The Infamous SIJ

The sacroiliac joints (SIJs) are the joints linking your spine to your pelvis. The purpose of the SIJs are to control load (force) transfer from your legs to the spine and vise versa. If these joints are too mobile, stiff, or irritated you may have pain. Sacroiliac joint dysfunction (SIJ dysfunction) is a term used to describe pain at either or both of these joints.

Issues at the SIJs can be caused by pregnancy, leg length discrepancy, trauma to the area such as fractures or soft tissue injury, general instability, poor lower body and core strength, pelvic floor issues, and hip or low back pain. The vast majority of SIJ cases, 88%, are caused by direct trauma to the area itself. This can be due to repetitive microtrauma in certain sports or physical activity, or more direct trauma during falls or car accidents. Typically, 20% of SIJ cases are pregnancy related due to hormone changes which increase the laxity of the sacroiliac ligaments. (3)

Often, sacroiliac joint issues are misdiagnosed as low back pain. SIJs are a significant source of pain in 15-30% of people with mechanical low back pain. It can be difficult to differentiate between SIJ and low back issues, and therefore it is hard to get a clear diagnosis. Common symptoms can include, but are not limited to:

  • Pain localized over the buttock

  • Complaints of sharp, stabbing, and/or shooting pain that can extend down the back of the thigh, usually not past the knee. 

  • Tenderness to palpation at the sacroiliac joint (near the PSIS)

  • Pain during forward or backward bending

  • Difficulty sitting in one position for too long due to pain

  • Complaints of pain while sitting down, lying on the same side of the pain, climbing stairs, or during asymmetric or unilateral movements (single leg exercises, lunges, bulgarian split squats, step ups, etc.)

Physical therapy is an integral treatment for improving SIJs issues. Physical therapy for SIJ issues typically focus on, improving core and hip strength, and gaining control and stability at and around these joints. Occasionally using an external stabilizer belt can be helpful in managing SIJ hypermobility, like during pregnancy. It’s important to progress strengthening exercises and reduce external support over time. (1)

 These are some of my go to exercises for SIJ issues: (2)

Phase 1: 

     Learning Diaphragmatic vs 360 breathing

     Learning abdominal bracing (starting in supine [face up] and progressing to quadruped [hands & knees] positions)

     Hooklying Marching and Bent Knee Fall Outs with abdominal bracing

     Bridging while holding a ball between your knees to increase stability and lower abdominal activation 

     Quadruped rock backs to learn how to separate the hip hinge motion and lumbar flexion (bending)

Video of these exercises: https://www.instagram.com/reel/DMQoYILpg02/?utm_source=ig_web_copy_link&igsh=ODlqYnZ3bzdqOXhr


Phase 2:

     Bear pose with a ball between your knees 

     Bird dog variations (arms only, legs only, both arms & legs)

     Front plank variations (elbows & knees, hands & feet, unstable surface, unstable surface with intentional movement)

     Side plank variations (elbows & knees, elbows & knees with clamshell, hands & feet)

     Bridge variations

Video of these exercises: TBA


Phase 3:

     Hip thrusts (progressing to add weight)

     Hip hinging movements (progressing to single leg & weighted variations)

     Squatting movements (progressing to add weight)

     Double and single leg balance training (progressing from stable to unstable surfaces)

Video of these exercises: TBA


As always, please email me at restorepelvicrehab@gmail.com if you have any questions. 

x, Dr. Bethany 

 

Citations:

Kamali, F., Shokri, E., The effect of two manipulative therapy techniques and their outcome in patients with sacroiliac joint syndrome. Journal of Bodywork & Movement Therapies, 2011.

Exercises for Lumbar Instability. (2024, April 24). Physiopedia, . Retrieved 19:33, July 15, 2025 from https://www.physio-pedia.com/index.php?title=Exercises_for_Lumbar_Instability&oldid=353599.

Sacroiliac Joint Syndrome. (2025, June 13). Physiopedia, . Retrieved 19:37, July 15, 2025 from https://www.physio-pedia.com/index.php?title=Sacroiliac_Joint_Syndrome&oldid=369707.

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“Under Pressure” - Breathing and the Pelvic Floor, Part 1