8 ways to manage Sacroiliac Joint pain during pregnancy
A few weeks ago, my patient came into my office for the first time. She was 26 weeks pregnant and her main complaint was sciatic pain. That’s what she told us when she called the clinic, what she talked about in the paperwork she filled out, and what she told me during our first appointment. Her pain started a couple weeks ago and felt like sharp, sudden pains in her low back on the left side, near the dimple above her buttocks, sometimes shooting down the left thigh. The pain was the worst when she rolled over in bed and when she was putting on socks but she also felt it getting in and out of the car.
It quickly became clear that she wasn’t experiencing sciatic pain at all. She was experiencing sacroiliac (SI) joint pain, also referred to as SIJ pain. SI joint pain, commonly confused with sciatic pain, is characterized by sharp, sudden, short lived shooting pain at the dimple in the back of the pelvis. It is usually experienced on one side, though it can move from side to side in some cases.
Some activities that commonly trigger SI joint pain include:
getting in and out of the car
rolling over in bed
walking up stairs
transitioning from sitting to standing
putting on socks or pants, etc.
asymmetrical exercise like lunging, running, elliptical, etc.
lifting heavy items (and children)
Sacroiliac joint pain is pain at the.. you guessed it! Sacroiliac joint! This joint is where the hip bone meets sacrum. SI joint pain is common during and following pregnancy due to postural changes, activity level changes, weight gain, changes in weight distribution and hormonal changes. Important note: Relaxin is not the sole cause of SI joint pain and though this pain may improve with birth, treating this pain during pregnancy reduces the likelihood that pain persists throughout pregnancy and following childbirth. Waiting until you give birth is not the only (or the best) option to address SI joint pain, sciatic pain or any form of pelvic pain during pregnancy.
There are two major steps for treating SI joint pain during pregnancy.
Step one: Reduce activities that aggravate your symptoms.
It’s difficult to resolve pain when you’re continuously irritating the source. It’s like picking at a scab while waiting for the wound to heal. The first step in managing SI pain at home is identifying your triggers and reducing aggravating activites.
Step two: Treat the underlying cause of the symptoms.
Once you modify or reduce activities triggering your pain, you can start treating the underlying cause of the pain. Though you may want to hold off on running, lunging or jumping on one foot to put your sock on in the short term, the end goal is to get you back to doing all of those activities and more. Treating the underlying cause of symptoms is how we get you there. Read on for 8 tips to tackle both steps.
6 tips to tackle step one
Log roll when in bed
Does rolling over in bed trigger that sharp, sudden pain? If it does, try moving around in bed using the log roll technique. The idea of the log roll is moving your body like a board. Rather than rotating your upper body, hips and lower body separately, you want to move everything like a plank together. This technique reduces shearing force at the sacroiliac joint and can make moving around in bed much more comfortable. Check out this blog post for more details and a video demonstration on how to log roll.
Get in and out of the car with knees together
Rather than stepping one leg out and then following with the other, keep your knees parallel like they are stitched together. Turn your entire body so both legs are outside of the car, knees parallel, and then stand up with equal weight distributed between both feet.
Sit down to put on socks and pants
Sit. That. Booty. Down. Seriously, sit down. Sit down to put on socks. Sit down to put on shoes. Sit down to put on pants. Standing on one leg while trying to lift the other to put on pants/socks/shoes is a common trigger for SI joint pain and sitting down is the simplest solution.
Avoid asymmetrical exercise in the short term
Asymmetrical exercise activities are common aggravating factors for sacroiliac joint pain and other forms of pelvic pain during pregnancy. Instead of running, lunges or using an elliptical, try rowing, squatting, bridge variations and other exercises that keep your legs parallel to one another. Your SI joint will thank you <3.
Sit with your knees parallel
Are you sitting with your legs crossed right now? Gotcha. Sitting asymmetrical positions and can aggravate SI joint pain. Sitting with your knees parallel and feet flat on the floor can feel unnatural but can make a huge difference for your pain.
Consider an SI belt
This isn’t the first place I recommend you start, but if your SI joint is really angry, an SI belt can play an important role in calming your pain. If your pain has gotten you to a point where you feel incapable of doing your daily tasks, an SI belt is a great way to support your body and let that pain calm down. This is the belt I typically recommend. Wear it while you’re out of bed for a week or two. Take it off it you notice your pain getting worse.
2 tips to tackle step two
See a PT
If you have the ability to access physical therapy, PT is where I recommend you begin. SI joint pain can happen for a number of reasons and be aggravated by a number of factors. An assessment by a pelvic floor physical therapist is the best way to determine the cause of your pain and your best treatment course. If you want to learn more about working with a pelvic floor PT either in person or virtually, contact us for your free 15 minute phone consultation.
Strengthen your deep core and glutes
As mentioned above, the cause of SI joint pain can vary from person to person. Strengthening your core and glutes is somewhat reductive, but this is where I start many of my SI joint pain patients. Strengthening the muscles supporting your pelvis can take some stress off of your joints, helping to reduce your pain and improve your resilience over time.
Any-who, if you’re still with me, know that SI joint pain is common during and following pregnancy. Also know that this pain is treatable. You can seek help today if you’re in pain, whether you’re pregnant or have already given birth. You do not have to wait. If you’re hurting, the sooner you get started, the better.
Want to learn more about working with a PT through pregnancy or postpartum recovery? Contact us here! And don’t forget to sign up for our newsletter for monthly pelvic health tips!!
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.