Sleeping and Sex Positions for SI Joint Pain

If you have sacroiliac joint pain, you may feel that successful treatment is elusive. While doctors and physical therapists offer everything from exercise to medication, injection, and fusion surgery, many patients claim none are particularly effective for long-term resolution of the problem.

Modifying your lifestyle and learning how to live with your SI joint problem can provide relief.

A woman sleeping in her bed
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Anatomy and Function

The first thing to keep in mind is that the SI joint is complex. So complex, in fact, that even some physical therapists have a hard time understanding how it's put together, and more importantly, how it stays together.

For a pain-free SI joint, the two bones that comprise it, the ilium and the sacrum, must fit together properly. Otherwise, you're at risk for a sprain.

A number of forces are at work to make that fit happen. These include the way the bones fit together naturally, called form closure, the mechanical tension in the muscles that surround or affect the joint, called force closure, and the nervous system's input into these muscles, called motor control.

Not only that, but the surfaces of both the ilium and the sacrum are irregular, to say the least. Along with bumps and grooves spread all over each, the entire SI joint changes type depending on the area. The same is true for the cushioning and/or binding material found between the two articulating surfaces.

For example, the bottom two-thirds of the joint is considered to be mobile, but the upper third is not. And your SI joint can become either hypermobile, which is related to spinal instability, or hypomobile, which may lead to movement compensations and stiffness.

Either way, the delicate balance between the bones of the SI joint becomes disrupted. The likely result in each case? Pain and dysfunction.

Easing SI Joint Pain in the Bedroom

When SI joint pain keeps you up at night, a little lifestyle guidance may be in order. Here are a few tips for dealing with bedtime and sleeping when you have SI joint pain.


SI joint dysfunction tends to occur on one side of the body. You may benefit from bending one leg up while sleeping. In general, be aware of which side has the problem can be used to your advantage.

According to Lauren Hebert, physical therapist and author of Sex and Back Pain, 80% of people who experience sacroiliac joint pain find relief from their symptoms when they can relax the affected hip backward. This can be accomplished by bending the leg of the painful side, she says.


SI pain may also occur during sex. If you have SI pain, you might consider the modifying the bottom missionary position so that one leg is bent up and resting on the outside of your partner's leg.

Another possibility is to sit at the edge of a chair with the leg on the painful side up so that the heel can be placed on the seat of the chair. The other foot is placed on the floor. The top partner kneels on the floor.

If you're on top, you might modify the missionary position by propping your partner up with pillows. That way you can be on top with your leg of the painful side bent.

Lying on your side is a positioning option that may help you develop emotional intimacy with your partner. Both partners can lie on their sides, facing one another. If you are on top, place a bent leg under your partner's (closest) leg, and if you're on the bottom, you too can bend the leg on the painful side.

Pelvic Floor Strengthening

And finally, you may want to look into a pelvic floor strengthening program. Relevant for people of any sex, pelvic floor work can help you develop balance and stability through your hips, pelvis, and low back, while at the same time improving your sex life.

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Weill Cornell Medical College. Weill Cornell Brain and Spine Center. Sacroiliac Joint Dysfunction.

  2. Hebert, Lauren, A., P.T. (2001). "Sex and Back Pain." Greenville, ME: IMPACC USA.

  3. Yoo WG. Effects of individual strengthening exercises for the stabilization muscles on the nutation torque of the sacroiliac joint in a sedentary worker with nonspecific sacroiliac joint pain. J Phys Ther Sci. 2015;27(1):313-4. doi:10.1589/jpts.27.313

Additional Reading
  • Kisner C, Colby LA. "Therapeutic Exercise: Foundations and Techniques." Philadelphia: F.A. Davis Company.

  • White A. "Your Aching Back: A Doctor's Guide to Relief." New York, NY: Simon & Schuster/Fireside.

By Anne Asher, CPT
Anne Asher, ACE-certified personal trainer, health coach, and orthopedic exercise specialist, is a back and neck pain expert.