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Intro To SI Joint Pain

A common cause for lower back pain can typically come through an issue with the sacroiliac (SI) joint of the body. This is the joint where your Sacrum (lower spine, just above your tailbone) connect with our Ilium (aka the hip bone). These issues will typically reside across the lower back and into the glute, or butt, muscles.

An image depicting the sacroiliac joint, found within the pelvis, connecting the sacrum and ilium bones.
https://www.pelvisandhips.com/si-joint/

For many, this pain can be debilitating and quite frustrating to deal with, as it can be aggravated from too much sitting, standing, or even running/climbing stairs. Fortunately, there are plenty of ways to address the issue and help relieve the pain through manual therapy and exercise.

We can also help address this issue with weight management, anti-inflammatories, and lifestyle adjustments. I’ll quickly address each topic individually:

Weight Management

The more we weigh, the more pressure there is put on our joints. By managing our weight, and reducing extra body fat we can release a significant amount of pressure on our SI Joint in almost every situation. Click Here For 5 Simple Tips to get started with your weight loss journey.

Anti-Inflammatories

With SI Joint issues there is a good chance there is some type of inflammation happening that could be pressing into the nerves of the joint. By reducing our inflammation through medicine and food, we can reduce the pressure on the SI joint and alleviate pain.

According to Harvard Health Publishing – we should focus on anti-inflammatory foods such as tomatoes, olive oil, leafy greens (spinach/kale), nuts (almonds/walnuts), fatty fish (salmon/tuna), and fruits (berries/cherries). We would also want to avoid inflammatory foods like fried foods, sugar sweetened beverages, and processed meats.

Lifestyle Adjustments

To reduce pressure on the SI Joint, and help keep the surrounding muscles stronger we should implement more physical activity throughout the day. Begin to go for walks, exercise regularly, and reduce the amount of time sitting. During times of prolonged sitting, take breaks to stand up, stretch, and walk around. This can help improve blood circulation to the joint and reduce the stiffness/soreness in the hip/back.

Implementing all of these factors, along with an exercise routine, will be the best approach to alleviate lower back pain caused by the SI Joint.

Exercises should you be doing

There are many exercises that could be included into this list – but to keep things focused and concise these exercises would be my primary recommendations based off my work as an Edmonton Personal Trainer over the past 12 years, and consultations with other health professionals.

While there are a number of different muscles which can contribute to these issues, directly and indirectly, we are going to dive into 4 different muscles to focus on to help relieve our SI Joint Pain. For each muscle I’ll include a Self-Myofascial Release exercise (SMR, basically foam rolling), a Stretching exercise, and a Corrective/Strengthening exercise. Perform the exercises in that order for best results.

*Every injury and situation is different. While these are general guidelines, please get assessed by a healthcare practitioner for more specific guidance.

The Lats aka Latissimus Dorsi

An image illustrating the back muscles, specifically highlighting the lat muscle's structure and positioning.
https://www.kinfolkwellness.com.au/blog/2017/5/23/get-to-know-your-muscles-lattisimus-dorsi

SMR: Lat Roll

Depending how tight/tender the lats are, we may want to use a soft foam roller to begin with

Trainer Tips:

  • Alternate the arm from above the head, to directly in front of the shoulder to get into different parts of the musculature
  • Roll side to side as well as up/down to get into sticky spots of the lat
  • Focus on breathing throughout the movement

Stretch: Lat Stretch

Also known as child’s pose in yoga this is a great stretch for almost every muscle in our back.

Trainer Tips:

  • Reach the arms forward and let the hips sink back to get a more effective stretch
  • To make more intense, elevate the arms on a foam roller or perform a standing variation
  • Alternate between the stretch and engaging the lat muscle by pressing the hands into the surface as hard as possible for 5-15 seconds at a time, then relax for 20-30 seconds.

Corrective: DB Pullover

Use this exercise as a loaded stretch to further improve the lengthened position of the Lat

Trainer Tips:

  • Use a light weight for this exercise
  • Move slowly through the lowering portion of the exercise, and pause while the dumbbell is overhead. Think about 2-5 seconds for each
  • To get a deeper stretch in the lats, drop the hips as the dumbbell comes over head then raise them again when the dumbbell is over top the chest

Transverse Abdominis, Rectus Abdominis, Obliques – Core Muscles

 Anatomical image of the core muscles in the abdomen, including the rectus abdominis, obliques, and transversus abdominis.
https://www.backtobasicschiropractic.com.au/muscles/what-are-the-core-muscles/

SMR: Psoas

A hidden muscle that can cause havoc on our lower back when it’s tightened up

Trainer Tips:

  • Play around with the positioning to find the sticky point
  • Breathe deeply into the ball, as if we’re trying to push it thought to our back

Stretch: Cobra

An underrated movement to stretch out the overused core muscles

Trainer Tips:

  • Don’t force the body into an extreme position, go until your feel resistance and stay there
  • Try to keep the hips planted in the ground to ensure we are using the core muscles
  • Look upwards to further lengthen the abdominal wall

Corrective: RKC Plank

Thought planking was easy? Try this. Thought it was hard already? …Well sorry

Trainer Tips:

  • Think about pulling the elbows to the toes, and toes to the elbows while performing the plank
  • Squeeze the glutes, quads, chest, and biceps to engage the entire body
  • Lasting over a minute in the plank position? It may be time to try different core exercises

Gluteus Maximus & Piriformis – Glute Muscles

Illustration depicting the musculature of the hip and posterior thigh, displaying the complex network of muscles responsible for movement and stability

SMR: Glute Trigger Point Release

Relieve pain in the a.. butt with this great Myofascial Release.

Trainer Tips:

  • Breathe deeply during this exercise
  • Pivot around to find the sticky spots in the glute
  • For less pressure use a foam roller or tennis ball for this

Stretch: Pigeon Stretch

Birds may not be real (depending on who you talk to), but this stretch is legit

Trainer Tip:

  • Try elevating the front leg on either a foam roller or a bench for a deeper stretch
  • Press into the front leg for 5-15 seconds and relax into the stretch for 20-30 seconds
  • Load this exercise by performing a Pigeon Squat on a bench (see the video below)

Corrective: Banded Clamshell

Strengthening the small muscles of the glute is going to be vital to improving our SI pain.

Trainer Tips:

  • Add in a pause at the top of the movement for more muscular engagement
  • Keep the bottom knee on the ground
  • Allow the glute to be the primary mover, not the knee or hips. Think of it like a door hinge

Hamstrings

An anatomical diagram showcasing the hip muscles and posterior thigh muscles, highlighting their intricate structure and interconnections.
ILLUSTRATIONS: SHUTTERSTOCK

SMR: Adductor Foam Roll

While not directly a hamstring muscle, there is a hamstring section of your your adductor magnus. The hamstring is quite a difficult muscle to get into with a foam roller or trigger point ball, so the adductor is another way to help out.

Trainer Tip:

  • If this movement creates a cramping sensation in the hip, I’d recommend working on exercises to stretch/activate internal rotation in the hip such as the 90/90 stretch
  • Keep the knee at a 90-degree angle as much as possible throughout the movement

Stretch: Prone Hamstring Stretch

The hamstrings are typically a pretty tight muscle due to the amount we sit, undo that with this stretch

Trainer Tips:

  • Intensify the stretch by pointing the toe towards the body
  • Use a band or towel if movement is difficult to hold onto with just your hands

Corrective: DB Romanian Deadlifts

Don’t load this too heavy, we are going for a stretch sensation here, not a new PR

Trainer Tips:

  • Aim the dumbbells towards the heels instead of the toes
  • Find you can reach the ground without rounding the spine? Elevate the heels to feel it more through the hamstrings

Other exercises to consider:

Single Leg Exercises such as Lunges, Split Squats, Single Leg Deadlifts, Step ups

Cossack Squats Or Lateral Lunges

Banded Side Steps

Hip Thrusts & Bridges

Fire Hydrants

Birddogs & Deadbugs

Carry Variations

90/90 Stretch Variations

World’s Greatest Stretch (Look it up, it’s actually called that!)

Squat & Deadlift Variations

I could go on and on all day with different beneficial exercises but this would be a good place to begin with. If you struggle with the form for any of these please reach out directly for more assistance.

For each workout, choose 1-4 of the specific target muscles and perform each movement for around 1 minute each per leg (if alternating), and repeat on the other side before moving onto the next exercise. Repeat that 1-3x per workout. These can be used as a warm-up, cooldown, or the workout themselves.

SAMPLE WORKOUT

Prone Hamstring Stretches – 1 minute per side

Foam Rolling Adductor – 1 minute per side

DB Romanian Deadlifts – 1 minute total

Repeat 3x

Total Workout Time = ~15 minutes

As with any injury, we need to stay patient and persistent when dealing with the issue. It won’t be an overnight fix.

However, by doing as little as 15-minutes daily on these types of exercises we can help relieve that pain. Adding in additional exercise as well as getting treatments from Physiotherapists, Chiropractors, and Massage Therapists can greatly increase our recovery time from pain. Working in conjunction with a health/wellness team, Personal Training can be an excellent route to get back into the gym and strengthen the body to prevent the SI Joint from flaring up again.

If you’re looking for a workout program that will help you relieve your lower back pain and help with your SI Joint issues, I want to help. CLICK HERE TO BOOK A CONSULTATION CALL – both Personal Training in Edmonton and Online Training are available.

References:

Brolinson PG, Kozar AJ, Cibor G. Sacroiliac joint dysfunction in athletes. Curr Sports Med Rep. 2003 Feb;2(1):47-56. doi: 10.1249/00149619-200302000-00009. PMID: 12831676.

Harvard Health Publishing, 16 November 2021, Foods that fight inflammation, accessed 19 October 2023, <https://www.health.harvard.edu/staying-healthy/foods-that-fight-inflammation>

Dr. Lisa Covey, 22 May 2023, Sitting and Sleeping Comfortably with SI Joint Pain, accessed 18 October 2023, <https://www.spine-health.com/blog/sitting-and-sleeping-comfortably-si-joint-pain#:~:text=Sitting%20for%20a%20prolonged%20period,hip%20and%20lower%20back%20stiffness.>