SI Joint Pain During Pregnancy

Understanding SI Joint Pain

What is SI joint pain?

SI joint pain, or sacroiliac joint pain, is pain that occurs around the SI joint and is often felt in the low back. 

The SI joints are in the back of the pelvis and are typically very stable joints. 

Causes of SI joint pain during pregnancy

The SI joint stability is maintained largely by ligamentous support. The ligaments that support the SIJ include: 

• interosseous sacroiliac ligament

• posterior sacroiliac ligament 

• anterior sacroiliac ligament 

• sacrotuberous ligament 

• sacrospinous ligament 

• iliolumbar ligaments

Hormonal changes during pregnancy lead to ligamentous laxity, which ultimately leads to decreased support and joint instability. The instability causes the pain that women feel during pregnancy. 

Symptoms and how to identify SI joint pain

SIJ joint pain is usually felt in the low back or buttocks region— it does not radiate. Sometimes it feels sharp/stabby, but most often it is achy. 

Most patients feel it the most when: 

• Bending forward 

• Sitting for long periods of time

• Getting out of the car/putting pants on 

• Taking first steps after standing 

• Standing on one leg 

• Laying flat on their back for an extended period of time 

Patients who have SIJ pain usually don’t experience: 

• Radiating pain

• Pain in the front of their pelvis 

• Lightening crotch 

Managing SI Joint Pain

• Exercises to relieve SI joint pain in pregnancy

I like to think of exercises for musculoskeletal pain as prescriptive similar to medications. The exercises that should be prescribed really depend on the exact source of the pain (adductor tension, glute weakness, etc.), but in general glute med and adductor strengthening is beneficial. 

You have 3 glute muscles: 

• glute max (think large and powerful) 

• glute med (smaller and more stability) 

• glute min (smaller and also more stability) 

The glute med is the one I am targeting the most when it comes to SIJ pain and a good way to do that is to add a resistance band just above the knees to many lower body exercises like: 

• glute bridges

• side steps

• squats 

• hip hinge 

• any balance exercise 

Another nice muscle group to target with SIJ pain is the adductors, or the inner thigh muscles. Lateral lunges are my favorite, simple exercise for targeting the inner thigh muscles.

• Tips for sleeping with SI joint pain

I typically recommend side sleeping during pregnancy, especially towards the end. Most people know to place a pillow between their knees, BUT don’t put one between their ankles too. By having your ankles together and knees apart, you are tractioning the SIJ. 

An easy solution for this is to put two pillows length wise between your knees/ankles to keep everything in good alignment without tractioning the SIJ. You want your ankles to be the same height as your hips. 

• Lifestyle modifications for managing SI joint discomfort

Other lifestyle modifications for managing SIJ pain include not crossing your legs, and moving like a mermaid. Imagine you have a mermaid skirt on that forces you to keep your knees together when you do things like: 

• get out of bed 

• get out of the car 

And a good rule of thumb for managing pain but enjoying life: if it hurts, don’t do it. 

Professional Help and Treatment

• When to see a doctor or therapist for SI joint pain

During pregnancy we can be told this kind of pain is normal and it’ll go away once the pregnancy is over and we just have to deal with it, however, that’s not exactly what I have experienced professionally. 

Why deal with pain when you don’t have to?

SI joint pain is typically treated very easily with pelvic floor physical therapy. The treatment is non-invasive, effective, typically patients respond pretty quickly. 

I’ve had patients who are pregnant that deal with this pain for months before seeing a provider and feel so much relief once they begin physical therapy. They always say they wish they’d come sooner.

And I’ll go back to— pain is often a sign of dysfunction and musculoskeletal imbalance can impede birth progression. 

So my advice is to start physical therapy at the onset of pain rather than waiting to see if it dissipates. 

• Physical therapy for SI joint pain in pregnancy

So what does physical therapy for SI joint pain look like during pregnancy? I can honestly say for this diagnosis in this population I don’t have to change my treatment for pregnant women compared to non-pregnant women. 

I typically treat with a combination of manual therapy (hands-on treatment), dry needling, and exercise for pregnant and non-pregnant women. 

Each patient also has a very specific home exercise program to complement what treatment is done in clinic and continue working towards the goal of being pain-free. 

• Safe treatments and medications for SI joint pain

we all know treatment options available to pregnant women are far less than non-pregnant women. There are surgical options available to non-pregnant women but obviously this is an ideal for a pregnant woman.

Pregnant women are often looking for a far more conservative approach for managing SI joint pain during pregnancy. The two options that are recommended most frequently include: 

• Physical therapy

• Chiropractic care

And while this might shock a few people, I actually recommend both. I benefited greatly from the care I received from both pelvic floor physical therapy and a chiropractor during my pregnancy. 

Preventing SI Joint Pain

• Prenatal exercises to prevent SI joint pain

If I were giving a patient a wellness exercise plan at the beginning of pregnancy or prior to conception to prevent the onset of SI joint pain during pregnancy I posture can and will for sure affect the SI joint. would recommend a lot of the same exercises as I would for the treatment of SI joint pain. 

Additionally, I would give exercises to improve single leg stability as single leg stability requires a high functioning glute med muscle. These exercises should only be performed if pain-free.

Here are a few examples of exercises to strengthen muscles around the SI joints with the goal of preventing SIJ pain: 

• Single leg deadlift

• Step ups 

• Lateral lunge

• Potentially skater jumps

Importance of proper posture during pregnancy

Posture can and will for sure affect the SI joints. Typically during pregnancy a growing belly and growing breasts lead to more slouching. This definitely affects the spine and because the spine and pelvis (where the SI joints live) are so connected will affect the SI joints as well. Focusing on sitting upright with your shoulders and head back will help improve posture during pregnancy.

Additionally, sitting with legs crossed will put strain on the SI joints as well, so sitting with feet flat on the ground and shoulders back are two fabulous cues during pregnancy to mitigate likelihood of SI joint pain.

Tips for reducing strain on the SI joint

Lastly, tips for reducing strain on the SI joint are similar to treatments as well.

During pregnancy, you really want to try to move like a mermaid to limit the torque on your SI joint.

Specific places to consider this include:

• Getting into and out of bed

• Getting into and out of the car

• Leaning forward to pick things up

• Getting on and off of furniture

Of course, strengthening the muscle muscles around the SI joint will also limit the strain of the SI joint.

If you’re struggling with pain in the back of your pelvis, good news! We are currently taking new patients with prolapse in Rockwall, Canton, and Sulphur Springs. If you are interested in scheduling an appointment, please request an appointment here and someone from our team will reach out to you to get you scheduled.