SI Joint Pain during Pregnancy

When it comes to pregnancy, experiencing various aches and pains is quite common. However, it can be challenging to accurately identify the specific discomfort you’re feeling and determine the appropriate remedies. One frequently encountered pain during pregnancy is sacroiliac (SI) joint pain. Often, individuals may not recognize this as the source of their discomfort. They attempt remedies that might inadvertently worsen the pain. Here are some tips to help you determine if you might be experiencing SI joint pain and provide guidance on what to focus on (and avoid) to alleviate it.

Identifying SI Joint Pain:

SI joint pain is typically felt in the backside of the pelvis, specifically around the buttocks region. It often occurs on one side of the body (similar to the illustration below). The pain tends to intensify during weight-bearing activities, particularly when relying on one leg, such as climbing stairs, using elliptical machines, participating in exercise classes, or engaging in prolonged periods of walking. The pain can vary from a chronic and dull sensation to a sharp, shooting pain that may radiate down the leg to some extent.

What Causes SI Joint Pain

The human body possesses two sacroiliac (SI) joints, one on each side, located in the posterior region of the pelvis between the sacrum and the ilium bones. These joints play a role in resisting anterior pelvic tilt, a forward tipping of the pelvis.

During pregnancy, certain factors can place additional strain on these joints, potentially resulting in pain. These factors include:

  1. Pregnancy Alignment Shifts: Pregnancy often causes the body to deviate from its neutral alignment, causing the pelvis to tilt forward into an anterior pelvic tilt and shifting the body’s center of gravity upward and outward. As a result, the two bones meeting at the SI joint may rub against each other, leading to discomfort.
  2. Hormonal Changes: Pregnancy brings about hormonal changes, including an increase in the hormone relaxin. Relaxin softens the joints, ligaments, and connective tissues in preparation for carrying a growing baby and facilitating childbirth. However, this softening can also increase joint mobility and decrease stability, potentially causing hypermobility of the SI joint and subsequent pain.
  3. Increased Body Weight: As pregnancy progresses, the added weight places greater stress on the pelvis. This accentuates the aforementioned issues, further contributing to SI joint discomfort.

It’s important to note that certain hormonal changes, such as the influence of relaxin, can persist into the postpartum period. Consequently, the increased joint mobility and decreased stability may still be present after giving birth, potentially leading to SI joint pain. The duration of this postpartum period is a matter of debate.

Moves to manage SI Joint Pain

Many people ask what stretches they can do to manage the pain. If this was muscle pain, there could be stretches that could alleviate it. However, we are talking about pain in a jointthat is likely caused by hypermobility in that joint. Therefore, the keys to addressing it are: decrease stress on the joint and 2) strengthen the muscles surrounding the joint to provide greater pelvic stability.  Here are some moves to help you do that:

  • Get in neutral alignment 
  • Bridges: Your glutes work with your core to stabilize your pelvis, so strengthening your glutes is important for mitigating  joint pain. Bridges are a great way to target your glutes because they keep your pelvis in a stable position.
  • Clamshells: These are also great at targeting the glutes in a safe non-weight bearing way.  
  • Deadlift: Great exercise to strengthen your glutes and hamstrings. 
  • Single Arm Row: This is also a great movement to target the lats to help stabilize your pelvis.
  • Incline Plank:  A plank targets the core muscles at the front of your body, training these muscles to help you resist that excessive lower back arch we showed at the beginning. During pregnancy we must be very careful about managing intra-abdominal pressure.  Full planks performed with a larger belly will create too much intra-abdominal pressure. Therefore, beginning in the second trimester, we regress these by performing them at an incline.

Moves to Avoid

Engaging in the aforementioned movements can effectively prevent SI Joint pain from occurring in the first place. However, if you are currently experiencing pain, it is advisable to minimize activities that involve bearing weight on a single leg to maintain a more stable pelvic position. This includes the following considerations:

  1. Lunges or step-ups: Exercises such as lunges or step-ups/downs can potentially destabilize the pelvis. It is better to focus on exercises that distribute your weight evenly across both feet. 
  2. Impact exercises: High-impact activities like running, jumping, or other ballistic movements can exacerbate pain due to the increased mobility of the pelvis. Your body will likely provide signals indicating that these movements are not suitable.
  3. Traditional cardio machines: Cardio machines like the elliptical, Stairmaster, or treadmill typically involve single-leg movements, so it is best to avoid using them when experiencing SI Joint pain.
  4. Crossing legs while seated: Maintaining an evenly distributed weight distribution is essential, even when sitting. Aim to sit with an upright posture, both feet flat on the floor, and refrain from performing deep stretches that target a single leg, such as pigeon pose or figure four.
  5. Any activity that triggers pain: Identifying the specific activities that trigger pain can vary from person to person. Pay attention to these triggers and be cautious. Sometimes the pain may not arise immediately but the following day. It may be necessary to reflect on your previous day’s activities.
  6. Single-leg daily activities (use caution): Everyday activities like walking, climbing stairs, or getting up and down from the ground often involve single-leg movements. While it is not feasible to completely avoid these activities, it is important to keep moving. During severe pain, consider limiting prolonged periods of walking or stair climbing. Additionally, when rising from the ground, use the side that is not causing pain as the stepping point.

Please note that these guidelines are intended to provide general advice. It is always recommended to consult with a healthcare professional for a personalized assessment and guidance regarding your specific situation.

 

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