Reader question: Is it okay to work out in a pool if your SI joints are out of alignment?

Hi everyone! Hope you’re all enjoying the holidays.

I’ve been getting some really great questions from readers recently that I think are worth sharing with you all.

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I recently heard from G., who was wondering it was okay to perform aquatic exercise when her SI joints and sacrum were out of alignment.   (She goes to an osteopath, who is able to put her joints into alignment, but then they only stay that way for a few days).

G. was wondering if she should only exercise on the “good days” but, once she was out of alignment, then wait until she was able to go back to the osteopath.

Her predicament really reminded me of my own journey, so I wanted to be sure to answer this question as best as I can.

My answer:

I think the best way to think about aquatic exercise, and exercise in general, is to try to do as much as you can in ways that don’t create pain.

Yes, I would expect that the optimal days for you to work out would be when you are in alignment.  However, you may find that there are some exercises you can do even when your joints are out of alignment.

For example, when one of my SI joints was locked up (and remember, only one side can actually “lock” at a time, thankfully) I would find that it wasn’t painful to do most of my pool exercises with my other leg.

For example, I could practice my balance standing on a noodle with my good leg.  I could also do a lot of exercises where my legs were hanging beneath me in the deep end– I really think this is a powerful tool for anyone with pelvic or low back pain.  I don’t know if you’ve seen my post on it, but you use floatation devices to support your upper body and let your legs hang straight down.  This way, gravity can gently pull your legs down, which helps to create space in any joint spaces that may have been compressed.

You may have heard of this concept before in other contexts– it’s called “traction.”  For me, I think it was a really important part of why my problems eventually got better.  Not just aquatic therapy alone, but traction.  I think that when you start to have some subtle imbalances in alignment, sometimes even just a little bit of this type of traction can help reverse them or stop them from getting worse.  You might find that it helps you go a little longer in between adjustments.

Core Strengthening

There are also some gentle core strengthening exercises you can hopefully do on days when you can’t make it to the pool.  The first video I included in this post shows someone learning to activate the transverse abdominis muscle, which is generally said to be the most important muscle in the core.

It’s actually more about learning where it is and how to contract it, than it is about huffing and puffing and sweating.  That’s why many people actually call it core training, rather than core strengthening.  If you can have a PT show you how to do this outside of the pool, that should help a lot.

It’s also a great tool to know how to activate it in the pool, because once you know how to activate it on demand, it helps you maintain proper posture and provides a lot of support for your SI joints and lower back.

Working with an aquatic physical therapist:

The unfortunate reality is that not all aquatic therapists are going to be familiar with the SI joint.   I had a really awkward experience with one of the PT’s I was actually observing as part of a requirement to apply to PT school.  We thought it would be fun for me to actually get in the pool and try out some of the exercises– while one of my SI joints was locked up– and I found he had no appreciation for what was happening.

I was trying to do some water running while wearing a floatation belt, letting my legs hang beneath me.  And I simply couldn’t get full range of motion in the leg on the side my SI joint was locked.  And he didn’t get it.

He kept giving me instructions about correcting my form and swinging my legs “all the way through.” I just couldn’t make my body do it.  It was really awkward, especially because I was counting on this person for a recommendation to PT school.  I didn’t want to disagree with him, or tell him he had no idea what he was talking about.  I tried to do the best I could, kicking my leg as far as I could despite the fact that my SIJ on that side was stuck.  No matter what, I couldn’t make my leg move that far, and I ended up with pain in my knee for a few days after that, because that’s how my body was compensating for my stuck SI joint.

It was a total a disaster, and I never opted to get in the pool under his instruction again– even though he was actually the head PT at that office who’d been there for decades.

So be choosy and make sure you find someone who respects your pain level.  In the case of the SI joints, more pain is not necessarily more gain– if the pain is coming from your ligaments, you are potentially just prolonging your healing.  So make sure you find someone who gets it.

Listen to your body.  In the case of the SI joints, pain is NOT gain– it is potentially you re-spraining your ligaments.  It is NOT good.

The point is to find ways to strengthen your muscles as much as you can, without causing pain in the ligaments.

Okay… I think that is all for now!  As always, if you have any questions, feel free to leave me a comment below!

And Happy New Year!