I received a really interesting comment over on Sunlight in Winter the other day. It was from Maritza, who suffers from both SI joint dysfunction and lumbar spine issues (the term “lumbar spine” refers to the part of the spine that’s in your lower back).
Her comment inspired me to share some information with you guys, in a new way that I might not have otherwise thought of (which is why I totally love getting your comments and emails!).
Maritza had been told by both her spine doctor and her chiropractor to rest for a while before beginning any exercise at all. And, when I read this, I wondered if it was really the same advice a knowledgeable physical therapist would give.
Now, before I go on, I must remind you that the things I write here are not intended as a substitute for individualized medical attention. This is for general informational purposes only– to help you find your way, to help you think of questions to ask your doctor, or maybe to help you decide when to get a second opinion.
Generally speaking, I am not sure it’s necessary or even wise to tell someone with low back pain not to do any exercises at all.
One of the most important things you need to do to stabilize both the SI joint and the lower back is to develop core strength– specifically, the strength of your transverse abdominis muscle, which wraps around the whole front of your body.
When you contract the transverse abdominis, it acts like a corset or a stabilizing brace. When I contract mine, it almost feels as though someone is giving me a gentle hug in the front of my body, helping hold me up so I stand up straight.
Research has shown that when this muscle is contracted, it actually helps to limit the amount of force that travels through the SI joint, meaning it won’t be as vulnerable to moving around in response to every little thing that could aggravate it.
Again, you would absolutely need to consult a physical therapist on this– do not just take my word for it–
But there are exercises you can do to start building core strength– specifically the transverse abdominis muscle– that should not put unhealthy pressure on your SI joints or lower back.
The video below shows what it should look like when a physical therapist is first showing you how to identify and contract the transverse abdominis. You should be lying on your back, on a comfortable surface, and actually, the point is that you’re not moving your spine or pelvis at all:
Since one of the main jobs of the TA is to prevent motion in your spine, these beginning exercises all allow you to activate it while the spine is remaining still.
Once you know how to activate the TA, and your PT has assured you you’re doing it correctly, these are what some of the next exercises would be, which are a little bit more difficult:
The goal of these exercises, essentially, is to learn to perform movements which recruit your core muscles (like lifting your legs up) without allowing your spine to move. That’s how you know you’re working the TA. If your spine starts to change position, that’s actually a sign that you’re doing it wrong.
When you’re doing these exercises correctly, your lower back really shouldn’t be moving much at all. That’s what makes them such an ideal way to strengthening. (And again, that’s why you want to make sure you learn to do them under the supervision of a qualified PT).
So if you can receive medical clearance to perform these exercises (which I think the vast majority of people with SI joint dysfunction should be able to), I actually think it’s really important to get started on them sooner, rather than later.
1) Because you’re eventually going to need to strengthen it anyway– it’s kind of kicking the can down the road to wait.
2) The longer you wait, the weaker your TA might become. There are two reasons for this:
–We’re probably all familiar with the concept of muscular atrophy, or, as you might have learned in gym class, use it or lose it. The body wants to conserve energy; it will not maintain strength in a muscle you don’t use very much. You’ve got to use it for the body to keep it strong, but also:
–Research has actually shown that when you have lower back pain, it can actually confuse your nervous system and weaken communication between your core muscles and your brain.
We don’t know exactly why this happens, but studies have demonstrated that people who’ve suffered from low back pain for a long time actually have less awareness of these muscles, because the brain has sort of forgotten how to communicate with them.
That is why learning to activate the core muscles, and the TA, isn’t only about simple exercise; it’s actually more about training. These exercises are meant to be gentle– especially when you’re first starting out like in the first video above.
It’s not so much that you’re working “hard” and getting out of breath and sweating. Instead, you are trying to open up and deepen the connection between these muscles and your mind, and — in the case of someone who’s had low back pain for a long time– helping your brain to “remember” some of the knowledge it might have forgotten.
So, if you’re suffering from SI joint dysfunction, or lower back pain, I really recommend consulting a qualified PT to help you with these.
You can see a general outpatient orthopedic PT– they offer the type of PT most people are probably familiar with– the kind you normally see for injuries or back pain.
However, you can also look into pelvic floor physical therapy– a lot of what I learned about this mind/brain connection I actually learned from a pelvic floor therapist, who was super amazing.
For more on building muscle strength, you can also check out these related posts I wrote:
- Three major muscle groups to strengthen for SI joint dysfunction
- The most important place to start strengthening: the core & transverse abdominis
And for more on relationship between back pain and the core muscles, I recommend the article Core Training versus Strengthening, by well-known physical therapist Diane Lee.
I hope this post was helpful to you! Any questions, please comment below or email firstname.lastname@example.org.