The Power of Motion: Mobilization for S.I. Joint Pain Management

SI joint pain, or sacroiliac joint pain, refers to discomfort or pain in the sacroiliac joints, which are located in the lower back where the sacrum (the triangular bone at the base of the spine) meets the iliac bones (the large pelvic bones). These joints are responsible for transferring the weight of the upper body to the hips and legs. SI joint pain can be quite uncomfortable and may limit a person's mobility. Let’s talk about the characteristics, causes, and movement suggestions to alleviate SI joint pain discomfort.

Common characteristics of SI joint pain include:

Location: Pain is typically felt on one side of the lower back or buttocks, but it can radiate down the back of the thigh and into the groin or even the lower leg.
Symmetry: Pain is often experienced on one side but can affect both sides simultaneously.
Worsening with Activity: Pain can be exacerbated by activities that involve standing, walking, or climbing stairs.
Sitting and Sleeping Discomfort: Sitting for prolonged periods, especially on a hard surface, can be uncomfortable, as can lying on the affected side.
Stiffness: The SI joint area may feel stiff or locked, and it can be challenging to change positions.

SI joint pain can result from various causes, including:

Arthritis: Inflammation of the SI joints due to conditions like ankylosing spondylitis or osteoarthritis.
Pregnancy: Hormonal changes during pregnancy can lead to increased flexibility in the SI joints, potentially causing pain.
Trauma or Injury: Falls, accidents, or sports injuries can damage the SI joints and lead to pain.
Infection: In rare cases, infections in or around the SI joint can cause pain.
Leg Length Discrepancy: When one leg is slightly longer than the other, it can place extra stress on the SI joint.
Inflammatory Conditions: Conditions like psoriasis and certain types of inflammatory arthritis can affect the SI joints.

Disclaimer:

If you have SI joint pain, these mobilizations may help, but please understand that there are many pelvic distortions so there are no guarantees. If you decide to try these, you are making the choice to try these without being assessed first. They may not be right for you at all if your back pain is more complicated than simply an SI joint problem.

To be safe, see a physical therapist to find out if these exercises are appropriate for you. I think this may work if your distortion is an obliquity of the pelvis – an inflare/outflare distortion. If you do find these mobilizations helpful to realign your pelvis, do them before you do your stabilization exercises.

If your SI joint continually goes out, you are doing your stabilization exercises correctly and you have been doing them for a while, there is probably an underlying problem such as an organ adhesion or an anatomical leg length discrepancy or smaller hemipelvis on one side that is putting constant stress on the SIJ and needs to be sorted out. Call Neurosomatic Educators at 1-866-597-3772 to find an Integrated Neurosomatic Therapist near you to find out if this is why you can't get better.

1) Dontigny knee brace: Lie on your back in a doorway, one foot on the door jamb, knee pointing slightly out to the side, other leg reaching into the other room. Push through your heel into the doorjamb using your buttocks and hamstrings. Push for 6 seconds, rest for 6 seconds, repeat 6 times. Move over to the other side of the doorway and do the other side. This alone may do wonders for SI joint pain. If this has helped, leave out exercise 2 and 3 and skip to the Swiss ball superman.

2) Inflare correction: Do on the SORE side. If both sides are sore, don't do this at all. Lie with a sore side about 6 to 8 inches away from a wall, knee bent, foot on the floor, other leg straight. Push the side of the knee into the wall, activating the hip muscles on the sore side. Allow your trunk to rotate the other way. Push for 6 seconds, rest for 6 seconds, repeat 6 times or more.

3) Plank: This is a VERY challenging exercise so evaluate your abilities carefully before attempting this! You can modify it by doing a plank from the knees if you need to. Get into an elbow plank (or high plank on the hands if you prefer), making sure the trunk is straight from the shoulders to the toes or knees. The hips are not hiking way up into the air. If you are able to, lift and reach the leg of the side that is NOT sore, without allowing anything to move in the pelvis. You should feel the front of the hip working hard on the sore side. This will work even better if you can turn the tops of the toes under like a yoga up-dog to do this, but very few people have that kind of flexibility. If you can't lift the leg, push the SORE side toes or knee into the floor for 6 to 10 seconds, feeling the front of the hip working. Hold the position for 6 to 10 seconds, rest for 6 to 10 seconds, and repeat if possible. Do NOT do the opposite side. If both sides are sore, just do a plank without lifting your legs.

4) Swiss Ball Superman: Balance your belly on a small Swiss ball such that you have even weight between your hands and feet, and your spine remains neutral. Anchor those toe pads down and feel the connection to your pelvic floor. Lift the "not sore" leg and reach it back without allowing your trunk to rotate or side-bend on the ball, and without allowing the ball to move. If you are successful, lift the opposite arm off the floor and reach it forward without allowing any movement in the trunk or ball. Hold for 6-10 seconds and repeat. If your trunk or ball is moving, you are not stabilizing correctly, so try smaller movements, and check to make sure you are holding in your pelvic floor. Sometimes it helps to do the "easy" side a few times, to teach the brain how to connect for the "hard" side. If both sides are sore, do both sides equally.

I suggest finishing off with the Dontigny knee brace again. If these exercises work, do them a few times a day. If you have long standing SI joint pain and the bones simply won't move, see a soft-tissue therapist before trying again.

There, you see? Sometimes pain serves a purpose. Forced me to think hard, and I think I learned something useful because of it. Movement practitioners out there, feel free to comment and let me know if you think I am completely out to lunch on this, or if you have found anything else that works well that you would like to share. And those with SI joint pain, feel free to let me know if these ideas work for you … or if they don't.

Vreni Gurd - OMP