How to Treat Sacroiliac Joint Pain During Pregnancy
Sacroiliac (SI) joint pain during pregnancy can be difficult to diagnose and feel like a real pain in the butt…literally! Still, SI joint pain can be successfully treated with the right exercises and physical therapy.
Let's dive deeper into SI joint pain during pregnancy and how to find relief (so you don't have to keep asking your partner for back and butt rubs!).
What Causes Sacroiliac Joint Pain?
The sacroiliac joint is where your two hip bones (ilia) meet your tailbone region (sacrum)— which explains the name sacroiliac joint.
The SI joint is a very strong joint structure with thick ligaments supporting it. It's also very jagged, like a jigsaw puzzle. Because of these features, it is very difficult to knock the SI joint out of place. For people who aren't pregnant, it usually takes a major fall or accident to experience SI joint pain. But when you're pregnant, that's not the case.
Why Do I Have Sacroiliac Joint Pain During Pregnancy
Sacroiliac joint pain can start pretty early during pregnancy, typically in the first trimester. Pain can also progress as your belly grows. Pregnant women tend to experience SI joint pain during pregnancy due to hormonal changes, weight gain, and labor and delivery.
During pregnancy, your body produces a hormone called relaxin. Just like the name sounds, it causes the ligaments and connective tissue around the pelvis to relax and soften, which helps prepare your body for a baby to come down and out of the birth canal. In the meantime, that means your pelvis is less stable, which can compromise your SI joint and cause some serious aches and pains.
Weight gain during pregnancy also plays a part. As you gain weight in pregnancy, your feet rotate outward to increase your base of support. This pregnancy waddle (yes, that's actually the medical term for it) causes your hip muscles to shorten and become less effective. Less effective muscles place more pressure on joints, leading to sacroiliac joint dysfunction and pain.
On top of everything, traumas from labor and delivery can also cause SI joint pain postpartum. And most of the time, it does not correct itself after your baby arrives.
Symptoms of SI Joint Pain During Pregnancy
SI joint pain during pregnancy can vary in sensation. Typically, SI joint pain feels like pain, numbness, and/or tingling that starts in your butt and radiates down the back of your thigh.
Some people experience very intense and severe SI joint pain during pregnancy. Others may feel more of a dull, constant ache. Women who experience this pain will often have a decreased tolerance to standing, walking, or sitting. They constantly feel the need to change positions and find it hard to get comfortable. Some individuals feel a "catching" or "clicking" of the hip when walking. Others feel like SI joint pain makes it feel like they can't walk.
How to Treat SI Joint Pain During Pregnancy
STEP 1: Correct Alignment with Physical Therapy
Your SI Joint is complicated and an area you can't easily fix on your own. If you're experiencing SI joint pain during pregnancy, physical therapy can help correct SI joint alignment and make sure your low back is moving well. This will temporarily alleviate your symptoms before moving on to strength training.
I suggest finding a good women's health PT in your area (try searching here and here). If there are any in your area, call them and ask if they have ever worked on SI joints before scheduling your appointment. Not every PT works on this, so be picky!
As a women's health PT, I have adjusted and realigned numerous SI joints and pubic bones in the clinic, but my pregnant patients always seem to come back. Why? The root of sacroiliac joint pain during pregnancy is typically a lack of muscle strength. So, be cautious about spending too much time and money on PTs, chiropractors, massage therapists, etc.
During my first pregnancy, I saw a chiropractor twice a week and a PT once a week from 19 weeks on. It helped, but it was definitely more of a short-term fix. During my second pregnancy, I started having pain at 15 weeks, but I was able to start testing the Expecting and Empowered Pregnancy workout program (now available in the Expecting and Empowered app!) at 20 weeks. The pain was completely gone by 25 weeks! Even better, I followed the Pregnancy program to a tee during my last pregnancy and had no pain.
STEP 2: Identify SI Joint Instability
The root of SI joint pain is instability, which makes your joint unable to move through its full range of motion (aka hypomobility). This means that strength training is a must. But before you start exercising, you'll need to identify which side is causing SI joint instability. Often, there will be asymmetries from one side of your body to the other. What tends to happen during pregnancy is that one side of your latissimus dorsi (lats) and the opposite butt cheek will become weak.
A hypomobile SI joint is complex to fix because you must be very specific to which side you are "treating." You will need to rebalance the joint by strengthening the gluteus maximus on one side and the latissimus dorsi on the opposite side. You likely fall in this category if you have a combination of weak hip extension on the right and weakness on the latissimus dorsi on the left, or vice versa.
To test for SI joint instability, try these tests with a partner:
Hip Extension Test (second test in video):
Lean forward over a table so that your hips are on the table. You can hold onto the table, but do not use your arms to generate force.
Leading with your heel reaching toward the ceiling, lift one leg about 12 inches off of the ground. You should be able to hold this while your partner pushes down on the back of your leg just above the knee.
Repeat on the other side. If either leg gives way, this means you probably have some hip weakness on that side.
Stand upright and hold your arms in an upright "Y" position with palms facing forward.
Test one arm at a time by holding this "Y" position while your partner places pretty significant forward pressure on each arm (as if they are trying to push the back of your hand forward).
You should be able to hold this without breaking. If you cannot hold this, it means you are weak on that side.
STEP 3: SI Joint Pain Pregnancy Exercises
During pregnancy, your core—which consists of your abdominals, pelvic floor, diaphragm, and back muscles—becomes compromised. You should focus on waking these muscles back up as soon as you can, especially if you're starting to feel SI pain.
Strength training helps add stability back into an unstable system. This means that your nagging SI pain will decrease or be eliminated, making sleeping, walking, and sitting more comfortable.
Try these exercises for a positive hypomobile SI test:
1) Single Leg Bridge (ONLY PERFORM ON WEAK GLUTE SIDE):
Lie on your back with your arms at your sides, knees bent, and feet flat on the floor.
Keep the foot of the weak glute on the floor and lift the other at a 45-degree angle.
Engage your abdominals and slowly lift your hips off the ground into a bridge position, keeping your back straight.
Hold briefly, then lower yourself back down to the ground. Repeat for 3 sets of 5-8 repetitions.
2) Bridge with March (ONLY PERFORM ON WEAK GLUTE SIDE):
Lie on your back with your arms at your sides, knees bent, and feet flat on the floor. If you are pregnant, place your upper back on the edge of the couch or a stability ball.
Slowly lift your hips off the floor into a bridge position, keeping your abdominals engaged the entire time.
Lift the foot of your strong leg off the ground, keeping your knee bent.
The goal is to do this without letting your pelvis tilt to either side.
Only lift your leg 2-3 inches off the ground.
Repeat for 3 sets of 8 repetitions.
3) Standing Lat Pulldown with Resistance Band (ONLY PERFORM WEAK LAT SIDE):
Anchor a resistance band high above you. Stand facing the anchor, and grab both ends of the band with your weak side hand, holding the ends shoulder height to start. Make sure your arm stays straight.
Pull your weak arm straight down towards your hip. Think about pulling your elbow down and back towards the opposite butt cheek — even though you're still keeping your arms straight and pulling straight down.
Return to the starting position and repeat. Make sure your back stays straight throughout the exercise, and do not allow your shoulders to shrug.
Repeat for 3 sets of 8 repetitions.
STEP 4: Wear an SI belt
Temporary stability can be created using an SI belt (aka a Serola belt) until you can strengthen this area. Wearing an SI belt can help if you experience SI joint pain. You can find our favorite SI belt on our Amazon storefront.
If it is more painful to wear the brace, it means that your SI/pubic bone is poorly aligned, and you are trying to hold your hip bones and sacrum in the incorrect position. Or, you may have the belt on wrong—wearing it too high can actually cause the problem we are trying to correct.
For proper SI belt placement:
Place the bottom of the belt directly above your greater trochanter (the large pointed part on the side of your hip). You can locate this by rotating your leg like you are squishing a bug and holding your hand over your hip. You should feel a bone rotate as you do this.
Then, take the two side straps and place them like a butterfly, pulling the main part of the belt tight and then reach back for the two additional side straps.
For more help, watch this video to learn about proper SI belt placement.
STEP 5: Focus on Symmetrical Movement
You can also fix SI joint pain by being mindful of symmetry in your everyday movements. Movement is the fountain of youth. Joints love movement. Movement pumps synovial fluid through the area, which is basically like WD40 for your joints. Walking is great for this condition. Just be sure to monitor how much you're walking because too much walking can also aggravate it.
You'll want to avoid deep asymmetrical movements such as lunging, cleaning in a half-kneeling position, etc. I advise patients to pretend that they are wearing a mini skirt, meaning avoid allowing your legs to become more separated than you would if you had a mini skirt on. For example, while getting into the car, sit your butt down and then move your legs together into the car, instead of one leg in at a time.
Other ways to add symmetry with your everyday movement:
Avoid crossing your legs. Crossing your legs (or any other asymmetrical lower extremity movement/positioning, for that matter) places more pressure on the joints, which equals more pain.
Sit down to take your shoes off.
Do not push objects with your legs (moving a box across the floor with your foot).
Do not sit with your legs crossed under you.
STEP 6: Relieve SI Joint Pain While Sleeping
SI joint pain can make sleeping uncomfortable and not as restful. The key to relieving nighttime pain is minimizing pressure on your SI joint.
If you're sleeping on your side:
Place a pillow between your legs up into the thighs, starting at your pubic bone and down toward your knees.
Make sure that both knees are bent (do not sleep with one leg straight and the other bent).
Use a pillow to support your baby bump if pregnant.
When getting in and out of bed, try using the log roll technique.
How to Treat Sacroiliac Pain in Early Pregnancy
Need more help relieving SI joint pain during pregnancy? Our free SI Joint Exercise Guide teaches you how to identify SI joint instability and rebalance the joint to decrease pain in your first trimester or your last weeks of pregnancy.
You'll learn how to strengthen the glutes and lats to improve SI joint stability and make it more comfortable to walk, sit, and stand.
💌 Want the guide delivered straight to your inbox? Drop your email below, and we'll send it your way!
Since SI joint pain doesn't usually correct itself postpartum, it's important to start on it early. But also know that it's never too late. Happy healing, mama!
Krystle Howald, PT, DPT
JOIN THE EXPECTING AND EMPOWERED APP
Avoid SI joint pain during pregnancy and postpartum with the E+E fitness app. The Expecting and Empowered Pregnancy Workout Program offers a balanced program to help you strengthen unstable SI joints and avoid other common pregnancy issues. The app avoids asymmetrical movements (i.e., lunges) after 20 weeks of pregnancy and transitions to using both sides symmetrically during movements. You'll see many more exercises like squats and RDLs instead of lunges or single-leg RDLs.
Workouts follow along on your pregnancy journey, week by week, and help you recover postpartum. It is never too late to start! Even if you are 37 weeks, you can still start now.
SOURCES
Filipec M, et al. (2018). Incidence, pain, and mobility assessment of pregnant women with sacroiliac dysfunction. https://pubmed.ncbi.nlm.nih.gov/29876919/
Fiani B, et al. (2021). Sacroiliac Joint and Pelvic Dysfunction Due to Symphysiolysis in Postpartum Women. https://pmc.ncbi.nlm.nih.gov/articles/PMC8580107/