Why standard PT exercises don’t work

Hey everyone,

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).

Lumbar spine
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. Motions that I myself learned through trial and error to avoid, such as twisting and lumbar extension, are now actually a regular part of your routine.

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.

Si joint ligaments
ligaments of the SI joint

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.

As I always tell my coaching clients, the SI joint was only meant to move a few millimeters.

However, 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.

It’s like trying to sail a ship but none of the ropes are tied tightly enough… the sails are flopping every which way, instead of steering the boat in one direction.

That’s why some of these “beginner” exercises, such as a bridge or a squat, might be appropriate for someone with an issue further up their spine.

However, trying to do them with sprained SI joint ligaments is putting stress on a joint that can no longer redirect that stress optimally.

That’s why so many of these “beginner” exercises are actually very painful for someone with SI joint dysfunction.

The joint no longer has 100% of one of the main systems that was meant to stabilize it– it’s going to experience these exercises differently now.

And if your ligaments have been sprained— which we know they are, if your joints are moving out of alignment— 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.

Luckily, the answer is to build up your body’s other main system of stabilization: your muscles.

If there’s anything I’ve learned over the course of my SI joint saga, it’s that there is always a way to modify your exercises.

Doing nothing is never the final answer— you just have to get creative, and find the right people to work with you.

Coming up, I’m going to be explaining more about some of 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.

And to check in with me for individual recommendations about your situation, go here.

Keep going, everyone!

Photo credits:

  • Lumbar spine: Anatamography
  • SI joint ligaments: Gray’s Anatomy/Public Domain

4 thoughts on “Why standard PT exercises don’t work

  1. Patricia Bruce says:

    Hi Christy,
    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.
    Best wishes


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