What To Avoid With SI Joint Pain (and What To Do Instead)

What To Avoid With SI Joint Pain

When dealing with SI joint pain, you should avoid repeatedly getting your SI joint manipulated by a chiropractor or a physical therapist.

Now, let me clarify:

I’m a fellowship-trained Orthopedic Manual Physical Therapist, which means I’ve undergone two and a half years of postgraduate training specifically in hands-on techniques such as spinal manipulation.

Manipulation, when used correctly and sparingly, can be a beneficial tool to treat SI joint pain.

In fact, if your SI joint has slipped out of place or locked up, a manipulation can be an effective way to get it feeling better quickly.

However, there's an important caveat:

The SI joint is inherently a very stable joint.

It only moves about 1 to 3 millimeters or less than 1/8 of an inch.

So, it really shouldn’t be slipping anywhere.

Why the SI Joint Is So Stable

The stability of the SI joint comes from the curved shape of the joint surfaces, along with the wedge shape of the sacrum, which is wedged between the two ilia.

This structure makes the sacrum the "keystone" bone of an arch, giving the SI joint its inherent stability.

Additionally, the joint is supported by a network of ligaments that further enhance this stability.

However, every time you manipulate the SI joint, you slightly stretch out those ligaments, making the joint a little bit more unstable.

When the SI joint ligaments are tight, they hold the joint surfaces together and prevent slipping.

But if those ligaments get stretched out—whether from an injury like a fall, hormonal changes during pregnancy, or the expansion of the pelvis during delivery—it can allow for slipping or even locking of the SI joints

The Risk of Repeated Manipulations

Each time you manipulate the SI joint, you risk further stretching those ligaments.

This can make the SI joint more likely to lock up in the future.

Therefore, while it’s okay to get a manipulation when you’re in a lot of pain, you should save it for those times when it’s absolutely necessary.

What to Do Instead: Gentle Techniques and Stabilization

So, what should you do instead of repeated manipulations?

There are gentler ways to unlock the SI joint.

However, it’s important to remember that whether you get manipulated or unlock the SI joint yourself, it doesn’t return to normal.

It returns to its previously hypermobile state.

This means that once the SI joint is unlocked, you need to stabilize it to prevent it from slipping out of place again.

First, I'll show you some techniques to unlock your SI joint on your own.

Then, I'll guide you through exercises to stabilize the joint and offer tips to prevent the pain from recurring in the future.

Techniques for Unlocking Your Own SI Joint

If your SI joint has slipped out of place or locked up, you probably know which side is painful, but it may be difficult to determine in which direction it has shifted or rotated.

Chiropractors or physical therapists often assess this by checking if one leg appears longer than the other.

If you can't tell this on your own, try this technique on one side to see if it helps. If it doesn’t, then try it on the opposite side.

The pelvis is essentially a ring, so if you rotate one side in one direction, it's like rotating the opposite side in the opposite direction.

Here’s a technique you can use to unlock your SI joint:

1. Lie on Your Back: Position yourself close to the side of a bed.
2. Pull the Long Leg Up: Bring the leg that appears longer up towards your chest.
3. Drop the Short Leg: Let the leg that appears shorter hang off the side of the bed.
4. Use Your Hands: Pull the longer leg closer to your chest with your hands.
5. Kick and Hold: Gently kick your thigh into your hands, engaging your gluteal muscles on that side. This action should rotate the pelvis in a way that could help unlock the SI joint.
6. Repeat: Hold the position for about five seconds, then pull the leg closer to your chest. Kick and hold again, repeating the process.

After performing this exercise, stand up and move around. If you feel better, don’t repeat the exercise on the opposite side. If you don’t feel better, try the exercise on the other side.

Stabilizing the SI Joint After Unlocking It

Once you’ve unlocked the SI joint, remember that it has returned to a hypermobile state, meaning it’s time to stabilize it.

To stabilize the SI joint, we’ll use the transverse abdominis, a deep abdominal muscle that runs across the lower abdomen, compressing the SI joint in the front.

Additionally, the gluteus maximus, which crosses the SI joint in the back, helps stabilize it as well.

1. Transverse Abdominis Activation:
   1. Lie on Your Back: Begin by drawing your belly button in, flattening your lower back against the table.
   2. Hold: Maintain this position for five seconds, then relax.
   3. Daily Practice: Ideally, you want to get good at maintaining this slight contraction throughout the day to keep your SI joint stable.
2. Bridge Exercise:
   1. Draw in Your Abdomen: Start with the transverse abdominis activation.
   2. Lift Your Glutes: Push your heels down and lift your glutes, but only go as far as you can without allowing your lower back to arch.
   3. Hold: Hold this position for 5 to 10 seconds, then lower back down.
   4. Repeat: Perform 10 repetitions.

As you bridge up, you’re not only strengthening the muscles that stabilize the SI joint, but also stretching the hip flexors, which can affect the positioning of the SI joints.

SI Belts

While you ultimately want to get your muscles to stabilize your SI joints, using an SI belt can help in the short term.

BraceAbility SI Joint Belt - Sacroiliac ...

$49.99 (as of October 8, 2024 01:38 GMT -05:00 - More infoProduct prices and availability are accurate as of the date/time indicated and are subject to change. Any price and availability information displayed on [relevant Amazon Site(s), as applicable] at the time of purchase will apply to the purchase of this product.)

The best time to use an SI belt is when you'll be particularly active on your feet or dong activities that require lifting or twisting.

Improving Hip Mobility to Reduce SI Joint Stress

Another key to SI joint stability is ensuring adequate mobility in other areas, particularly the hips.

If your hips aren’t moving enough, your SI joint ends up having to move excessively to compensate.

Here are three exercises to improve hip mobility, reducing stress on the SI joint:

1. Rocking Hip Stretch:
   
   1. Kneel on All Fours: Find a neutral spine position, not too arched or rounded.
   2. Rock Back: Slowly rock back towards your heels as far as you can without letting your lower back round out. This isn’t a child’s pose; it’s a controlled movement focusing on hip mobility.
2. Piriformis Stretch:
   
   1. Cross Your Leg: While seated, cross one leg over the other.
   2. Check Flexibility: Compare how far each side goes down. Stretch the tighter side more to create balance.
3. Hip Flexor Stretch:
   
   1. Kneeling Position: Kneel on a bed or floor.
   2. Pelvic Tilt: Engage your glutes and abdominals, then gently drive your hips forward until you feel a stretch in the front of your hip.

Functional Activities to Support SI Joint Health

After unlocking and stabilizing your SI joint and improving hip mobility, it’s essential to incorporate functional activities into your daily routine to support SI joint health.

This may include functional glute strengthening exercises like squats and lunges.

Remember, the goal is not just to relieve pain temporarily, but to prevent it from returning by addressing the underlying issues that contribute to SI joint instability.

Need Help For SI Joint Pain?

If you live in the St. Louis area and would like to find a long-term solution to your SI joint pain, tap the button below to request an appointment with one of our specialist physical therapists.

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