If you’re like many of the people who come to my site, you’ve already been through physical therapy several times.
Your PT gave you a printout of exercises. Technically, they’re the “correct” exercises to do for lower back pain. But none of them helped you, and in fact, you’re in even more pain now.
Why is this?
The reality is that the exercises you need to do to stabilize the SI joint are different than the standard exercises for lower back pain (aka, pain that’s coming from issues with the lumbar spine).
Unfortunately, many physical therapists don’t know this. All they know is that you need to get stronger, so they give you the same exercises they learned in PT school for someone with low back pain.
I hear this time and time again. So many of you are in PT being told to perform movement that I myself learned to avoid, such as twisting and lumbar extension.
Maybe you don’t necessarily have excruciating pain in the moment, but you’re also definitely not getting better.
Why is this?
It’s because, after an injury to your SI joints, things are going to be very different in your body.
The SI joint is the shock absorber of your body.
Similar to the shocks in your car, one of the major jobs of the SI joint is to absorb the force that travels up your leg every time you take a step. The shape of the joint then directs this force in a very precise way up the rest of your body.
If your SI joints are functioning perfectly, this is a completely effortless process. You don’t have to think about it– it just happens.
However, once you’ve had an injury that sprains the SI joint ligaments, everything becomes a whole different ball game.
Research has shown that the SI joint was only meant to move a few millimeters.
That might not sound like a lot, but, if you take a joint that was only meant to move a few millimeters and then increase its range of motion by half a millimeter… that’s a pretty huge difference.
All of a sudden, that joint that was efficiently directing forces in a very precise way is now… sloppy.
That’s why so many of these “beginner” exercises are actually very painful for someone with SI joint dysfunction.
The joint no longer has the benefit of one of the main systems that was meant to stabilize it, so it’s going to experience these exercises differently now.
And if your ligaments have been sprained, putting further stress on them is not what you want. You want to leave them out of the equation as much as possible, so they can heal.
You can still move forward.
Where a lot of people –even those working with physical therapists– get stuck is by thinking there is only one way to strengthen a muscle.
I got caught in this cycle myself, where I was told I would “never get better” if I didn’t perform a set of exercises that was painful for me.
Instead, I learned how to stabilize my own SI joints by developing a routine that let me minimize the negative impacts on my joints, while directly strengthening the muscles I needed to build up.
Ultimately, it’s all about striking the right balance between activating the muscles and letting the ligaments rest, and it absolutely can be done! For me, it required breaking out of the idea that certain PT exercises are the ones you have to do.
After all, it’s not about which exercise you’re doing, it’s about which muscles you’re strengthening– and that is how you can start to reframe your thinking.
Now, I help my one-on-one clients incorporate these principles into their routines, as part of a comprehensive recovery plan.
Coming up, I’m going to be explaining more about how to overcome the common difficulties people run into, and the best exercises to start building up your baseline, so that you can tolerate a wider range of movements.
Keep going, everyone– this gets so much better!
- Lumbar spine: Anatamography
- SI joint ligaments: Gray’s Anatomy/Public Domain
4 thoughts on “Why standard PT exercises don’t work (and how to move forward!)”
Hi would love to see what strengthening exercises would be appropriate for me with my SI issues thanks x
Stay tuned for more info!!
This post is perfect timing for me.
After months of rest trying to heal, my body has now calmed and healed enough to start the strengthening process. Has been on my mind how to do this safetly.
I have just been getting my movement back doing light housework. I never thought I’d love housework so much…but it is so great to be able to do it again.
I Look forward to your recommendations.
And so grateful to have guidance.
Hi Tricia, so glad I can help! That’s awesome you’re able to start doing things again. I totally know the feeling of being exhilarated when you can start doing housework again!!