A lot of physical therapy for back pain involves stretching to loosen sore muscles in some degree of spasm. That is often exactly what those muscles need.
However, if your problem is pain originating in the sacroiliac joint, stretching may be the wrong answer. The sacroiliac, or SI, joint can become painful just like any other joint, like a shoulder or a knee for example. But the SI joint doesn’t do that much. Really it just wiggles a little bit in all directions. It usually only becomes painful when it has become loose or unstable.
You can imagine how excessive stretching to loosen a joint that is already painful and unstable will not help. In fact it often makes things worse. Instead a painful SI joint needs to be treated with realignment and joint stabilization exercises.
A chiropractor can help you with realignment, and a physical therapist can teach you joint stabilization exercises, but there are also some things you can do on your own. Start small and easy and work your way into the exercises. And don’t expect it to fix things right away. It might take weeks or months to get the full benefit.
1. Isometric hip adductor activation and stabilization:
Lie on your back with your legs bent. Put a ball or pillow between your knees. Squeeze your legs together holding the ball for 15 seconds then relax. Repeat 3 to 5 times.
2. Isometric hip abductor activation and stabilization:
This is the opposite of the last exercise. Again, lay on your back with your legs bent. Wrap a belt or a rope around your knees. Open your legs bilaterally pushing against the belt. Hold it for 15 seconds and then rest and repeat 3 to 5 times.
3. Pelvic bridge:
Lie on your back with your knees bent so that your heels are up near your buttocks. Keep your arms at your sides. Lift your pelvis off the the ground so your body forms a straight line from your shoulders to your knees like a bridge. Hold it for 10-30 seconds then rest and repeat.
4. Isometric leg cross for torsional stability:
Lie on your back with your knees supported by a couple of pillows. Cross one leg over the other. Squeeze your legs together pushing backwards with the top leg and forward with the back leg. Hold for 8-10 seconds then repeat. Then do it with the other leg on top.
5. Plank:
Lie down on your stomach on the floor basically in the push up position. You can do this in bed if it is easier too. Raise up your body up on your elbows and toes keeping your back as straight as possible. Hold it for 30 seconds to a minute and then relax.
6. Gentle pelvic rotations:
Lie on your back with your lower legs on a couple of pillows, bent at the knees and the hips. Slowly rotate knees and your lower body to one side until you feel the first pangs of back discomfort. Stop and go back to neutral. Then do the same rotating the legs and pelvis to the other side. Try twisting from one side to the other very slowly like a windshield wiper. Go far enough so that you can sense the first traces of discomfort but stop before any real pain. Do this 8-10 times.
7. Check out the exercises for the Multifidus muscle as these can also be helpful.
Sometimes, SI joint pain can cause the muscles of the low back to become stiff and sore through a process called guarding. Basically, the muscles are overworked trying to stabilize the joint. When the muscles fatigue from these efforts they start to hurt. In this case, some gentle stretching might help. But don’t overdo the stretching and make sure it’s not actually worsening your pain. Here are some stretches you can try.
Lastly, you should avoid activities that put torsional or sheer stresses on the SI joint. Usually, this is pretty easy because these type of activities frequently bring on the pain: activities like repetitive bending and lifting, sitting unevenly on one hip or standing on one leg more than the other, sitting with your legs crossed, jogging, running or stair climbing.
In conclusion, pain from the SI joint can be severe and disabling. Fortunately most patients will get better with a therapy and exercise program. Usually, this works best under supervision from a provider like a physical therapist or chiropractor, but you can help yourself at home by doing some of these simple exercises. If it is making your pain worse instead of better talk to your healthcare provider. Otherwise take it slow and be patient with your body. It often takes time to reap the real benefits.