SI joint pain during pregnancy shows up as a one-sided, sharp pain low in your back, right above your glute. It can catch you when you stand up from the couch, roll over in bed, or go on a walk. As a pelvic floor physical therapist, it’s one of the most common complaints I hear from my pregnant patients!
SI joint pain in pregnancy is very treatable, but what surprises many women is that the fix is more strength and stability, not rest and stretching.
Below, I’m walking you through what SI joint pain is, what’s causing it, and the 5 exercises I use with my pregnant patients to get them out of pain.
What Is SI Joint Pain in Pregnancy?
Your sacroiliac joints are where your sacrum (the triangular bone at the base of your spine) meets your pelvis. You have one on each side. They’re sturdy, and their job is to transfer the load between your spine and your legs when you walk.
SI joint pain happens when one of those joints gets irritated.
SI joint pain is usually one-sided and sits low in your back, in that dimple area just above your glute. It falls under the umbrella of pelvic girdle pain, but it’s distinct from SPD (also called groin pain), which shows up in the front or center of your pelvis, around your pubic bone.
SI joint pain during pregnancy can feel:
- Dull and achy, like a bruise that won’t go away
- Sharp or stabbing when you walk or stand for a while
- Worse when you put weight on one leg, like climbing stairs or stepping into pants
- Tender to the touch on one side of your lower back
Around 50% of pregnant women get pain in their low back or pelvis, and the SI joint is one of the most common sources of it. For many of them, it doesn’t stop at delivery. Studies have followed women whose pain was still hanging around two years postpartum.
Learn more about groin pain during pregnancy.
SI Joint Pain vs Sciatica During Pregnancy
The main difference between SI joint pain and sciatica is where you feel the pain.
Sciatica pain travels down the leg from the lower back. It follows the path of your sciatic nerve, so you’ll feel it moving through your glute, down the back of your thigh, sometimes past your knee and into your calf or foot. It often comes with numbness, tingling, or a burning line of pain.
SI joint pain sits in one spot in your low back, on one side, and if it goes anywhere, it usually stops in your upper glute or the back of your hip.
If your pain is running down your leg, you’re likely dealing with sciatica. If you feel it in one corner of your lower back and flaring when you load that side, you’re likely dealing with your SI joint.
You can also have both types of pain at once.
Sometimes an irritated SI joint is what sets off sciatica. When the joint and surrounding tissue become inflamed, that inflammation can irritate the sciatic nerve running nearby, so you end up feeling SI joint pain in your low back and sciatic pain traveling down your leg together.
What Causes SI Joint Pain in Pregnancy?
SI joint pain is caused by irritation of the sacroiliac joints.
Your pregnancy is putting those joints through a lot of change at once, and the irritation builds when your body doesn’t have the strength to manage all of it.
Here are a few different factors contributing to it:
- Increased relaxin loosens the ligaments holding your pelvis together, which is the most common driver of sacroiliac joint pain during pregnancy
- Your posture shifts as your belly grows, increasing the arch in your lower back and changing how your pelvis and sacrum sit
- Your growing baby adds pressure to your lower back and pelvic joints
- Your abdominal muscles stretch and weaken, so they stop giving your pelvis the support they used to
- Your gait changes into what people call the pregnancy waddle, which alters how your pelvis moves
- Muscle imbalances mean one side picks up the slack, and your SI joint takes on more strain
Overall, your joints are getting less stable, and your muscles are often getting weaker. At the same time, your body is asking those joints to carry more. This is the root cause of SI joint pain during pregnancy.
Pelvic floor physical therapy can help your muscles get stronger and reduce SI joint pain.
How to Help SI Joint Pain in Pregnancy
The fastest way to feel better is to get stronger.
But if you build strength on a joint that’s sitting in a poor position or surrounded by imbalanced muscles, you’ll still hurt, because the joint is still taking friction and irritation right where it sits, and it still doesn’t have the stability it needs to offload that force.
First, you need to correct posture asymmetries. Then, you need to address the muscle imbalances that are pulling your pelvis out of alignment.
Once the joint is in a good position, it’s time to build the stability that lets your glutes, deep core, and pelvic floor take the load off it.
Pelvic floor physical therapy walks you through all of it, and it’s what I teach in my program, Strong Expecting Mama!
You can also use these tips to manage SI joint pain in the meantime:
- Ice packs bring down inflammation and calm an angry joint
- Heat increases blood flow and relaxes the muscles around your SI joint
- An SI support belt gives your pelvis extra support and can make walking and standing feel more manageable (take a look at my Favorites page to see my favorite brand!)
- Stretching can feel wonderful in the moment (but doesn’t fix the root cause!)
At the same time, try to:
- Avoid standing on one leg, which puts your whole body weight through one SI joint at a time
- Sit down to put your socks and shoes on instead of balancing on one foot
- Use the log roll to get out of bed, rolling onto your side first, then pushing up with your arms while your legs swing down together
- Stop crossing your legs when you sit, and keep your weight even on both hips
- Take stairs one at a time if the alternating pattern flares you up
However, remember that the tips above are for managing SI joint pain. They don’t fix the root cause. To treat SI joint pain and get lasting relief, you need to correct the asymmetries and imbalances in your pelvis first, then build strength and stability with pelvic floor PT exercises, like the ones that I’m sharing below!
5 SI Joint Pain Pregnancy Exercises to Try
These are the exercises I use with my pregnant patients in the clinic when they come in looking for SI joint pain relief. You’ll just need a small ball, a chair, and a dumbbell or kettlebell!
1. Child’s Pose Inhibition
- Start on your hands and knees with your knees out wide.
- Walk your hands forward and bring your elbows in close to your knees.
- Sink your bottom back toward your heels into a modified child’s pose.
- Widen your knees more if you need more room for your belly to so your bottom can reach your heels comfortably.
- Inhale through your nose and send the breath into your upper, middle, and lower back.
- Exhale through your mouth.
- With each inhale, open up your back a little more.
2. 90/90 Hip Lift
- Lie on your back with your feet up on a chair, hips and knees both bent to 90 degrees.
- Place a small ball between your knees.
- Push your low back down into the mat and lift the tip of your tailbone up, so you’re in a posterior pelvic tilt.
- Hold that position throughout.
- Inhale through your nose and breathe into your side ribs.
- Exhale through your mouth and let your ribcage drop down toward the mat.
- As you exhale, engage your hamstrings by digging both heels into the chair and gently squeezing the ball with both knees.
3. Quadruped Straight Leg Hip Stabilizer
- Get on your hands and knees, with your hands under your shoulders and knees under your hips.
- Extend your right leg straight out behind you.
- Lengthen through that leg and squeeze the glute on that side.
- Lift the leg off the ground.
- Rotate it across your body and tap the toes down to the floor on the other side.
- Lift the leg back up and reach it across again.
- Keep your hips level by engaging your core and glutes and keeping your pelvis still while the leg moves.
4. Side Plank Hip Abduction
- Lie on your right side with your right elbow directly underneath your shoulder.
- Bend your bottom knee and keep your top leg straight.
- Inhale through your nose.
- Exhale as you lift your right hip off the ground and lift your left leg up at the same time.
- Keep your top foot parallel to the floor as it rises, lifting with your whole foot instead of leading with your toes so you feel your outer hip engage.
- Hold at the top for a couple of seconds.
- Slowly lower back down.
5. Staggered Stance Romanian Deadlift
- Grab a heavy dumbbell or kettlebell and stand on your left leg.
- Kickstand your right foot behind you, up on the toes, with most of your weight on your left leg.
- Inhale as you hinge at the hips and reach the weight down toward your left knee, then your left shin.
- Reach cross-body, so the weight travels toward the outside of your left leg.
- Go as far down as feels comfortable for you so you feel a stretch and lengthening on your left glutes.
- Exhale as you slowly stand back up.
SI Joint Pain Pregnancy Stretches: Do They Work?
Not really.
Stretching feels good! It can make SI joint discomfort feel better and relieve pain for a little bit. But stretching doesn’t address what’s causing SI joint dysfunction, and it doesn’t provide pelvic stability.
Your SI joint hurts because your ligaments are loose and your muscles can’t support the load being asked of them. Stretching just makes tissue even longer and looser, which feels nice in the moment, but doesn’t create any meaningful change in your body.
Strength is what you’re missing.
When your glutes, deep core, and pelvic floor start carrying their load, your pelvis and SI joints stop getting overloaded, and the pain decreases. If you don’t know where to start, try these strengthening exercises:
FAQs
Does SI joint pain go away after pregnancy?
Sometimes. Many women find their SI joint pain eases up shortly after delivery. It’s not that their ligaments tighten back up right away, because that takes much longer, but the weight comes off the joints quickly once the baby is out, and that alone brings a lot of women relief.
But at the same time, research shows that for some women, SI joint pain can persist even two years postpartum. If there were imbalances in your pelvis and the surrounding musculature before pregnancy, along with underlying weakness, your joint is still being asked to handle more than it can during postpartum recovery, which often aggravates SI joint pain.
How to sleep with SI joint pain in pregnancy?
You can try sleeping on your side with a pillow between your knees. This position keeps your hips stacked and stops your top leg from dragging your pelvis into a twist. You can also use the log roll to get in and out of bed instead of twisting.
When does SI joint pain start in pregnancy?
Most women start feeling it in the second trimester, and it tends to peak in the third. This is because your center of gravity shifts forward with your growing baby and often adds more arch to your low back, your abdominal muscles stretch and lose some of their ability to support your pelvis, and relaxin is loosening your ligaments more and more. That said, it’s also possible to feel SI joint pain during your first trimester, especially as hormones ramp up.
Get Stronger and Get Rid of Pain with Strong Expecting Mama
Strong Expecting Mama is my pelvic floor physical therapy program for pregnancy.
It gives you safe, pregnancy-appropriate core and pelvic floor exercises, in-depth education on what’s happening in your body, and access to me for your questions as you move through the program.
It’ll help you:
- Get relief from SI joint pain and other pregnancy discomfort
- Build strength and stability in your pelvis, core, and glutes
- Prepare your core and pelvic floor for labor & delivery
- Build a healthier foundation for your postpartum recovery
The program is fully online, so you can do everything at home on your own schedule instead of having to schedule PT appointments months in advance or drive there.
Plus, it’s a fraction of the cost of a single appointment!
Join Strong Expecting Mama and start building more strength and stability during pregnancy and beyond!
