Sacroiliac (SI) Joint Pain: Finding Relief Through Pelvic Floor Physical Therapy

Overview

Sacroiliac (SI) joint pain develops when the joints connecting your sacrum (the triangular bone at the base of your spine) to your pelvis become irritated or dysfunctional. These small but mighty joints bear the significant responsibility of transferring forces between your upper body and legs while maintaining stability during movement. When they're not functioning properly, the resulting pain can significantly impact your daily activities and quality of life.

This condition affects approximately 15-25% of individuals experiencing chronic low back pain, making it a more common source of discomfort than many people realize. SI joint dysfunction can occur across all age groups and genders, but certain populations experience it more frequently. Pregnant individuals face increased risk due to hormonal changes that soften ligaments, with studies showing that up to 76% of pregnant people experience some form of pelvic girdle pain, including SI joint dysfunction. The condition also commonly affects athletes involved in running sports, individuals with physically demanding jobs, and those who have experienced trauma to the pelvis or spine.

Research indicates that people assigned female at birth are more likely to develop SI joint dysfunction, particularly during reproductive years and menopause when hormonal fluctuations affect joint stability. However, this condition also impacts people assigned male at birth, especially those involved in heavy lifting, contact sports, or following spinal surgeries. Age-related changes, previous injuries, and certain medical conditions can increase susceptibility regardless of gender.

Pelvic floor physical therapy plays a crucial role in treating SI joint dysfunction by addressing both the immediate symptoms and underlying movement patterns that contribute to joint stress. At Mendwell Pelvic Health, our specialized approach recognizes that effective SI joint treatment requires attention to the entire pelvic region, including the deep stabilizing muscles, breathing patterns, and movement coordination that support these vital joints.

Symptoms

Understanding SI joint dysfunction symptoms can help you identify whether this condition might be affecting your daily life. The pain and discomfort associated with SI joint problems often follow specific patterns that distinguish it from other types of back pain.

Primary pain symptoms include:

• Sharp, aching, or burning pain in the lower back and buttock area, typically affecting one side more than the other
• Deep pelvic pain that may feel like it's coming from inside your pelvis
• Discomfort that radiates down the back or side of your thigh, sometimes reaching the knee
• Pain that intensifies with prolonged sitting, especially on hard surfaces
• Increased discomfort when standing from a seated position or getting out of bed

Movement-related symptoms often involve:

• Difficulty climbing stairs or walking on uneven surfaces
• Pain when rolling over in bed or getting comfortable for sleep
• Discomfort during activities that require single-leg support, such as putting on pants or shoes
• Stiffness and pain that's often worse in the morning or after periods of inactivity
• A sensation of the pelvis "giving way" or feeling unstable during movement

Daily life impacts may include:

• Challenges with prolonged walking or standing
• Difficulty finding comfortable sleeping positions
• Pain that fluctuates throughout the day based on activities
• Increased symptoms during menstrual cycles or hormonal changes
• Discomfort that affects work productivity and exercise participation

For individuals who are pregnant or postpartum, SI joint dysfunction may also present as increased discomfort when walking, difficulty with weight transfer during movement, and pain that affects sleep quality and daily caregiving activities.

Causes

SI joint dysfunction develops through various mechanisms, often involving a combination of factors rather than a single cause. Understanding these contributing elements can help in both treatment and prevention strategies.

Biomechanical factors frequently play a central role in SI joint problems. Poor posture from prolonged sitting or standing, muscle imbalances between the left and right sides of the body, and altered walking patterns can all place excessive stress on these joints. Leg length differences, whether from birth or acquired through injury, create ongoing asymmetrical forces that the SI joints must accommodate. Previous injuries to the lower back, pelvis, or legs can also alter movement patterns in ways that overload these structures.

Hormonal influences significantly impact SI joint function, particularly for individuals with menstrual cycles. The hormone relaxin, which increases during pregnancy and menstruation, softens the ligaments that stabilize the SI joints. While this is beneficial during childbirth, it can lead to increased joint mobility and potential dysfunction. Menopause brings different hormonal changes that can affect joint health and muscle function, potentially contributing to SI joint problems.

Pregnancy and childbirth create unique stresses on the SI joints. As the body adapts to accommodate a growing baby, the center of gravity shifts forward, placing increased demands on the pelvic joints. The physical process of childbirth can further stress these structures, and postpartum recovery involves gradual return to normal joint stability while managing the physical demands of caring for a newborn.

Activity-related causes encompass both high-impact and repetitive stress scenarios. Athletes involved in running, jumping, or contact sports may develop SI joint dysfunction from repeated impact forces. Conversely, individuals with sedentary lifestyles may experience problems related to muscle weakness and poor movement patterns. Occupations requiring heavy lifting, prolonged standing, or repetitive bending can also contribute to joint stress over time.

Medical conditions such as arthritis, ankylosing spondylitis, and other inflammatory conditions can affect SI joint function. Previous surgeries, particularly spinal fusions that alter normal movement patterns, may place additional stress on the SI joints. In rare cases, infections can affect these joints, though this is much less common than mechanical causes.

How Pelvic Floor Physical Therapy Can Help

Pelvic floor physical therapy offers a comprehensive approach to treating SI joint dysfunction that goes beyond simply addressing pain symptoms. Our treatment philosophy recognizes that effective SI joint care requires attention to the entire pelvic region and its relationship to the rest of the body.

Comprehensive assessment and diagnosis form the foundation of effective treatment. At Mendwell Pelvic Health, we begin with a thorough evaluation that examines not just the SI joints themselves, but also the surrounding muscles, movement patterns, and functional activities that may be contributing to your symptoms. This includes assessment of your pelvic floor muscles, core stability, breathing patterns, and how these systems work together to support the SI joints.

Manual therapy techniques provide immediate relief while addressing underlying joint mechanics. Our skilled therapists use gentle mobilization techniques to improve SI joint mobility when joints are stiff, or stabilization approaches when joints are too mobile. These hands-on treatments can help reduce pain, improve movement, and create the optimal environment for healing. We also incorporate soft tissue techniques to address muscle tension and trigger points that may be contributing to joint dysfunction.

Targeted exercise therapy focuses on building the strength and coordination needed for long-term joint stability. This includes specific pelvic floor muscle training to improve deep core support, strengthening exercises for the muscles that stabilize the pelvis and spine, and flexibility work to address areas of tightness that may be creating imbalances. We design exercise programs that progress gradually and accommodate your current fitness level and lifestyle demands.

Movement retraining and education help you develop new movement patterns that protect your SI joints during daily activities. This includes learning proper body mechanics for common activities like lifting, bending, and carrying, as well as strategies for modifying work and exercise activities to reduce joint stress. We also provide education about positioning and posture that can help manage symptoms throughout the day.

Specialized techniques unique to our practice include integration of breathing pattern work with pelvic floor function, which can significantly improve deep core stability and joint support. We also focus on the connection between emotional stress and pelvic tension, recognizing that addressing both physical and emotional factors often leads to better outcomes.

Pain management strategies incorporate techniques for managing acute flare-ups as well as preventing future episodes. This may include education about activity modification, positioning strategies, and when to use heat, cold, or other comfort measures. We also teach self-management techniques that empower you to take an active role in your recovery.

The ultimate goal of pelvic health physical therapy for SI joint dysfunction is not just pain relief, but restoration of confident, pain-free movement that allows you to fully participate in the activities you value most. Treatment plans are individualized based on your specific symptoms, lifestyle, goals, and preferences, ensuring that your care is both effective and sustainable.

Frequently Asked Questions

How long does it typically take to see improvement in SI joint pain with pelvic floor physical therapy?

Many patients begin to notice some improvement within 2-4 weeks of starting treatment, though complete recovery timelines vary based on individual factors such as symptom duration, activity level, and adherence to treatment recommendations. Your therapist will provide realistic expectations based on your specific situation and monitor progress throughout treatment.

Can SI joint dysfunction during pregnancy be safely treated with physical therapy?

Yes, pelvic floor physical therapy is safe and highly effective during pregnancy. Treatment approaches are modified to accommodate the changing body and focus on techniques that provide relief while supporting the natural changes occurring during pregnancy. Early intervention can often prevent symptoms from worsening and improve comfort throughout pregnancy and delivery.

What's the difference between SI joint pain and sciatica, and why does this matter for treatment?

While both conditions can cause pain that radiates into the leg, SI joint dysfunction typically causes pain in the buttock and posterior thigh, while sciatica often extends below the knee and may include numbness or tingling. Accurate diagnosis is important because treatment approaches differ significantly between these conditions.

Will I need ongoing physical therapy sessions for SI joint pain, or can this condition be permanently resolved?

Many people achieve lasting relief from SI joint dysfunction with appropriate treatment and learn self-management strategies that prevent recurrence. The need for ongoing therapy varies by individual, but most patients transition to independent management with periodic check-ins as needed.

Can lifestyle modifications help prevent SI joint dysfunction from returning after treatment?

Absolutely. Your therapist will provide specific recommendations for maintaining joint health through proper posture, regular exercise, stress management, and activity modifications. These preventive strategies are often just as important as the initial treatment in achieving long-term success.

Is SI joint dysfunction more common after childbirth, and what can be done to address postpartum symptoms?

SI joint dysfunction can indeed persist or develop after childbirth due to the physical changes and stresses of pregnancy and delivery. Postpartum pelvic health physical therapy can effectively address these issues while accommodating the demands of caring for a newborn, helping restore function and comfort during this important transition period.