Your Sacroiliac (SI) joints lie between the sacrum, the triangular-shaped bone at the base of the spine, and the ilium, or pelvic bone. These joints have limited motion, fitting together much like a lock and key, are surrounded by strong ligaments, and function as a shock absorber for the spine. One or both of these joints can become inflamed and unstable, resulting in pain and possible limited mobility.
What is SI Joint Dysfunction
As with other joints in the body, the SI joints can experience hypomobility–reduced movement and stiffness, or hypermobility–slackness that leads to instability.
When the SI joint is out of balance, pain can often be felt in the lower back and/or hip. The pain may be sharp, stabbing or dull, can be felt on one or both sides of the body, and can radiate into the groin as well as down the back of the leg. Pain can increase upon activity that puts pressure on these joints such as when rising from a seated position, walking up a hill, sitting or walking for long periods as well as twisting or bending. Other disorders that may be mistaken for SI joint dysfunction include hip disorders, lumbar disc herniation, or a pinched nerve. Though anyone can experience SI joint dysfunction, it more commonly occurs in young and middle-aged women.
Dysfunction in this weight-bearing joint is due to many causes. It occurs during pregnancy when changing hormones cause ligaments to relax leading to hypermobility. It can be the result of the degeneration of the cartilage that lies between the two bones and ultimately leads to osteoarthritis. Sitting or standing for long periods of time with inappropriate back support can place undo stress on this joint. It can also be the direct result of an injury from a fall or overexertion.
Conservative treatment should always be considered before medical intervention such as injections or surgery. A physical therapist will design an individual treatment approach dependent on the cause of the joint pain. It can include manual therapy to correct a misalignment, soft tissue, and joint mobilization to improve mobility as well as stabilization, flexibility, and strengthening exercises. The following exercises are designed to provide stabilization and increase the strength of the pelvic, glutes, and core muscles. Stop immediately if you experience an increase in pain and check with your physical therapist before initiating an exercise program. If the joint is experiencing hypomobility, manual physical therapy must be performed prior to exercise in order to correct the underlying disorder.
Perform the following exercises on a comfortable surface such as a yoga mat. Soreness is not uncommon and should subside with rest. Your physical therapist may recommend applying intermittent ice and moist heat for 15 minutes each before and after exercising. Always warm-up before exercising by walking or bicycling for 5 to 10 minutes. Focus on keeping your core muscles contracted as you perform these exercises.
Ball Squeezes with Knees Flexed to 90 degrees in Supine Position
Lay on your back with your knees bent to 90 degrees. Place a ball in between the knees and squeeze for 3 to 5 seconds. Relax and repeat 10 to 15 times for 1 to 2 sets. This strengthens the adductors, the muscles on the inside of the thighs, as well as the glutes.
Clam Shell Exercises in Supine Position
Lay on your back with your knees bent to 45 degrees. Place a Theraband or other elastic exercise band around your legs above your knees. Keeping your feet together, slowly open and close your knees. Repeat 2 sets of 15 repetitions. This exercise is designed to help reduce pain by strengthening the hip, glute, and thigh muscles as well as stabilizing the pelvic muscles.
Simultaneous Alternating Hip Flexion and Hip Extension Isometrics
Isometric exercises involve extended muscle contractions in which specific muscle groups remain contracted for a specific amount of time. These types of exercises limit potential joint injury. This is a standing exercise that will require a chair or exercise bar for balance. Lift one leg to 90 degrees at the hip and knee. Your thigh will be parallel to the floor. Hold for 10 to 30 seconds. Now slowly lift that same leg straight back behind you, keeping it as straight as possible. You will need to bend slightly at the waist. Try to get your leg parallel to the ground and hold for another 10 to 30 seconds. Perform with the other leg. Repeat 2 to 3 times and remember to breathe. This exercise strengthens your hamstrings, quadriceps, glutes, and lower back.
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