Hi everyone!
One of the topics people ask me about most frequently is my exercise routine for SI joint dysfunction. However, before I go into specific exercises, I wanted to take a moment to try to shift your thinking on what strengthening means for SI joint dysfunction.
What a lot of people get wrong is thinking there are certain exercises that they have to do, no matter what.
This idea often comes from working with a PT or other healthcare professional who tells you that there’s only “one” way to do things, and that you’ll never get better unless you push through a certain number of reps, no matter how much it hurts.
I encountered this idea myself, when I was first starting out. Yet, being told to do exercises that were painful never worked for me– and now, I know that it doesn’t work for my clients, either.
Here’s a better way to think about it: which muscle GROUPS are you activating?
The key to stabilizing your SI joints is to build up your strength in the muscles that surround the joint. However, the end result you’re looking for is an increase in strength.
For any muscle in the body, there is more than one way to get there. You don’t have to do things that are painful.
So before we talk about specific exercises, I like to talk about muscle GROUPS.
#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.
Exercises to strengthen the TA actually don’t involve crunches. Instead, contracting the TA is more of an “inward” motion. 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.
I personally think the easiest position to start learning how to do this is when you’re lying flat on your back. Then you maintain this “sucking in” while you perform other motions that challenge your body– but only you’re 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.
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 about it here!
#2. The Muscles in the Back of the Hip (Hip Extensors, Abductors, and External Rotators)
Did you know there are actually several different muscles that make up the glutes?
The term “glutes” actually refers to several different muscles which perform slightly different functions: the hip extensors, abductors, and external rotators..
Rather than giving you an oversimplification, I want to walk you guys through the thought process that really helped me in my own recovery. I started to take much more control over my own situation once I began to understand things on a more technical level.
That’s why I’m giving you the official names for these muscle groups, which are all located in the back of the hip/SI joint.
One of the reasons why the SI joint is so difficult to treat is that there are no muscles that directly act on 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 motion is supposed to occur. Instead, it’s meant to transfer forces as part of a larger overall force transfer system. That’s why there aren’t any muscles that specifically act on it, compared to the muscles acting on the joints in your arms and legs.
That’s why it’s a bit more complex to identify which muscles to strengthen. However, these muscles in the back of the hip, such as the gluteus maximus and gluteus medius, are *super* helpful.
For me, strengthening these muscles made a big difference in healing my recurring posterior rotation. Weaker muscles are more likely to get tired easily, tense up, and then, in my case, pull that hip bone backwards. Once I managed to get stronger, they had a lot more endurance, and stopped constantly pulling me into that posterior rotation.
There are multiple ways to strengthen these muscles.
The key is to find the ways to target these muscles, so that your brain is sending a signal to those muscle fibers… without causing any pain and stressing out the joint. (We talk more about this in my coaching program!).
#3 Muscles of the Lower Back (Spinal Stabilizers)
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 SI joint.
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 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.
Instead, when you do proper core activations with the correct breathing and posture, these spinal stabilizers are recruited as well– all the more reason to invest in a good core routine.
Conclusion
Learning to re-frame my thinking on strengthening was a key part of my recovery.
I went from thinking I had to push through certain exercises, to realizing I could modify anything I needed to. That’s when I started strengthening in a way that was actually gentle on my ligaments.
If you’d like to learn how to strengthen in a way that actually helps you heal, rather than causing setbacks, you’ll love my coaching program! Click here for more info.
What do you guys think?
Has anyone ever told you to push through a list of exercises that are painful? How does the idea of targeting muscle groups instead sit with you?
Let me know in the comments below!
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
My Sacroiliac Joint Saga 
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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Charlotte Bell has a thoughtful book called Hip Friendly Asanas. It tailors specific yoga postures for inflamed sij sufferers as well as those who have had hip replacement.
Separately, I am having a pretty bad bout right now. Three weeks, two chiropractors, very limited benefit. I think my obsession with focusing on pullups has my lats yanking on my si or affecting an attached muscle.
Finally I’d advise sufferers to avoid extension exercises. They are all the rage, Cobra, etc. You wrote a concise article pertaining to this some time ago. Very true. I am wondering, though, when you should focus on stretching vs strengthening, what is the point of transition? Thank you again.
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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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Thank you so much for taking the trouble to share this information & your story. I have been suffering for years from this condition & was already doing several of the exercises you recommend. These have helped me a great deal but have not cured me completely. I have found that most doctors I have seen, unless they have suffered themselves, do not really understand what it means to suffer with this .Do you think that denervation treatment could help ? I was also wondering if I needed to work on the piraformis muscles & hamstrings too as I have been told that they have always appeared very tight? If so what exercises would you recommend & how soon after an attack should they be commenced ?.
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My new PT discovered my hips to the side are weak… I’m hoping once I get them strong abbductors and adductors, that things will get better for me too. I’m just a little confused about stretching now… especially after listening to a podcast called Stop Stretching!
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