Physical therapy and exercise is typically an essential part of the treatment plan for sacroiliac joint dysfunction pain relief and recovery.
The sacroiliac joint, which connects the spine to each hip, can cause pain in the low back, pelvis, groin, and/or legs due to abnormal motion at the joint. An estimated 15% to 30% of low back pain cases originate at the sacroiliac joint.1 Most pain that stems from the sacroiliac joint, also called the SI joint, can be managed or treated using nonsurgical methods, including physical therapy, manipulation and exercise.
This article previews a well-rounded exercise program for SI joint pain relief, which typically includes a combination of muscle stretches, strengthening exercises, and certain types of aerobic exercise that elevate heart rate and promote circulation of healing nutrients.
Sacroiliac Joint Anatomy and Function
Before starting an exercise program, it is helpful to understand the anatomy and function of the sacroiliac joint.
The SI joints connect the triangular bone at the bottom of the spine (the sacrum) with both hip bones.
- The front part of this joint is held together by ligaments with a synovial lining.
- The back part of the sacroiliac joint includes a network of strong ligaments that extend across the joint to provide extra support and stability.
The main function of the sacroiliac joint is to absorb pressure transmitted between the upper and lower body. For example, the SI joint helps absorb shock placed on the lower body with movements such as walking, running, or jumping to reduce the pressure felt in the lower spine.
The joint typically has very little motion, allowing small movements to stabilize the pelvis when walking, bending forward or backward, and twisting the spine.
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How Exercise Can Relieve SI Joint Pain
A series of stretching and strengthening exercises may be prescribed to help reduce sacroiliac joint pain. These exercises are designed to restore natural movement of the joint, by:
- Relaxing tense muscles and ligaments that limit natural motion at the joint
- Conditioning the surrounding muscles and ligaments to better support the joint
Because a range of muscles support the SI joint, exercises may target the pelvis as well as the lower back, groin, hamstring and thigh, and/or abdominal muscles.
Aerobic exercise is an essential aspect of any exercise program. The goal of aerobic exercise is to elevate the heart rate for a minimum of 20 minutes. The improved circulation from aerobic exercise delivers a range of nutrients and oxygen throughout the body, promoting the healing process in weakened or injured soft tissues in the sacroiliac joint.
It is recommended that a doctor or physical therapist familiar with the patient’s specific needs is consulted before starting a new exercise program. A prior consultation ensures that a new exercise will not cause further exacerbation of pain.
It is common to pair rehabilitative exercise with other therapies and pain management methods for optimal pain relief. Additional treatments may include pain medications, heat or ice application, manual manipulation.
SI Joint Pain Relief Considerations
If pain does not improve within 2 to 3 weeks of stretching, strengthening, and aerobic exercise, manipulation (also called chiropractic) should be considered by a trained Osteopath (DO), Chiropractor (DC) or Physical Therapist (PT).
If this treatment does not help resolve the pain, further diagnostic tools may be considered, including x-ray and possible ultrasound- or fluoroscopic-guided injection into the SI joint. An injection test includes a local anesthetic combined with steroid or Plasma Rich Platelets (PRP). If the anesthetic temporarily relieves the patient’s pain, it confirms that the sacroiliac joint is the pain source. In addition to diagnostic aid, an injection can also provide temporary pain relief.
- Cohen SP, Chen Y, Neufeld NJ. Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment. Expert Rev Neurother. 2013 Jan; 13(1):99-116.