Three major muscle groups to strengthen for SI joint dysfunction

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).

256px-Transversus_abdominis (1).png

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 about learning to activate the TA!).

#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.

posterior_hip_muscles_3

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:

The Erector Spinae:

Gray389_-_Erector_spinae.png

And the Multifidus:

300px-Multifidi

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:

Additional Resource:

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