How to Fix S.I. Joint Pain and Instability with Exercise
By Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body
Introduction to S.I. Joint Pain
The sacroiliac joint (S.I. joint) can sometimes be a literal and figurative pain in the butt. The advice I give here is based on my own personal experience with S.I. joint pain and what I've seen with some clients. It's not guaranteed to fix everyone's S.I. joint pain, but it's definitely a good place to start.
I'm not a medical doctor and take a staunchly non-medical approach to joint pain. Nothing you see here should be construed as medical advice. The strategies and ideas here are focused on muscle function rather than obsessing about structures the way medical professionals are trained to do.
The Cause(s) of S.I. Joint Pain and Instability
I think there are likely two major causes of S.I. joint pain: having super stiff posterior hip muscles and having super weak posterior hip muscles. It's also very possible to have a combination of these - meaning one side is super stiff and the other side is super weak.
You can get super stiff posterior hip muscles from high intensity and/or highly repetitive athletic activities. Think lifting weights or running.
You can get super weak posterior hip muscles from just sitting on your butt all day. And if you tend to lean to one side (very common), you'll be crushing the blood and life out of that side a lot more than the other side.
I have seen some medical professionals, chiropractors, and physical therapists claim that S.I. joint pain is from the sacrum and the ilium needing to be realigned with contractions. They try to achieve this with manual adjustments or very specific activations of muscles in opposite directions. While I think there is likely some merit to these ideas, these "quick fixes" don't ever address how you will prevent the malalignment in the future. You just end up doing these fixes over and over again. Forever.
This leaves you powerless to care for your own body and quickly leads to feelings of frustration and hopelessness because you become utterly dependent on these band-aid fixes to relieve the discomfort.
By addressing the muscles around the hip, I've found it can be relatively easy to relieve the discomfort of an unstable S.I. joint and also get to feel better and more stable over time.
The Exercise Fix for Sacroiliac Joint Pain for Active People
If you regularly participate in high intensity or endurance sports like weight lifting, sprinting, or long distance running, you definitely want to integrate regular hip stretching into your training regimen. When you train muscles to constantly contract and shorten, you eventually lose range of motion.
That loss of range of motion eventually leads to loss of efficiency. A muscle trained to be too short becomes a weak muscle. It no longer recruits as many muscle fibers during contraction and thus creates less force.
It would be great if your body had a way to tell you when this is happening, wouldn't it? Well, it's called pain and discomfort. So your body IS telling you that it's happening.
In addition to your regular hip flexor and hamstring stretches, you will likely also find some deep glute stretching helpful.
This video, from the Healthy Hips program gives you an excellent start.
Your goal is to restore as much symmetry as possible. If you have a stiffer side, make sure to do an extra set or some extra time for that stiffer side. You may never achieve PERFECT symmetry to your two sides, but you should aim for it. Having a much stiffer set of posterior hip muscles is a recipe for feeling out of whack in the S.I. joint.
Another option you may find helpful is this deep glute stretch as demonstrated by physical therapist Garrett Kuljian.
But it's not all about your hips.
If you're an active athlete, you may also find big benefits from stretching the latissimus dorsi and the Quadratus Lumbora.
If you're a swimmer, surfer, or any kind of athlete who regularly does pulling motions, your lats can get very stiff and tight. The lats insert into the thoracolumbar fascia which can create tension all the way into the SI joint area. Regular lat stretching can make a big difference.
The Q.L. and obliques can also get quite stiff. Some simple side stretches like the one shown in this video below may help restore length to your core muscles. If you notice that one side is obviously more stiff, spend extra time on that side.
And remember that stretching isn't always the answer.
If you find that frequent side stretching actually makes your SI joint worse, then experiment with the strengthening exercises you'll find in the next section (particularly the side plank progressions).
The Exercise Fix for Sacroiliac Joint Pain for Sedentary People (Chronic Sitters)
If you spend a lot of your day sitting, your S.I. joint may be very unstable. You might experience clunking and popping in your hip and lower spine. In this case, stretching is unlikely to help you. Stretching may actually make you feel worse.
Instead, you want to strengthen muscles all around the hip and core and implement a few lifestyle changes (which we'll get to).
Here are four exercises you can use in a circuit that I find really helpful for restoring enough muscle activity to stabilize the S.I. joint.
Plank - This exercise makes sure your abs stabilize your pelvis. Doing 30-60 second holds will help ensure you can stabilize your spine and pelvis when doing the following exercises. Start with the easiest variation on your forearms and knees before progressing to doing it on your toes with knees straight.
Glute bridge variations. Start off with the easiest variation on the floor and gradually work up to doing it on one leg at a time. Progress to doing bridges with your back elevated on a bench or sofa. Then progress to the same setup with one leg at a time.
It's crucial that you get good at the back elevated position. That setup gives your hip muscles the chance to work in a flexed hip position. If you sit a lot, that's the position that gets the absolute worst and weakest. Sitting all day puts your hips in flexion and then smashes the life out of your butt and hamstrings. Do these until you get a decent sense of fatigue in your glutes.
If you're doing single leg versions, make sure to do a few extra reps or an extra set for the weaker side.
Side planks help restore stability to your pelvis. That makes it easier for all your muscles to keep the S.I. joint feeling good. Start on the floor on your knees. Once you feel confident with 30-60 second holds, add elevation under your knees. Work up to around the height of a chair.
Another helpful variation is to do repetitions where you allow your hips to sag down, then use the side abs to lift your pelvis up toward the ceiling. Hold that top position for 3-5 seconds (or more) so you can really feel the muscles working. Do 30-60 seconds of work per side. If one side feels obviously weaker than the other, do some extra time on that weaker side.
Front foot elevated contralateral split squat - Have your foot elevated on a block or step. Hold a weight in the opposite hand. Slowly descend with a bias toward the front leg. You're trying to get the hip of the front leg to go into adduction and internal rotation as you descend. Focus on feeling the lower butt working on the front leg side.
Only go as far as you can feeling the right muscles work. Pause at the bottom for 3-5 seconds and then return to the top. This also builds strength in the hip flexed position so is crucial to restoring S.I. joint balance. Do 5-10 reps. If one side feels obviously weaker than the other, do some extra reps for the weaker side.
You can use these four exercises as a short, simple circuit to rebuild your hip muscles. Do these for two to three rounds two to three days per week to start. You may find it helpful to do some or all of these exercises more often, but don't increase the frequency for at least one week so you don't cripple yourself with soreness.
Remember that SLOW IS SAFE and FAST IS FOOLISH. There's no rush to overload your body by pushing hard at the beginning. Take your time, and you'll reap the rewards.
Lifestyle Changes for S.I. Joint Pain
To help your hip muscles stay stronger and happier, you'll want to implement a few changes to your life.
- Sit less. Sitting crushes the life out of your butt muscles.
- Use some cushion when you do sit. Sitting on hard surfaces will crush your hip muscles and can lead to much more discomfort very quickly.
- Get a sit/stand desk so that you can vary your positions frequently throughout the day. I personally aim to do a majority of my work time standing. It's normally around a 70/30 split throughout the day, but you'll need to find what works for you without causing pain elsewhere in your body.
- Use hip exercises throughout the day. I recommend taking breaks at least once every hour to do hip exercises. This will give your hip muscles some stimulus throughout the day.
Closing Thoughts on S.I. Joint Instability and Pain
I've had a couple bouts of major instability in my S.I. joint since my twenties. Every time it has happened, I've felt a little lost, confused, and scared. But every time I've implemented more focused hip training into my regular regimen, the instability has gone away.
At the time of writing, I'm in my forties, and remembering to ATM (Always Think Muscles) keeps my S.I. joint feeling stable, secure, and strong for the long run.
While the ideas I've shared here may not work for EVERYONE, I hope you find the perspective and exercises helpful in the journey out of S.I. joint instability and pain.
And if you're looking for a practical, powerful program to help you rebuild your hips at home, be sure to check out the Healthy Hips program.
More Resources for Hip Pain
Why You Don't Need Orthopedic Surgery for Your Joint Pain
Hip Labral Tears - What Your Doctor Won't Tell You
Hip Impingement Bone Shapes Don't Cause Hip Pain
