SI Joint Stretches and Other Exercises

The sacroiliac (SI) joints are located on either side of the base of the spine. SI stretches and other exercises that help preserve the health and function of these joints are important when working to improve lower back pain because of the role they play in your day-to-day movements.

SI joints support and stabilize your spine when you walk, climb stairs, bend, and lift heavy objects. Simply put, if these joints are stressed or compromised, the back can be too.

Fortunately, a consistent exercise program can help. The program should include a combination of:

• SI joint stretches, which improve mobility by loosening up any tight muscles in your back, hips, or buttocks that may be placing extra stress on your SI joint
• Strength-building exercises to stabilize your SI joint by strengthening the muscles that support it, including your core, gluteus (butt muscles), and thigh muscles
• Light aerobic activity, like walking or swimming, to improve blood flow so that oxygen and nutrients can repair soft tissues in the SI joint

This article walks you through how to perform SI joint stretches and strength exercises properly, as well as what activities qualify as light aerobics.

Strengthen: Pelvic Tilt for Core

It is important to engage your core when doing lower back stretching and strengthening exercises. People with lower back pain often can have difficulty finding their core muscles. An easy move to get you started is the pelvic tilt.

How to Do It

Lying on your back with your feet on the floor and knees bent:

1. Press your lower back down, tighten your abdominal muscles, and tilt your pelvis upward.
2. Hold the position for a count of five.
3. Release the position, returning your spine to a neutral position.
4. Repeat 10 times or more.

To increase the intensity, add marching:

1. Once in the pelvic tilt position, tighten your core muscles, and lift one foot off the ground.
2. Hold for a count of two, then slowly lower it back down, keeping ab muscles tight.
3. Staying in the pelvic tilt, repeat with the other foot.
4. Release the pelvic tilt and return your spine to a neutral position.
5. Repeat 10 times or more.

To add even more intensity, add more reps to each round. Remember to keep your abdominal muscles tight.

Tips

If you have had SI pain for a while, pelvic tilts may feel awkward or uncomfortable due to stiff muscles. The exercise should start to feel more natural after a while, especially if you do it every day.

• Keep your core muscles and abs engaged while doing the following exercises.
• If you can't "find" your core muscles, return to the pelvic tilt position and tighten your abs.
• Practice engaging your core muscles throughout the day.
  

Stretch: One Knee to Chest

It's best to start your SI joint exercise session with easier moves. Your body's tissues need to be warmed up before they can be safely stressed. Warming up is key to preventing injury.

Warming up also lets you check your pain levels. Notice how much pain you feel with each move and set limits for what you let yourself do.

How to Do It

In the supine position, bend your knees and place your feet flat on the floor.

1. Gently grasp one knee and bring it towards your chest. Don't worry, you don't have to get your knee all the way to your chest. Only go as far as you can without pain. 
2. Hold the position for a second or two. Then set your foot back down on the floor.
   

You might find that this move feels OK on one side but painful on the other. Again, the rule of thumb here is to move only within pain-free limits. If you have to skip one of the legs, that's fine.

Stretch: Both Knees to Chest

If your back is up for it, try this double knees to chest stretch. Note that this exercise may be painful for some people with weaker ab muscles.

How to Do It

Start in the supine position with bent knees and feet flat on the floor.

1. Bring one knee towards your chest just as you did in the exercise above.
2. Keeping that knee there, make the same move with the other leg.
3. Grasp both legs just below the knees and pull them towards you.
4. Hold for a second or two. Then lower the legs one at a time.

Bringing one leg down at a time is important for your safety. Unless your abs are very strong, putting too much stress on the joint at once may worsen your SI problem.

Strengthen: Inner Thigh Squeeze

This move can help to reset a misaligned SI joint. It works by triggering your adductors (inner thigh muscles). Some people report getting short-term relief from this move.

Adduction simply means bringing the thigh closer to the middle of your body. You can try that in a standing position. Simply cross the leg on the painful side of your body in front of your other leg.

Adduction can also be done in a supine position (lying on your back):

How to Do It

Begin in supine with your knees bent and your feet flat on the floor.

1. Place a soft ball or rolled up pair of socks between your knees.
2. Very gently squeeze for a count of five and then slowly release.

Do about three to five of these, but let your pain be your guide. 

Stretch: Outer Hip Muscles

If you stand up straight and relax your arms down the side of your body, your fingers should just reach your outer hip muscles. Stretching this muscle group can have the same effect as adduction. It just might be less intense.

This stretch can also release some chronic tension, which may help realign your SI joint.

As with any one-legged move with SI joint issues, this exercise may be more painful on one side than on the other. If it hurts, don't continue.

How to Do It

1. Start in supine, with your knees bent and your feet flat on the floor.
2. Place the ankle of one foot on the knee of the other.
3. Wrap your hands under the supporting knee.
4. Using your abs, gently lift the supporting knee off the floor, going only as high as you can without pain at the SI joint. 
5. Stay up for just a short time and set the leg down again.

Do up to five of these and then rest. Repeat on the other side.

Stretch: Spinal Twist

If your pain levels permit, you can move from the supine hook lying position (lying on your back with knees bent and feet on the floor) into a gentle spinal twist.

How to Do It

1. Start in supine position with straight legs.
2. Keeping your shoulders flat on the ground, lift your knees, bend them to a 90-degree angle, then lower them to one side of your body.
3. Move gently and monitor for pain. Stay only for a few seconds and bring your legs back up. Return to supine position.
4. Repeat on the other side.

It may help to place some pillows or blankets where your knees will go when you twist. This may offer a bit more support and help you relax excess muscle tension.

Advanced Stretch: Quadriceps

Taking the tension out of your quadriceps muscles may help alleviate some of your SI pain.

How to Do It

In the image above, the model is demonstrating the easiest type of quadriceps stretch:

1. Lie on one side. Then grasp your foot, ankle, or even your shin behind you.
2. Pull your heel to your bottom.
3. If you can't reach, consider tying a strap or belt around your foot and hanging onto the other side of the strap to pull your foot in.

This move is not for everyone, especially those who are new to exercising with SI joint pain. Being on your side with your knee bent behind you may stress your SI joint or knee.

Strengthen: Bridge for Glutes and Abs

Once you have warmed up your SI joint with stretches, you can move on to some strength-building exercises. The goal of these moves is to help stabilize your SI joint.

This first, low-impact exercise is known as a bridge. Add the bridge to your series to build strength in your glutes, abdominal muscles, lower back, and hips.

How to Do It

Begin in supine position with your knees bent, feet flat beneath your knees, and arms by your side with your palms face down.

1. Squeeze your glutes and keep your shoulders against the ground. Slowly lift your hips.
2. Hold your hips in the air for five seconds.
3. Keep your glutes squeezed as you slowly lower your hips to the ground.

Repeat these steps eight to 10 times or until you feel any pain in your SI joint or knees.

Stretch: Cat-Cow for Hips and Back

The cat-cow exercise is a common pose in yoga. It can be used to warm up. Or, you can use it to stretch and strengthen your back, hips, and abdominal muscles.

This pose places pressure on your knees, so you may want to skip it if you have knee pain or any kind of knee injury.

How to Do It

1. Start on your hands and knees with your chin up, your back flat, and your eyes forward.
2. Slowly arch your back up as you draw your chin towards your chest. Hold for two to five seconds.
3. Slowly bring your chin away from your chest and return your eyes forward as you arch your back down. Hold for two to five seconds.

Repeat these steps eight to 10 times. If you feel any pain or weakness in your SI joint, hips, or knees, stop the exercise and take a rest while lying on your back.

Strengthen: Triangle Pose for Hips, Thighs, and Abs

The triangle pose is another great stretch-strengthen exercise that anyone, no matter how flexible they are, can benefit from.

This exercise helps stabilize your SI joint by strengthening your core, lower back, hips, and thighs all at once.

How to Do It

1. Start by standing with your feet slightly wider than hips-width apart and your arms by your side.
2. Stretch your left hand to the sky.
3. Slowly bend at the waist and bring your right hand towards your left ankle. If you can reach your ankle, go ahead. If not, reach for your calf or knee.
4. Straighten your body back up to the standing position.
5. Alternate sides by reaching your left arm towards your right ankle.

Repeat these steps five times or until you feel any pain or weakness in your SI joint or knees.

Low-Impact Aerobics

The American Heart Association recommends fitting in 150 minutes of moderately intense aerobic exercise each week.

That's a great goal to work up to. But when it comes to aerobic exercise for SI joint pain, rule #1 is this: Go at your own pace. Although the point is to raise your heart rate, you don't need to work out with the same intensity as you might in order to lose weight.

Stay focused on your pain and only allow yourself to exercise at a level you find comfortable.

Aerobic exercises you can easily adjust to your pace and pain level include:

• Walking: This is the simplest way to raise your heart rate either by yourself or with a friend.
• Water aerobics: Swimming is one of the best low-impact exercises for people with chronic pain. If swimming doesn't work for you, try walking in the pool or wading while holding onto a raft.
• Stationary cycling: If you don't have a stationary bike at home, think about joining a class. Go at your own pace, and don't feel pressured to keep up with those around you.
• Tai chi: This gentle workout uses slow, controlled movements and relaxation techniques that stretch, strengthen, and get your blood flowing.

When to See a Healthcare Provider

SI joint stretching and other exercises may be enough to improve pain in some, but talk to your healthcare provider if you:

• Are unable to do the above exercises without pain
• Do not experience relief after three weeks
• Experience new pain in your back, hips, or legs
• Feel pain, numbness, or tingling that radiate down one or both legs
• Have not improved your range of motion after three weeks of consistent exercise

These are signs that you may need other treatment to reduce inflammation, restore mobility, and stabilize the joint.

This may include cold/warm compresses, over-the-counter anti-inflammatory medications, physical and other therapies, or use of a back brace.

In some cases, more intense medical intervention may be needed. Common treatments for SI joint instability or dysfunction include injections into and around the SI joint, radiofrequency ablation (radio waves heat and disable certain nerves that transmit pain signals), and fusion surgery (one or both SI joints are surgically joined).

Summary

Sacroiliac joint stretches and strengthening exercises help to relieve pain and stiffness from SI joint instability. It should take about three weeks of consistent exercise to feel a noticeable difference.

If you are unable to do the above exercises, experience an increase in pain, or do not feel improvement after a few weeks of at-home treatment, talk to healthcare provider. Other interventions may be needed.