Home Program for SI Joint Dysfunction

What you are treating

The sacroiliac (SI) joints connect the base of the spine to the pelvis. They are meant to move only a little, held steady by thick ligaments and by the muscles around the pelvis. SI joint pain usually means the joint is irritated and the muscles that should hold it steady are not doing their job: the gluteal muscles are weak, the hip flexors and hamstrings are tight, and the deep abdominal muscles switch on late. The program below is built to fix those three things.

Two rules for the whole program:

• Work on both sides, even if only one hurts. The pelvis is a ring.
• A mild stretch or a working muscle is fine. Sharp pain at the joint, or pain that lingers for more than an hour afterward, means too much too soon. Scale back and build up.

Week 1 to 2: calm it down

• Avoid the positions that pry the joint: sitting cross-legged, sitting on one hip, standing with all your weight on one leg, deep lunges, and long strides. Keep your steps a little shorter when walking.
• Sit evenly on both sit bones, with a small cushion if the seat is hard. Get up every 30 minutes.
• Roll over in bed by keeping your knees together and moving the shoulders and hips as one unit. Sleep on your side with a pillow between the knees, or on your back with a pillow under the knees.
• An SI belt, worn snugly around the pelvis just below the hip bones, can help during the day, especially for walking and standing. Take it off to sleep and during the exercises below, unless your therapist says otherwise.
• Ice over the sore spot for 15 minutes after activity, or heat before the stretches, whichever feels better.
• Medicines as we discussed: usually acetaminophen on a schedule and an anti-inflammatory for one to two weeks if your stomach and kidneys allow it.

Begin these gently, once or twice a day:

• Pelvic tilt. Lie on your back with knees bent. Flatten the low back into the floor by tightening the lower belly. Hold 5 seconds, 10 times.
• Knee to chest. Pull one knee toward your chest with both hands, hold 20 seconds, then the other, then both. 3 rounds.
• Gluteal squeeze. Lying on your back, squeeze the buttocks together, hold 5 seconds, 10 times.
• Hip flexor stretch. Half-kneeling, back knee on a cushion, tuck the pelvis under and shift forward until you feel the front of the hip of the kneeling leg. 20 seconds, 3 rounds each side.
• Hamstring stretch. Lying on your back, loop a strap or towel around one foot and raise the straight leg until you feel the back of the thigh. 20 seconds, 3 rounds each side.

Week 2 to 6: steady the pelvis

Add strengthening, three or four days a week. These are the exercises that matter most.

• Bridge. Lying on your back, knees bent, feet flat, squeeze the buttocks and lift the hips until the body is straight from shoulders to knees. Hold 3 seconds, lower slowly. 2 sets of 10. Progress to a single-leg bridge when the two-legged version is easy.
• Clamshell. Lying on your side with knees bent and feet together, lift the top knee without rolling the pelvis back. 2 sets of 15 each side. Add a band around the knees as it gets easier.
• Side-lying leg raise. On your side, bottom knee bent, raise the straight top leg about a foot with the toes pointing forward, not up. 2 sets of 12 each side.
• Bird-dog. On hands and knees, reach one arm forward and the opposite leg back without letting the pelvis tip. Hold 5 seconds. 10 each side.
• Dead bug. On your back with hips and knees at 90 degrees, press the low back into the floor and slowly lower one arm overhead and the opposite heel toward the floor. 10 each side.
• Side plank from the knees. Hold 15 to 30 seconds each side, 3 rounds. Progress to the feet.
• Adductor squeeze. Lying on your back with knees bent, place a ball or a folded pillow between the knees and squeeze for 5 seconds, 10 times. This is the one exercise that most reliably eases a flare in the first weeks.

Keep the stretches from week one in the program.

Why the hamstrings matter

The hamstrings also act on the pelvis itself: when they are tight they hold the back of the pelvis down and keep the SI joints under uneven tension. The hamstrings run from the sitting bones at the back of the pelvis to just below the knee. When they are tight, they pull the back of the pelvis down and tuck it under (a posterior pelvic tilt), which flattens the natural inward curve of the low back (the lumbar lordosis). A flat low back then has to round forward every time you bend, sit, or reach, because the hips cannot. Freer hamstrings reverse that chain: the pelvis can tilt forward again, the low back keeps its curve, bending comes from the hips (the hip hinge) instead of the spine, and the pressure inside the discs and the strain on the structures behind them fall. Stretch each hamstring for 20 to 30 seconds, 3 to 5 times, once or twice a day, with the low back kept flat, and roll the back of the thigh on a foam roller first if that helps. The gain comes from the nervous system allowing more length, so it stays only with regular stretching. The full explanation is in my core program for low back pain.

Week 6 and beyond: build it back

• Walking daily, working up to 30 minutes with an even stride. A stationary bike and swimming are good. Hold off on running, long strides, and single-leg sports until the single-leg bridge, the side plank on the feet, and a 30-second single-leg stand are all easy and pain-free.
• Progress the strengthening to standing: hip hinges, squats to a chair, step-ups, and monster walks with a band around the knees.
• Learn to lift with the hips and knees, load close to the body, no twisting under load.
• Wean the SI belt as the muscles take over. Most people are out of it by three months.

Notes for your physical therapist

These are my usual starting points, to be adjusted to your findings:

• Treat the pattern, not only the joint: lumbopelvic stabilization (transversus abdominis, multifidus, gluteus maximus and medius), with hip flexor and hamstring flexibility.
• Correct any pelvic asymmetry or leg-length difference you find; a heel lift is reasonable for a measured difference over a centimeter.
• Muscle energy techniques and manual correction are helpful in the first weeks for patients who respond to them; the exercises are what hold the correction.
• Progress to closed-chain and single-leg loading before return to running or sport.
• If pain is not responding by six weeks, send the patient back to me. The next steps are a diagnostic injection into the joint and, if it confirms the source, a steroid injection.

When to call

• Pain spreading below the knee, or new numbness or weakness in a leg.
• Pain that is not settling after six weeks of a real effort with this program.
• A fever with back pain.
• New trouble controlling your bladder or bowels: go to the nearest emergency room or call 911.

Learn more

My guide to sacroiliac (SI) joint dysfunction and my core program for low back pain.

OrthoInfo, Low Back Pain: orthoinfo.aaos.org (opens in a new tab)

This program is a starting place and a set of suggestions for your physical therapist, not a prescription. Your therapist will adjust it to your exam. Stop and call us if an exercise sharply increases pain, or if you notice new numbness or weakness in a leg.