Use caution with back extensions and the SI joint

Hello, hello everyone!

I wanted to check in with you about an issue I’ve heard a lot of people mentioning recently.  This time, it’s about an exercise that you may want to be careful with, if you have SI joint issues.

What I’m talking about, specifically, is back extension.  This is the term that refers to when you’re bending your spine backwards.

Back extension can be a component of several different exercises, including something called McKenzie exercises.

The first exercise in this video, the “press-up,” shows what I’m talking about:

Basically, you’re bending your spine backwards.  This motion is meant to gently nudge a herniated disc back into the proper position.

However… I’ve had about five different people email me now and say the McKenzie exercises actually cause the pain in their SI joints to increase.

Why are so many SIJ patients being prescribed McKenzie exercises?

I think it’s because the symptoms of a herniated disc and SI joint dysfunction can be very similar.  I think it’s possible that a doctor might send a patient to physical therapy, not necessarily being sure which condition the patient has, or thinking there’s a possibility they might have both.

And then the PT follows a treatment plan, thinking that perhaps if the McKenzie exercises help, then that must mean the patient did have a herniated disc.

However, I haven’t been surprised to hear SIJ patients not liking these exercises, because back extension is something I’ve learned to avoid myself.

I actually never tried the McKenzie exercises personally, but I used to try to do a similar exercise involving back extension, often called the cat-camel stretch.  Many of you may have been prescribed this stretch as well.

However, I’ve always found this motion to change the alignment of my SI joints.  Because think about it: when you extend your spine, you are moving the sacrum. After all, it’s the base of the spine.

But your hip bones aren’t necessarily going to follow along– especially if you’re using your legs to hold yourself up, as in this video.

The SI joint, you may remember, is the place where the hip bones and the sacrum meet.

So when you deliberately change the positioning of the sacrum, you’re automatically changing the alignment of the joint.

Again, everyone is different. 

Maybe some people won’t have this problem.  But for me personally, I’ve come to avoid anything that deliberately moves the sacrum.

It’s even one of the problems I’ve had with massage therapy, and why I stopped letting anyone except for my one trusted massage therapist go anywhere near my SI joints.  If they used too much force, even if it was on my upper back, somehow it would alter the alignment of my SI joints.

A lot of the time, I have found, less can be more.  (That’s the whole principle behind why I came to prefer the Muscle Energy Technique over chiropractic adjustments).

So if your PT is prescribing you exercises that involve back extension, be sure you ask why.  

Does the PT think you have a herniated disc?  What is his or her rational for thinking that, versus SI joint dysfunction?

And if you find McKenzie exercises make your SI joints worse, don’t be afraid to communicate your concerns to your doctor or PT!  We are all different as individuals, and the things that work for one person may not work for another.  That’s why it’s so crucial that your healthcare provider listen to your individual concerns. 

What do you think?

Has anyone recommended these exercises to you– and were you able to do them?

Let me know in the comments below!

Published by Christy Collins

Hi, I'm Christy! I'm a health coach who helps people overcome SI joint dysfunction and chronic pain.

2 thoughts on “Use caution with back extensions and the SI joint

  1. Wow. I moved my back hip pain ti a whole worse level a few hours after doing a few push ups aka Mackenzie. My doctor now thinks my pain is from the SI joint , but regardless, your article was spot on. Extreme press ups are terribly wrong for arthritis or SI joint. The only use should be bulging disk for which it makes sense. Bottom line in my opinion is to not undertake PT without a strong diagnosis. Stick with yoga and don’t do a pose that elicits pain.


    1. I completely agree– doing nonspecific exercises for “low back pain” is a recipe for disaster with this! Sorry you went through this– but it sounds like you’re starting to figure things out and get on a better path!


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