Physical therapy and exercise are essential components of a treatment plan for sacroiliac (SI) joint dysfunction pain relief and recovery.
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Physical therapy may help control pain originating from the SI joint.
The sacroiliac joint, which connects the spine to the hip, can cause pain in the buttock, groin, back of the thigh, and/or lower part of the leg due to abnormal motion at the joint. 1 Barros G, McGrath L, Gelfenbeyn M. Sacroiliac Joint Dysfunction in Patients With Low Back Pain. Fed Pract. 2019;36(8):370-375.
An estimated 15% to 30% of low back pain cases originate at the sacroiliac joint. 2 Buchanan BK, Varacallo M. Sacroiliitis. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448141/ Research indicates that most patients respond well to physical therapy and exercise to manage their symptoms and prevent the progression of the condition. 1 Barros G, McGrath L, Gelfenbeyn M. Sacroiliac Joint Dysfunction in Patients With Low Back Pain. Fed Pract. 2019;36(8):370-375. , 3 Al-Subahi M, Alayat M, Alshehri MA, et al. The effectiveness of physiotherapy interventions for sacroiliac joint dysfunction: a systematic review. J Phys Ther Sci. 2017;29(9):1689-1694. http://doi.org/10.1589/jpts.29.1689
SI joint exercises target the lower back and leg muscles.
Exercise therapy for SI joint pain relief consists of a series of guided stretching and strengthening exercises that aim to restore natural movement in the joint, by:
Exercises target several muscle groups in the abdomen and lower limbs.
advertisementAs one of the first-line treatments, guided physical therapy for SI joint pain relief aims to provide long-term improvement and symptom control through a set of 5 treatment aspects described below:
Patient education involves guidance on exercises and lifestyle modifications to reduce symptom recurrence.
Heat and cold therapy can help effectively control SI joint inflammation.
Improving flexibility can improve athletic performance and reduce the risk of injury.
SI joint strengthening exercises target the lower back, buttocks, hip, and hamstring muscles.
Aerobic exercises can build muscle endurance and increase stamina.
It is recommended that a doctor or physical therapist familiar with the patient’s specific needs is consulted before starting a new exercise program. A prior consultation ensures that a new exercise will not cause further exacerbation of pain.
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A normal SI joint can move forward and downward (nutation) and backward and upward (counternutation).
Understanding what the body needs is a crucial step toward an effective physical therapy program for the SI joint. Pain in this joint typically occurs due to hypermobility or hypomobility of the joint. 16 Dydyk AM, Forro SD, Hanna A. Sacroiliac Joint Injury. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. https://pubmed.ncbi.nlm.nih.gov/32491804/
Hypermobility of the SI joint means that the joint moves more than the normal limit, while hypomobility of the SI joint means that the joint doesn’t move enough. 16 Dydyk AM, Forro SD, Hanna A. Sacroiliac Joint Injury. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. https://pubmed.ncbi.nlm.nih.gov/32491804/ Both mechanisms can lead to discomfort and pain in the SI joint and surrounding areas, and the treatment approach varies for the specific underlying cause.
Common causes for SI joint dysfunction are traumatic or jarring events that involve one leg or one side of the pelvis. A few examples include stepping off a step thinking there is another below it, stepping into a hole while walking or jogging, or a rear-end accident with the right foot depressing the brake/twisting the pelvis.
Traumatic injuries, such as falls, can result in hypermobility of the SI joint.
Hypermobility of the SI joint often results from ligaments in the joint becoming loose, typically due to injury or pregnancy, making the joint more mobile than usual. 16 Dydyk AM, Forro SD, Hanna A. Sacroiliac Joint Injury. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. https://pubmed.ncbi.nlm.nih.gov/32491804/ , 17 Newman DP, Soto A. Sacroiliac Joint Dysfuction: Diagnosis and Treatment. Am Fam Physician. 2022;105(3):239-245. https://pubmed.ncbi.nlm.nih.gov/35289578/ Over time, this excessive movement can cause inflammation and pain in the joint.
To manage a hypermobile SI joint, physical therapists focus on strengthening the muscles around the SI joint, including the abdominals, buttocks, and lower back muscles. 16 Dydyk AM, Forro SD, Hanna A. Sacroiliac Joint Injury. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. https://pubmed.ncbi.nlm.nih.gov/32491804/ These exercises help stabilize the joint, reducing excessive movement and associated pain.
Arthritis is a common cause of hypomobility of the SI joint.
Hypomobility of the SI joint is typically a result of aging, arthritis, or previous surgery in the area that leads to scar tissue formation. 16 Dydyk AM, Forro SD, Hanna A. Sacroiliac Joint Injury. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. https://pubmed.ncbi.nlm.nih.gov/32491804/ The stiffness and restricted movement in the joint can cause a dull ache or sharp pain in the lower back or buttocks.
To manage a hypomobile SI joint, manipulation therapy and appropriate stretching and strengthening exercises are recommended. Stretching exercises increase flexibility, improve range of motion, and enhance overall joint function. 18 Lee J, Yoo W. Application of posterior pelvic tilt taping for the treatment of chronic low back pain with sacroiliac joint dysfunction and increased sacral horizontal angle. Physical Therapy in Sport. 2012;13(4):279-285. https://doi.org/10.1016/j.ptsp.2011.10.003 Specific stretches targeting the lower back, buttocks, and hip areas may benefit patients with hypomobile SI joints. 19 Shokri E, Kamali F, Sinaei E, Ghafarinejad F. Spinal manipulation in the treatment of patients with MRI-confirmed lumbar disc herniation and sacroiliac joint hypomobility: a quasi-experimental study. Chiropractic & Manual Therapies. 2018; 26(16). https://doi.org/10.1186/s12998-018-0185-z
advertisementThe guidelines for treating sacroiliac joint dysfunction are usually similar to treating most other musculoskeletal problems. The total length of an exercise program depends on the severity and duration of the symptoms and signs.
Exercise and physical therapy typically start with a few sessions performed under the guidance of a therapist followed by a longer-term home program. If the pain and other symptoms resolve, no further visits are needed, and the home exercises may be continued.
Darren Riccio is a licensed physical therapist who has been working in the fields of physical therapy and rehabilitation and fitness since 1995. He is also certified in Maitland orthopedic manual therapy techniques, Olympic weight lifting, sports performance coaching, as a running coach, and fitness training.
