Back & Neck Pain Exercise Exercises to Relieve Sacroiliac Joint Pain By Anne Asher, CPT Anne Asher, CPT Facebook LinkedIn Anne Asher, ACE-certified personal trainer, health coach, and orthopedic exercise specialist, is a back and neck pain expert. Learn about our editorial process Updated on November 01, 2021 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Grant Hughes, MD Medically reviewed by Grant Hughes, MD LinkedIn Grant Hughes, MD, is board-certified in rheumatology and is the head of rheumatology at Seattle's Harborview Medical Center. Learn about our Medical Review Board Print Your sacroiliac (SI) joints connect the base of your spine to your pelvis, supporting and stabilizing your spine when you walk, climb stairs, bend, and lift heavy objects. SI joint damage or injury can cause instability in the legs and is a common cause of lower back pain. There are several options available for treating SI joint pain, from physical therapy to surgery. Many people also find relief, whether temporary or permanent, in a low-tech way—with gentle, targeted body movement. This article discusses the causes and symptoms of sacroiliac joint pain along with several ways it may be treated. It also includes a list of exercises and stretches you can try at home to strengthen and stabilize your SI joints and relieve pain. Anupong Thongchan / EyeEm / Getty Images What Is Sacroiliac Joint Instability? An injury to one or both of your SI joints can disrupt how they stabilize you, resulting in too much joint movement (hypermobility) or too little movement (hypomobility). This is known as sacroiliac joint instability or sacroiliac joint dysfunction. Your SI joints act as shock absorbers by distributing force across your pelvis and lower body to protect and stabilize your spine. In doing so, your SI joints play a critical role in keeping you upright when you walk or run. But when injured, your SI joint becomes inflamed and loses its ability to evenly distribute stress across your pelvis. In turn, that stress is unevenly distributed on your pelvic joints and surrounding tissues, causing pain and other symptoms. People with SI joint injuries commonly feel instability in their legs, which may buckle or give way, particularly when the person is bending forward, twisting, walking upstairs or uphill, or standing from a seated position. What You Need to Know About Sacroiliac Joint Pain Symptoms SI joint instability is estimated to be the cause pain in in 10% to 25% of people with low back pain . The pain tends to be centered in the lower back, groin, hips, or tailbone. Whereas some people experience dull and achy pain, others feel sharp, stabbing pain that radiates into their lower extremities—particularly their thigh, knee, or foot. Other possible symptoms of SI joint instability include: Numbness or tingling Weakness Leg instability Trouble sleeping due to pain and discomfort Trouble sitting for long periods of time Pain when standing from a seated position SI joint instability may initially be confused for sciatica or lumbar disc herniation, as the symptoms are similar. Thus, it's important to see your doctor if you are experiencing the symptoms described above to ensure your injury is properly treated. First Steps to Treatment with Low Back Pain and Sciatica Risk Factors You can injure or damage your sacroiliac joints suddenly in an accident or abrupt injury, or they may become damaged over time due to aging, chronic illness, or overuse injury. Specifically, the following groups of people have a greater risk of SI joint injury: Athletes People who are pregnant People with scoliosis People with one leg that is longer than the other People who undergo intense, long-term training for a sport or physical activity People with low back or hip disorders that cause abnormal walking patterns People with spondyloarthropathies—a group of chronic, arthritic joint diseases SI joint instability may affect women more than men. According to a small study from 2021, out of 84 people receiving treatment for lower back pain, 69% of those diagnosed with SI joint instability were women. In addition, 49% were between the ages of 45 and 64. Recap Sacroiliac joint instability causes pain and weakness in your lower back, hips, and legs. It is a common cause of lower back pain, but you may have a higher risk if you are an athlete, pregnant, or have a chronic bone or joint disease like scoliosis or arthritis. Everything to Know About Bone Diseases Treatments Many people with sacroiliac (SI) joint instability report that it is painful and debilitating on a daily basis. Due to how common SI joint injury is, numerous treatment options have become available, from physical therapy to fusion surgery. The focus of treatment is reducing inflammation, restoring mobility, and stabilizing the SI joint. Although surgery normally isn't the first option your doctor will consider, they may eventually suggest it if all other treatment options fail. Possible treatment options include: Cold and warm compresses: Alternate between applying a warm compress and a cold compress to relieve inflammation and pain, taking care to never apply heat or ice directly against your skin. Over-the-counter (OTC) medication: When you need it, take an OTC pain reliever that reduces swelling, such as ibuprofen (Advil), or naproxen (Aleve). Manual manipulation: Contact a chiropractor who can adjust your SI joint to relieve your pain and restore joint stability. Physical therapy: For chronic SI joint pain, gradual physical therapy can help strengthen the muscles around the joint, restore stability, and speed healing. Water therapy: Performing physical therapy exercises in the water is a low-impact way to build strength around your SI joint and help stabilize it. Back braces: If your SI joint pain stems from hypermobility, your physical therapist or chiropractor may recommend a back brace or support to stabilize your SI joint so that it can heal. Sacroiliac joint injections: Your doctor may also recommend sacroiliac joint injections, which consist of a steroid and local anesthetic, and are administered into and around the SI joint to relieve pain. Radiofrequency ablation: For this minimally-invasive procedure, a surgeon will use radio waves to heat and disable certain nerves that transmit pain signals from the lower back to the brain. Fusion surgery: Another procedure in which a surgeon will fuse one or both sacroiliac joints together to restore stability. With your doctor's approval, there are also numerous stretches and exercises you can try at home to improve your SI joint pain and instability. The Controversy Over Sacroiliac Joint Pain Treatments Exercises That Help SI Pain A consistent stretching and exercise program can help strengthen, stabilize, and repair an injured SI joint. The program should include a combination of the following: Stretching: To 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: To stabilize your SI joint by strengthening the muscles that support it, including your core, gluteus, and thigh muscles Certain light aerobics: To aid the healing process by improving blood flow so that oxygen and nutrients can repair soft tissues in the SI joint The exercise therapies intended to treat SI joint pain aren't meant to push you too hard, and you should avoid anything that triggers or intensifies your pain. If at any point you feel that your pain gets worse or your SI joint feels weak, stop what you are doing, take a rest, and eliminate the painful exercises from your routine. Depending on your symptoms and the type of injury you have, your doctor may advise you to try certain exercises and avoid others. Doing the wrong exercises could worsen your pain or cause more injury, so it's important to consult with your doctor before getting started. How Do You Know if You Need Physical Therapy? 1 Stretch: One Knee to Chest Forgiss / Deposit Photos It's generally best to start your SI joint exercise session with the easiest possible move. This is good for injury prevention because the body's tissues need to be warmed up before the joints can be safely stressed. Warming up also provides a chance to check your pain "barometer," or those sensations that help you put safety limits on what you allow yourself to do. For sacroiliac pain, as well as many other types of back problems, lying supine—on your back—provides a lot of support. This may help release excess tension that contributes to the misalignment. How to Do It In the supine position, bend your knees and place your feet flat on the floor. 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 the chest. Instead, go only as far as you can without pain. Hold the position for a second or two and then set your foot back down on the floor. You will likely 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. 2 Stretch: Both Knees to Chest Blend Images - Jose Luis Pelaez Inc / Getty Images If your back is up for it, try this double knees to chest exercise. Note that this exercise may be painful for some people with weaker ab muscles. How to Do It Start in the supine position again, with bent knees and feet flat on the floor. Bring one knee up towards the front of your trunk just as you did in the previous exercise.Keeping that knee there, gently perform the same move with the other leg.Grasp both legs just below the knees and pull them towards you.Hold for a second or two, and 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, excessive pulling on the joint may make your SI problem worse. 3 Reset Your SI Joint nikitabuida / Deposit Photos A common remedy for a painful, misaligned SI joint is to reset it by igniting the adductors, or the inner thigh muscle groups. Some people report getting short-term relief from this move. Adduction simply means bringing the thigh closer to the midline of your body. You can try that in a standing position by crossing the leg of the painful side in front of your body. Another form of adduction is in supine position: How to Do It Begin in the supine position with your knees bent and your feet flat on the floor. Place a soft ball or rolled up pair of socks between your knees.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. 4 Stretch: Outer Hip Muscles Verywell / Ben Goldstein Stretching the outer hip muscles, which are the muscles that oppose the inner thighs, may indirectly have the same effect as adduction, albeit in a less intense way. Plus, it can help release chronic tension that may be at least partially responsible for SI joint misalignment. 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 Start in the supine position, with your knees bent and your feet flat on the floor.Place the ankle of one foot on the knee of the other.Wrap your hands under the supporting knee.Using your abs, gently lift the supporting knee off the floor, going only as high as you can without pain at the SI joint. 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 5 Stretch: Twist Your Spine cirkoglu / Deposit Photos If your pain levels permit, you can move from the supine hooklying position into a gentle spinal twist. How to Do It Start in supine position without bent knees.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.Move gently and thoughtfully. Stay only for a few seconds and bring your legs back up. Return to supine position.Repeat on the other side. You might consider arranging some pillows or blankets in the area where your knees will go when you twist. This may offer a bit more support and help you relax excess muscle tension. 6 Advanced Stretch: Quadriceps Verywell / Ben Goldstein 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: Lie on one side and grasp your foot, ankle, or even your shin behind you. Pull your heel to your bottom.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 position is not for everyone. If you are not used to exercising and you have SI joint pain, you may want to forego the side-lying quad stretch. Being on your side with your knee bent behind you may stress your SI joint or knee. Stretches for Tight Quads 7 Strengthen: Bridge for Glutes and Abs DjordjeDjurdjevic / Getty Images Once you have warmed up your SI joint with stretches, you can move on to some strength building exercises that will help stabilize your SI joint. This first, low-impact exercise is known as a bridge. Add the bridge to your series to strengthen 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. Squeeze your glutes and keep your shoulders against the ground as you slowly lift your hips.Hold your hips in the air for five seconds.Keep your glutes squeezed as you slowly lower your hips to the ground. Repeat these steps 8 to 10 times or until you feel any pain in your SI joint or knees. 8 Strengthen: Cat-Cow for Hips and Back Prasit Photo / Getty Images The cat-cow exercise is a common pose in yoga. It can be used as both a warm-up stretch and for strengthening 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 Start on your hands and knees with your chin up, your back flat, and your eyes forward.Slowly arch your back up as you draw your chin towards your chest. Hold for two to five seconds.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 8 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. 9 Strengthen: Triangle Pose for Hips, Thighs, and Abs CasarsaGuru / Getty Images The triangle pose is another great stretch-strengthen exercise that anyone, regardless of how flexible you 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 Start by standing with your feet slightly wider than hips-width apart and your arms by your side.Stretch your left hand to the sky.Slowly bend at the waist and bring your right hand towards your left ankle. If you can reach your ankle, terrific. If not, reach for your calf or knee.Straighten your body back up to the standing position. 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. Take special care during this exercise—and any standing exercises—not to lock your knees. Always keep them slightly bent to prevent them from buckling. 10 Light Aerobic Exercises Christopher Furlong / Getty Images 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 most straightforward 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, consider joining a class. Just remember to go slow, 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 Call Your Doctor Within three weeks of careful and consistent exercise therapy, you should start to notice some improvement in your SI joint pain and instability. If you don't, let your doctor know so that they can reassess your symptoms and consider other treatment options. Summary Sacroiliac joint instability is a common source of lower back pain that may start gradually or suddenly due to injury. Fortunately, your doctor or physical therapist can treat the pain with a variety of options, from back braces and physical therapy to surgery. You can also improve your SI joint pain and instability in the comfort of your own home with stretches and exercises. Talk with your doctor before you start an exercise program to make sure it's right for you, and avoid any exercises that worsen your symptoms. A Word From Verywell Explaining your pain to your doctors can be challenging, and you may not get the answers you need right away. Before you see your doctor, you may find it helpful to take notes about the pain you're experiencing and what seems to trigger it. If the treatment your doctor offers doesn't improve your condition, let your doctor know and don't give up until you find something that works. Frequently Asked Questions What other exercises are safe to do with SI joint problems? It can take some trial and error to find exercises that rehabilitate your SI joint without worsening your pain. Focus on strengthening the muscles that support your SI joint, particularly your core, gluteus, and thigh muscles. If you're not sure about an exercise, don't hesitate to get your doctor's opinion. What exercises may aggravate SI joint pain? Avoid standing exercises that shift weight on your hips, such as leg lunges and other moves where just one foot is on the ground at a time. Instead, try exercises that keep both of your feet planted on the ground. You should also avoid high-impact exercises like running or jump-roping, as well as cardio machines likes treadmills or Stairmasters. Is swimming a good exercise for SI joint pain? It depends. For some people, light and easy swimming strokes are helpful. For others, certain strokes, such as the breaststroke and butterfly, may irritate your sacrum. If you find that swimming is causing you pain, try the backstroke instead, or stick to walking through the water. 8 Ways to Manage Your Chronic Pain Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 8 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. Nejati P, Safarcherati A, Karimi F. Effectiveness of exercise therapy and manipulation on sacroiliac joint dysfunction: A randomized controlled trial. Pain Physician. 2019 Jan;22(1):53-61. Cedars Sinai. Sacroiliac joint dysfunction. Eniz D, Mayer J. Sacroiliac joint hypermobility biomechanics and what it means for healthcare providers and patients. PM&R. 2019 Apr;11(1):1-9. doi:10.1002/pmrj.12176 Wieczorek A, Campau E, Pionk E, Gabriel-Champine M, Ríos-Bedoya C. A closer look into the association between the sacroiliac joint and low back pain. SMRJ. 2021 Apr;6(1):1-6. doi:10.51894/001c.21971 Barros G, McGrath L, Gelfenbeyn M. 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