Sacroiliac Joint (SI) Pain during Pregnancy and Postpartum

Pregnancy can be a real pain in the butt…literally! Sacroiliac (SI) joint pain can be difficult to diagnose. In this blog post, I'll tell you why this is, and explain how to take the burden off your back and hips with helpful tips so you don't have to keep asking your husband for the back and butt rubs. 

Let's dive deeper into SI joint pain as it relates to pregnancy.

Sacroiliac Joints

Your sacroiliac joint is where your two hip bones (ilium) meet your tailbone region (sacrum)- therefore the name Sacroiliac Joint. The SI joint is a very strong joint structure and has thick ligaments that support it. The SI joint is VERY jagged like a jigsaw puzzle. Because of these features, the SI joint is usually very difficult to knock out of place. It would usually take a major fall or accident to experience issues here…when NOT pregnant. Let’s dive into why pregnancy changes this game for this joint.

Sacroiliac Joints.jpg

Why does it cause issues during pregnancy?

During pregnancy moms tend to experience SI pain early! This typically occurs in the first trimester and progresses with pregnancy. Pregnant women experience hormone fluctuations. One of these hormones that is produced in the body during pregnancy is called relaxin. Just like its name sounds, it causes the ligaments and connective tissue around the pelvis to become less stable, in preparation for childbirth. When you deliver your baby, you will be thankful for this instability because it allows your pelvis to soften as the baby comes down and out the birth canal.  However, in the meantime this can compromise your SI Joint and cause some nasty symptoms.

As pregnancy weight is gained, your feet rotate outward to increase your base of support (referred to medically as the pregnancy waddle). As your legs rotate outwardly your hip muscles shorten, making them less effective. Less effective muscles place more pressure on joints. 

It is also very common to have pain in the SI joint postpartum because of traumas experienced during labor and delivery. Unfortunately, most of the time it does not correct itself after your baby arrives.

Symptoms

SI joint pain can vary in sensation but typically individuals experience pain, numbness and/or tingling that can start in your butt and radiate down the back of your thigh. Pain created at your SI joint can be VERY intense for some and for others it is more of a dull constant ache. Women that experience this pain typically have a decreased tolerance to standing, walking or sitting. They constantly feel the need to change positions and find it hard to get comfortable. During walking some individuals feel a “catching” or “clicking” of the hip.

How To Fix It

STEP ONE:

First, you need to correct the alignment of the SI joint and make sure your low back is moving well. To do this, you will need help! Your SI Joint is complicated and not one you can fix on your own.

I would suggest finding a good PT in your area. 

Go to the Physical Therapist Locator and click on pregnancy and postpartum. If there are any in your area, give the PT a call and ask if they have ever worked on SI joints PRIOR to scheduling your appointment. Not every PT works on this, so be picky! 

http://www.womenshealthapta.org/pt-locator/

This will temporarily alleviate your symptoms. But, don't stop here.

On a PERSONAL NOTE:

I have “adjusted/realigned” numerous SI joints and pubic bones in the clinic but my pregnant patients always seem to come back! So be cautious with spending too much time and money on PTs, chiropractors, massage therapists etc., because the root of the problem is typically muscle strength.  

During my first pregnancy I saw a chiropractor twice a week as well as my PT once a week from 19 weeks on. It helped but was SO short term. During my second pregnancy, I started having the pain at 15 weeks, then started testing the Expecting and Empowered Pregnancy Guide at 20 weeks. The pain was COMPLETELY gone by 25 weeks! During this last pregnancy I followed the Guide to a tee and had NO pain. Nothing worthwhile is ever easy. It will take time but it is really best for you and your little one if you can operate comfortably. It is never too late to start! You want to prep your body for delivery and postpartum so even if you are at 37 weeks I would start NOW. 

STEP TWO: This step is the key tO avoiding long term problems

The root of the problem is instability. This means that strength training is a must! During pregnancy, your CORE (abdominals, pelvic floor, diaphragm and back muscles) becomes compromised. This is the time to wake these muscles back up and get them unstuck! Often there will be asymmetries side to side. What tends to happen during pregnancy is one side of your lats and the opposite butt cheek will become weak. Here is how to test for this:

Testing:

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”, which means 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 weak hip extension test on the right and display weakness on the latissimus dorsi test on the left, or vice versa.

  • Hip Extension Test: You will need a partner to help you. Lean forward over a table, enough so that your hips are on the table. You can hold onto the table but you are not allowed to use your arms to generate force. Lift one leg about 12 inches off of the ground. You should be able to hold this while your partner pushes down on your leg just above the knee. Repeat on other side. If either leg gives way, this means you probably have some hip weakness on that side.

  • Latissimus Dorsi Test: You will need a partner to help you. Stand in an upright position and hold your arms in an upright “Y” position. Hold this “Y” position, testing one arm at a time, by having your partner place 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 are unable to hold this, it means you are weak on that side.

Exercises for a Positive Hypomobile SI Test:

  • Single Leg Bridge on Foam Roller (ONLY PERFORM ON WEAK GLUTE SIDE)- Lie on your back with a foam roller under the knee of your weak side. Grab your opposite knee and hug it up toward your chest. 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.

  • Bridge with March (ONLY PERFORM ON WEAK GLUTE SIDE)- Lie on your back with your arms to your sides, knees bent, and feet flat on the floor. Slowly lift your hips off the floor into a bridge position, keeping your abdominals engaged the entire time. Lift 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 leg 2-3 inches off the ground. Repeat 8 repetitions for 3 sets. ****If you are pregnant place upper back on edge of couch or a stability ball.

  • Standing Lat Pulldown with Resistance Band (ONLY PERFORM WEAK LAT SIDE)- Stand with a resistance band anchored high above you, holding both ends of it in either hand and make sure your arms are straight. Keep your strong arm straight. Pull your weak arm down and back against the resistance by pulling your hand to your shoulder drawing your elbow down and back towards the opposite butt cheek. Return to the starting position and repeat. Make sure your back stays straight throughout the exercise and do not allow your shoulders to shrug.

You can start with the simple exercises in the free PDF. Be patient, it can take up to 5 weeks to see the benefits of strengthening! Adding stability back into an unstable system means that your nagging pain will decrease or be eliminated, making it more comfortable to sleep, walk, sit! What I would most highly recommend is doing the Expecting and Empowered Pregnancy Guide for a balanced program that will help you tackle/avoid other common pregnancy issues as well.

Below I’ve attached a form to get the freebie!

What else can I do?
Less pressure = Happier joints

SYMMETRY

  • 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 shoes off.

  • Do not push objects with your legs (moving a box across the floor with your foot).

  • Do not sit with legs crossed under you.

Exercise SYMMETRY

The Expecting and Empowered Pregnancy Guide is written so that the majority of asymmetrical movements are taken out half way through (i.e. lunges). We want to make it less likely that you will be the 33% of women that experience pelvic girdle pain during pregnancy (Albert 2000). There are still a ton of leg and core strength in the guide, but it shifts toward using both sides during movements. You’ll see a lot more exercises like squats and RDLs instead of lunges or single leg RDLs.

SLEEPING

This condition can make sleeping uncomfortable and not as restful!

If you are 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. I demonstrated it for you in this video:

BRACING

Stability Tip

Temporary stability can be created by using a SI belt called a Serola belt until you can strengthen this area.

Wearing an SI belt can help if you have this condition. 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 that are we are trying to correct. Squeezing the “wings” of the hips high gaps the SI joint at the bottom. OUCH.

Proper placement of the belt would be right above your greater trochanter which is the large pointed part on the side of your hip. You can located this by rotating your leg like you are putting out a cigarette and hold your hand over your hip. You should feel a bone rotate as you do this. Place the bottom of the belt directly above it. 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.

MOVEMENT

Movement is the fountain of youth! Joints love movement. Movement pumps synovial fluid which is like WD40 to a sticky joint. Walking is great for this condition. Just monitor because too much walking can also aggravate it!

You will want to avoid deep asymmetrical movements such as lunging, cleaning in a half kneeling position, ect. I advise patients to pretend they are wearing a mini skirt don’t allow 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.

Thank you so much for taking the time to read this post. If you found it helpful, share with your mama friends that are in need of help too! They don't have to be pregnant for this blog post to help. This would help anyone suffering from SI or pubic bone pain issues. Since this problem doesn’t usually correct itself postpartum, start on it early! But also know that it’s never too late. Happy healing mama! 

Our Instagram’s IGTV has a video that shows you how to test! Head there.

Krystle Howald, PT, DPT

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