
Side Lying Hip Abduction
This exercise will target your gluteus medius in the side of your hip. Again, this helps to strengthen your core and muscles surrounding the SI joint that are commonly underactive. Start lying on your side. You can use a pillow under your head or your arm to support your head and neck.
From here, make sure the hips are stacked directly on top of one another, and you’ll lift the upper leg slowly before lowering back down. You can have your bottom leg long or bent. For extra stability, push the heel of your upper leg away. Keep your leg slightly back, not in front of your body, and your toes pointed straight ahead or slightly downward in internal rotation.
As you go up and down, make sure to keep the core engaged and prevent the trunk from sagging. You should feel this on the outside of your hip, not in your back. Hold the leg up for three to five seconds on each repetition for a little extra challenge.
Swiss Ball Superman
Next, we’ll target some of the muscles in your lower back, including your spinal erectors in addition to the rest of your core.
Begin lying face down with your hips and abdomen on a stability ball. Your feet should be about hip with the part with your heels pointed straight upwards and your hips, knees, and toes all in one line. You can place some dumbbells or a wall behind your feet to prevent sliding backward. Make sure to keep your head and neck neutral, making sure that you’re not extending your neck by looking up. From here, engage your glutes, squeeze your core, and engage your back muscles by pulling your shoulder blades down and back.
As you raise your arms up behind you, try to put your shoulder blades into your back pockets and keep squeezing in your glutes. The progression here is to move your arms out in front of you like Superman. Hold the position for three to five seconds before slowly lowering down, keeping a straight back with head, shoulders, and hips in one straight line.
Now we have a couple of exercises that are great for strengthening the lower back and working on that proper hip hinge movement when bending over to pick something up in daily life.
Good Mornings
Stand with your feet hip-width apart. Put your hands up by your ears. Suck in the belly button and engage the core, and then push your butt back as far as you can.
Bend forward at your hips. Keep the core engaged and pull the shoulders down and back to keep the chest open and back straight. Keep the knees soft and slightly bent, and focus on hinging at the hips, not bending your back. You should feel a stretch in the hamstrings as you move down. Keep the back straight throughout the movement.
If the back starts to round as you bend farther down, stop the motion at the point where you can keep your back straight, and work on improving the range of motion over time. Squeeze your glutes to push your hips forward and stand up. Your legs and hips should be the prime mover here to push the ground away, as opposed to pulling from your back.
For rehab purposes, I recommend keeping the weight minimal here and focusing on proper form.
Kickstand Romanian Deadlift (Single Leg RDL)
This is a nice progression from the good morning, which works on the same hip hinge pattern and strengthens the core, glutes, and lower back. Stand on one leg, holding a light weight, using your back leg as a kickstand with toes touching the floor, but not bearing any weight in the back foot.
Hinge forward at the hips, keeping the core engaged back straight, and shoulders and hips level. Don’t let the hips open up. You should feel a stretch in your hamstrings. Go as low as you can while keeping the spine neutral, meaning you should stop descending if your back starts to round at the bottom of the movement.
Squeeze your glutes, push your hips forward, and stand up straight. If you don’t have a kettlebell, you can use a dumbbell or other small weight. Keep the loads light and focus on good form. Once you feel confident with this movement, you can lift the back leg off the ground to increase the stability challenge of the exercise. Again, keep the pelvis neutral and the hips level.
We hope that you feel better equipped to manage SI joint pain. Book now if you would like additional help.
Find out more about what we do at https://www.jhbackcountryhealth.com/services or call us with questions at (307) 203-2138.
