Hi everyone! I’ve had multiple requests recently to make a post about the exercises I do for my SI joint.
I’m definitely planning to put something up in the future– it’s just taking me a little while to figure out the best way to explain things, and also what sort of visual aids I might need. (And also, please allow me to direct you to my new “Disclaimer” page, which notes that I am sharing my experience as a patient, not a licensed medical professional!).
While I figure all this out, here is sort of a preliminary post I wanted to put up. It will help me to clarify my thoughts, and I’m also really curious to see if it resonates with you all, and if you find this sort of resource easy to understand.
So, here are the 3 major muscle groups I focused on strengthening, that made all the difference to stabilizing my SI joints.
Why a list of muscle groups?
Part of the reason I’m giving you this list of muscle groups to start out with, rather than specific exercises, is that it’s not so important which exercises you do, so much as you find a way to strengthen these muscles that works for you.
That’s something I really loved about my PT Paula, who ended up helping me the most with my SI joints. She knew which muscles I needed to strengthen, so we played around with things conceptually until we developed an exercise program that worked for me.
So, I’m giving you this list now to act as a reference for you to take to whatever doctor or physical therapist you’re working with. Your goal is to make sure you find a way to strengthen all of these, that works for you. And in the future, I hope to post more specific lists of exercises/diagrams/more concrete ways to strengthen them.
#1 The Core/Transverse Abdominis muscle
What we know about core strengthening has changed a lot in the past decade or so. When I was a high school runner, my coaches had us doing crunches and sit-ups.
Now we know that those exercises are actually not the best way to strengthen your core, because they don’t focus on the very most important muscle to core stability, the transverse abdominis.
The transverse abdominis is deeper than all of the other core muscles, and when it contracts, it acts like a “corset” to support your trunk. (It’s sometimes also called the “transversus abdominis”– same thing).
Exercises to strengthen the TA actually don’t involve crunches. Instead, a physical therapist can teach you how to contract it in a way that stabilizes your trunk. It will almost feel as though you are sucking in your belly button, as though you’re trying to squeeze into a pair of tight pants.
They’ll probably have you do this while you’re lying flat on your back. Then you maintain this “sucking in” while you perform other motions that challenge your body– but only once your PT is sure you’re contracting it correctly.
Here is a video that gives you an idea of what it’s like to learn how to strengthen the TA. As you’ll see, it’s a lot more about learning to identify the muscle and control it, than it is about brute strength. But don’t worry if you aren’t able to figure out what to do yourself– I’d definitely expect you to need a PT to help you get it right. (I certainly did!).
The TA is also activated quite easily and effortlessly by pool exercises that force you to stabilize your trunk and legs in the water– but you do have to know how to contract it, in order to make sure you’re doing it right. More on this later.
Update: I wrote another post focusing exclusively on the TA– you can read it here!
#2. The Muscles in the Back of the Hip (Hip Extensors, Abductors, and External Rotators)
I know this probably isn’t the most patient-friendly language–please bear with me as I try to clarify my explanations.
Something I’ve learned in all of my research on the SI joint is that one of the reasons why it’s so difficult to treat is that there are no muscles that directly cross it. (Other joints in the body have one or two major muscles that directly cross them, so rehab can be more straightforward).
For the SI joint, things are a little more complicated because it isn’t a joint where major motions are supposed to occur. Instead, it’s a subtle little joint that is really meant to transfer forces across it. It isn’t meant to move a lot– it’s instead part of a larger overall force transfer system. But when its 1-2 millimeters of motion are affected, it certainly triggers larger problems.
Although there aren’t muscles directly crossing it, these muscles in the back of the hip, such as the gluteus maximus and gluteus medius, are pretty much the next best thing.
For me, strengthening these muscles made a big difference in preventing that “slipping” feeling, which I came to learn was one of my hip bones rotating backwards and getting wedged against the ilium, aka getting “stuck.” So I can tell you based on personal experience that strengthening these muscles made a huge difference.
Again, there are multiple ways to strengthen these muscles, and what’s important is that you find a way to do it that works for you.
I tried to find a good video for you guys, but a lot of the exercises I found on Youtube looked too aggressive for someone with SIJ issues. (I’m definitely starting to see why everyone keeps asking for my exercises!).
However, just as a starting point, the Bird Dog exercise as shown below will definitely work hip extensors. (Anytime you’re lifting your leg behind you like this, or moving it backwards against resistance, you’re working the gluteus maximus):
But don’t worry– if it’s too strenuous for you, there are definitely less strenuous ways to activate the same muscles.
#3 Muscles of the Lower Back
Similar to the muscles in the back of the hip, the low back muscles are another “next best thing” to actually being able to strengthen a muscle that directly crosses the SIJ.
These muscle work hand in hand, along with the muscles in the back of the hip, to strengthen that whole part of your body.
Two major sets of muscles here:
And the Multifidus:
Both of the erector spine and the multifidus attach along the vertebrae and help to stabilize your low back and maintain good posture.
They are really deep inside the body, however, and aren’t the easiest muscles to visualize. Luckily, you don’t need to be thinking about them consciously to strengthen them– you just need to do your exercises.
The “Bird Dog” exercise, as shown above, also targets these spinal stabilizing muscles.
My favorite way to strengthen them, however, is a little closer to what Dr. Jo is doing in the deep end of the pool in this video. I hang my legs beneath me, using a flotation device to support my torso, and perform various movements with my legs:
You don’t need to wear ankle weights for the exercise to be effective. I don’t use them myself, and I’d definitely recommend checking with a doctor/PT before using them, regardless.
Basically, as long as you’re doing these exercises with good posture and keeping your core stable, you would be working these low back muscles as well as your core.
At the same time, you’d also be performing these exercises in a way that’s the most likely to be safe for your SI joints. That, my friends, is just one of the reasons why I love the pool so much!!!
Okay, so these are the main three.
Of course, a really thorough exercise program would have you strengthening all of the major muscle groups of the body, to ensure that your body is able to function optimally and let you do the things you want to do (not to mention preventing re-injury.
But for SI joint dysfunction, these are definitely the main three not to overlook.
I always welcome your comments and questions.
I know SI joint exercises are a topic people are hungry for information on, so please feel free to let me know if this type of post does (or does not!) work for you. I’m definitely trying to find the best way to explain complicated concepts.
So please, leave me a comment below or email me!
For more on SI joint exercise:
- The importance of pool exercise to my recovery
- The most important place to start strengthening: the transverse abdominis
- One of the best things you can do for yourself in the pool: traction
- My first preliminary attempt at outlining some of my exercises
- My Youtube playlist of helpful aquatic therapy videos, to give you ideas/inspiration
Additional Resource:
- The SI Joint Acts like a Shock Absorber, Taylored Training and Fitness
Photo Credits:
- Transverse Abdominis: photo courtesy of Ule Gille via Wikipedia
- Gluteus Maximus/Medius: image via Free Software Foundation/Wikipedia
- Erector Spinae: Illustration via Gray’s Anatomy/Wikipedia
- Multifus: Illustration via Gray’s Anatomy/Wikipedia
Pllss post ur version of those excercised … dat wud be soooo helpfulll… I knw its hard to make vidoes like u mentioned 👻 bt pls gv a try
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Thanks for your comment Rahima– it’s a good reminder that people are hoping to get this information! I’ll certainly get working on it!
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When the bird dog is to difficult, what do you do to replace that exercise
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Hi Jamie, the next step down to make it a little easier would be to do the arms or the legs at different times, rather than at the same time.
The superman exercise also works the same muscles, if you find it a little easier to do lying down. It’s at the 0:35 mark in this video: https://www.youtube.com/watch?v=cc6UVRS7PW4
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What about the bridge exercise? I don’t know what muscles it works but I’ve been told that it’s an important exercise to do for SI joint issues. Thanks for your informative article!
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Hi Katrina, yes the bridge exercise is great! It mainly works the gluteus maximus (one of the hip extensors, #2 in my list). However, assuming you’re doing it with proper form, it should also engage the core and, to a lesser extent, the muscles of the lower back. So yes, it’s a good one.
P.S. If any of you ever want to check which muscles a certain exercise uses, I definitely recommended looking it up on Bodybuilding.com. Don’t be intimidated by the name– we all have the same muscles and this info is valid for all of us, body builders or not! Here’s a link to the bridge exercise: https://www.bodybuilding.com/exercises/butt-lift-bridge
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Thank you so much for these exercises. I have fibro and RA and coming back into shape for spring is so hard. Two woks ago had to use a walker. Needed stamina and strengh. I have been doing a few pool exercises without weights and already feel better. I have a really bad SII problem and wanted to get ibetree before a college graduation 4 hrs away with lots of walking.
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Hi Carolyn, you’re so welcome! Really glad these exercises have helped!!
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I have had SI joint dysfunction for decades – usually flared up once or twice a year and cleared up in a couple of days. Needless to say, I did nothing to prevent further attacks and as the years went on it only got worse – I even had a ruptured disc at L5-S1 due to all the instability. I’m a massage therapist that has worked in the chiropractic and PT environment for years – This is the most comprehensive treatment plan I’ve seen and I thank you so much for sharing. I learned a lot! And I too quit going to the chiropractor because I believe now it only made my problem worse! Thanks again!
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Hi Melissa! Thank you so much for your kind words about my treatment plan– I really appreciate hearing it.
I’m sorry to hear all this has happened to you– I wish you the best of luck on your healing journey!
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If you don’t have a pool, how can one exercise the other two muscles (other than the ta)?
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Hi! The good news is that if you do the lying down TA exercise properly, you’ll also be working the lower back muscles (the erector spinae and multifidus). It isn’t *technically* an exercise to work them, but it still does (especially when you’re in the beginning stages of strengthening!). Of course, like all exercises I give out, the best thing to do would be to consult a PT to get started.
But, so you have an idea if what you’d be looking for, here’s another good video I found that shows the TA contraction at the beginning https://www.youtube.com/watch?v=AjADRr8AyhE Then, at the 1:30 mark, it shows some of the various additions you can add in to make it harder, and start working additional muscles.
Hope this helps!
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Thank you so much for the time and effort you put into sharing your journey through SI dysfunction. My pain started after a dirt bike crash. I’ve been chasing this pain for about the past 8 years through PT and my orthopedist. The focus was always on my lumbar spine. The physical therapists made it worse. I was able to get some relief with the first few rounds of injections from my Dr, but that eventually stopped having much of an effect. About 9 months ago my Dr suggest I see a PT that she really trusted, but was out of my insurance network. I didn’t care anymore, I just wanted relief. My pain wasn’t usually so severe that I couldn’t work and do stuff, but it prevented me from ever getting rest or good sleep. Within 5 minutes of seeing the new PT he identified my SI problem and adjusted me but tugging on my leg. Instant relief. I continued to see him for a couple months, then was released feeling much better. After a few more months I began to experience more discomfort and saw my Dr to ask if I could get a referral for a chiropractor to get adjusted for someone maintenance. The adjustments we’re much more harsh, I got worse and quit going. Went back to my Dr and previous PT, but progress seems much slower now. I fear I got really stretched out by the chiropractor and that’s how I found your blog. Your journey has many similarities to my own and I hope I can make some progress by incorporating much of the info you’ve so graciously shared.
Thanks again,
Kevin
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Hi Kevin! I’m so glad my blog has been helpful in this way!
That’s really unfortunate that the chiropractor seemed to make things worse, after you had been making progress. As patients with SIJD, it often seems like the only way for us to figure things out is through trial and error. That’s precisely why I work so hard on my blog– hopefully others can learn from my errors!
Thank you for the kind comment.
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So wondering if the elliptical is something you’d recommend? Sadly, I don’t have access to a pool:( And your thoughts on yoga? Trying to heal this without entirely giving up on exercise. Yoga has been so mentally helpful for me…I appreciate all of the knowledge you’re sharing😊
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Hi Lisa, for me the elliptical probably wouldn’t be a good idea but honestly we are all different. If it doesn’t give you any pain than I think it’s okay.
My answer about yoga, unfortunately, is probably not going to be what you’re hoping to hear. I actually think yoga can be pretty dangerous for SI joint issues, as the positions are pretty likely to stress the ligaments. I actually have a reader who used to be a yoga instructor and believes this is why she developed SI joint issues. I wonder if there’s something similar you can try, like a meditation class, to get similar mental benefits without actually involving your SIJ’s…
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Hi. I have been experiencing Burning, stabbing Pain starting from the left side of my sacrum through to the right side , into my right buttock and just about a quarter of the way down the right side of my thigh. It is provoked & most painful when sitting but it has gotten worse over the past 7 months & now I can’t stand for very long and it’s hard to find a comfortable position to sleep. I’ve had injections and physical therapy. An MRI shows mild herniation on L4 L5 but my doctor doesn’t think that’s where this pain is coming from. I am so tired of not living life. I happened upon your blog but would like more info. I am so desperate. Does this sound similar to your SI problem ?
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Hi Cindy, I’m so sorry to hear about this. Through running my blog and doing coaching calls, I have honestly heard people describe all kinds of symptoms coming from SI joint issues. Given that your doctor doesn’t think your spine is the source of the pain, it certainly does sound possible that your SI joints are causing this.
PT can help– but it has to be with the right person, as sometimes PT’s who don’t have the right experience can accidentally make things worse. Check out my Physical Therapy posts for more on how to find the right treatment: https://sijointsaga.com/physical-therapy/
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Hi, how long did it take you to heal after you started these exercises? how often did you do them?
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Hi Ami, a lot of people ask me this. The answer is a bit complicated, because there were more pieces that had to fall into place for me, in addition to the exercises (such as learning to realign the joint using the Muscle Energy Technique). But I would say I noticed a real benefit within 3-4 weeks of getting stronger. You can find out more of the specifics, in terms of timeline, in this post: https://sijointsaga.com/2017/09/04/recovery/
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Hi Christy!
One thing I’ve discovered (and after 10 years undiscovered with various docs, PTs, etc) with my SI joint dysfunction is that I have a slight twist in my lumber spine, so a bit of scoliosis that keeps my right QL and erector spinae chronically tight. When these muscles go into acute contraction, my SI joint is pulled out of alignment. The knowledge and exercises around these muscles has been really helpful! For me, changing from a posterior tilt to a slight anterior tilt has helped me to release my glutes to actually fire when walking and bending and exercising, something that I couldn’t do when I had a tucked pelvis. This explains why so many exercises given to me by PTs to strengthen my glutes never worked, and even worsened my pain. Have you found this with any of your patients?
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Hi Robin, that is so interesting! No, actually, you are the first person I’ve heard say this!
I know that I personally choose not to do the pronounced posterior pelvic tilt that many people recommend during core exercises, because I find it destabilizes the orientation of my SI joints. Instead I’ve always focused on the “sucking in” aspect of the transverse abdominis muscle. (You can see what I mean in my description under the second video in this post: https://sijointsaga.com/2017/06/19/core-training/
I wonder if the glutes may have been part of this without my realizing it. Thanks for bringing this to my attention!
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