SI Joint Pain in Pregnancy

What is SI Joint Pain in Pregnancy?

Sacroiliac joint pain in pregnancy is incredibly common, but what is it? The sacroiliac joint (SIJ) has been estimated to account for up to 30% of chronic low back pain in the general population. It may be a cause of pain in up to 50% of women during pregnancy.

The SI Joint is the joint where the sacrum and part of the pelvis, the ilium, meet. They are connected and supported by very strong ligaments. Additionally, there are muscles that surround it such as the hamstrings and pelvic floor muscles. The SI Joint is responsible for transferring weight between the lower body and our low back (lumbar spine).

As pregnancy progresses, there is more load and strain on the spine and pelvis. While this is normal, the pelvis has to accommodate the growing baby. Therefore, this changes the orientation of the pelvis and can create things like SI Joint pain and postural changes. Pain is typically located near the upper buttocks area where the low back meets the pelvis.

Symptoms of Sacroiliac Joint Pain in Pregnancy

Sacroiliac joint pain is typically felt in the back of the pelvis, hips, and sometimes the pain goes down the legs.

• Difficulty walking quickly or long distances
• Discomfort or pain during intercourse
• Pain with rolling over in bed
• Pain standing on one leg
• Difficulty lifting
• Difficulty performing normal daily tasks

Causes of Sacroiliac Joint Pain in Pregnancy

• Previous history of low back or SI Joint Pain
• Previous trauma to the pelvis or back
• Physically demanding work
• Multiparity (having had multiple pregnancies)
• Poor lifting mechanics and/or posture
• Asymmetrical postures
• Hormonal factors (Increased relaxin during pregnancy may increase joint laxity)
  • This link between hormones and joint laxity is up for debate

SI Joint Pain in Pregnancy: Relief

Finding relief form SI joint pain during pregnancy can be difficult. Our bodies go through rapid changes during pregnancy, and the nature of that can make SI joint pain hard to treat. Finding a physical therapist experienced with SI joint pain can be a huge help. They can check alignment of the SI joint and offer exercises to help relieve pain.

SI joint pain typically stems from instability in the joints. Strengthening the muscles of the core, back, and pelvic floor can help improve stability. This will help the SI joint stand up against the stresses and changes of pregnancy. Furthermore, strengthening the muscles around the SI joint can help with recovery postpartum.

Sacroiliac Joint Pain in Pregnancy: Exercises

• Posterior Pelvic Tilts
• Deep Core Strengthening

• Squats

• Isometric hip abduction/ adduction: Sorry, no picture! But find a comfortable seat in a chair. Place your hands on the outside of your knees and gently press outwards with 50% effort. Hold for 3-5 seconds, place hands on inside of knees. Press and hold for 3-5 seconds. Repeat 5-10 times.
• Clamshells

Modifications/ Supports

In addition to exercises, there are a few modifications and supports that can help with SI joint pain and work to prevent it.

• Neutral posture/ standing alignment
• SI Belt
  • I personally recommend the Serola belt for comfort and ability to adjust
• Ice/ heat
• Massage
  • This can be a good excuse for a prenatal massage or massage from your partner. Massage can help relax tight muscles around the sacroiliac joint.
• Symmetry in everyday movement
• Be conscious of how you move throughout your day. Avoid standing with all of your weight to one side. Additionally, pay attention to keeping your legs close together when you do things like getting in and out of a car.
• Sleeping Position- use a pillow between the legs and keep both knees bent

What to Avoid

• Sit with asymmetrical postures and movements
  • This could include things like lunges, carrying things on one side
• Continue movements that are painful
• Avoid pushing movements with your legs (i.e. pushing a box on the floor with your foot)