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Exercise Strategies to Correct Sacroiliac Joint Dysfunction & Lower Back Pain

Written by: Nick Jack
Category: 2014
on 12 August 2020
Hits: 4019

If there is one thing I have learned in my 16 years as a trainer it is to never assume people are the same and always use assessments and tests to guide you when designing an exercise program. When it comes to back pain this is very important to remember, for it is very easy to fall into the trap of assuming all these injuries are the same and using exercises that actually exacerbate their injury instead of correcting it.  Most of the lower back pain cases I see are what we classify as “flexion related” that usually end up as bulging discs or sciatica type injuries. The lesser known and not as common lower back injuries are the “extension related” cases and this is where we come across the sacroiliac joint (SIJ) problems. What we must understand is that the exercises that may work perfectly with the bulging disc injury may make things worse for the person with SIJ problems. In this article I am going to share with you some of the key things to understand about working with this type of problem and how you can correct it with specific exercise strategies.

The quote above is something that is very important to remember with ALL types of back pain. The reasons the lumbar spine either flexes or extends too much will vary from person to person but they end goal of ever program is to maintain movement in neutral.

What Is The Sacroiliac Joint & What Does It Do?

Before we jump right into the exercise corrections it is important to understand where this joint is and what its purpose is. I always find this is important to tell people what a certain muscle does or how a particular joint is supposed to function before giving them a set of exercises and stretches. When I explain to someone how it works, and what it is designed to do, I find they take more responsibility for the exercises I provide them and see a greater reason for sticking to the plan.

This also prevents people from going to You Tube and Google to find their own exercises and making things up as they go for they know the name of the muscle or joint but have absolutely no idea how it works. The people who do this end up in a constant state of confusion as they find countless videos and articles with conflicting ideas and methods.

The SIJ’s main responsibility is to transfer the weight of the upper body to the lower limbs. The joint as a result is very strong, so it can effectively support the entire weight of the upper body. We all have two sacroiliac joints, one on the left and one on the right, that often match each other. The stability is maintained mainly through a combination of bone structure and very strong intrinsic and extrinsic ligaments.

Like many other people I tend to think of the SIJ as a “shock absorber” as it helps to cushion the stress placed upon the lumbar spine and the discs.

Now that you have a better understanding of where it is and what it does, let’s look at some of the problem associated with this joint and what you can do about it.

Why Walking & Standing Hurt With SIJ Dysfunction

With most cases of back pain I often suggest walking as a great way to alleviate some of the pain and a great way to reset the core. And in most instances this is a great form of movement for a person with back pain, except for the person with SIJ pain. Walking and even standing can be very painful and elevate their symptoms!

Why?

This has a lot to do with the GLUTEUS MAXIMUS and the POSTERIOR SLING.

If a person has developed significant weakness within the gluteus maximus and the posterior sling they will be unable to generate the necessary hip extension needed to complete the gait cycle. To compensate for this, the body uses a reverse method of hip extension by using the lower back muscles (erector spinae) to extend the hip instead of the glutes.

To assist in this process the body will also increase activity in the contralateral latissimus dorsi and the hamstrings to assist with stabilisation of the leg during the single leg stance of walking. All of these compensations lead to more force being applied to the lumbar spine as it is compressed into extension. Over time this excessive force leads to the SIJ being crushed with high loads and eventual pain.

The forces on the SIJ is even greater during certain movements as the hip and pelvis are subjected to greater load to provide movement. The simple movement of standing on one leg increases the weight on the hip by 2.5 times your own body weight and walking upstairs increases by 3-4 times! Running and jumping can be as much as 8-10 times your own body-weight being forced upon the hip and pelvic region.

If the muscles in this area are not functioning correctly the SIJ will be compressed.

What Causes The SIJ To Become Unstable?

As I have stated in so many articles and videos before this always comes back to two critical factors.

  1. Lack of movement from inactivity
  2. Poor movement and coordination
  3. Weakness of the gluteus maximus

Inactivity leads to atrophy and weakness of our muscles and exposes joints to instability as there is no longer any support. The body is forced to react to this by coming up with an alternative strategy and it uses a method we call stiffness. Certain muscles are prone to laziness and weakness whereas others are the exact opposite and prone to overworking and becoming tonic. The longer you remain inactive you force your body to design more compensatory patterns to protect itself.

Guess what the gluteus maximus muscle is more prone to?

That’s right, laziness and weakness. And as we have just discussed this is a disaster to your hip and pelvic region, and eventually your SIJ as it is left to take all the load.

The older you are the more important it is to remain active and use strength training to preserve muscle strength. We lose muscle very fast as we age and inactivity can creep up on you very quickly.

You can read more about this in the article – How quickly we lose muscle from inactivity

The second major reason for SIJ dysfunction is poor movement.

This is where we see poor coordination within movement patterns like bending, squatting, lunges, and single leg stance. As with the bulging disc injuries I so often see, I would rate the bending pattern and the single leg stance as the two main areas of concern. And funnily enough both of these patterns require massive activation of the entire glute region.

Observe the poor use of the hips seen in the pictures below.

  • The first picture on the left demonstrates poor hip extension exposing the spine to excessive flexion. 
  • The middle picture shows excessive glute squeezing forcing the spine into extension and also ruining hip centration.
  • The third picture on the right demonstrates poor control of the hip in single leg stance.

All three of these examples are where glute weakness is present along with movement dysfunction and pelvic weakness.

It is impossible to generate glute strength if you move into posterior tilt as the anterior tilt is essential for loading the glutes. Too much anterior tilt is also a problem, but often this a reaction to the weakness as we discussed earlier. Learning how to hold the pelvis in neutral is vital for your body to have a solid foundation to use the powerful muscles of the hip.

This brings us to the third factor being weakness at the glutes.

Most people would think you just need to go and smash out a stack of glute exercises and the problems are all fixed. It sounds logical right? Unfortunately it is not as easy as that, for if you do not use exercises that reinforce good movement your efforts can backfire on you and cause other problems like butt gripping and hip impingement. More on this shortly.

Most of the isolated glute exercises used to strengthen these muscles target hip extension and hip abduction. What most people fail to understand is that there are actually three parts to the glutes that are used simultaneously in a movement like walking and running.

To effectively strengthen the glutes you must use exercises that performs these three key functions in order to restore optimal movement. The exercise needs to stabilize the hip, act as a hip rotator, and lock the head of the femur into the socket, creating a very tight and stable hip joint during gait. This prevents the ball and socket joint from rattling around during walking and running.

The strength is of no importance to the body if it does not relate to a movement pattern. 

What exercises should you use? Where do you start?

Breathing & Basic Pelvic Stability

Before I do any deadlifts or single leg work I will spend considerable time learning basic stability and correct breathing patterns to ensure my body can hold a neutral pelvis. Remember, strengthening is of no use to you if your stability is compromised.

This is the easiest place to start and really ensures that you know how to create stability at the pelvis using your abdominal muscles and not your hips. The videos below teach you how to activate your inner unit stabilizers in a series of very simple floor based drills. These are fantastic video to watch as I explain exactly how to find neutral, how to brace your core correctly, and then how to ensure it remains in neutral during simple movements. The second video to the right explains how valuable a stick placed on your spine can be when trying to learn how to remain in neutral.

These exercises set the base for you to build upon where you can introduce the more challenging exercises that will strengthen the gluteus maximus. This stage must precede the strengthening.

I suggest to read these articles for more about breathing and hip/pelvic stability.

Strengthening Gluteus Maximus

This can be very challenging and you may find you make many mistakes during this process which is fine. Once again I will start with basic exercises before progressing to the standing up movements that will make the biggest difference. If you rush the process or skip steps you will pay a price for this later on.

Below is a one page checklist you can download with all you need to know about glutes.

Without doubt the most effective floor based exercise and my “go-to” movement in the early stages is horsestance. This is a popular exercise with most core programs and is used by therapists all over the world for all types of back pain. This is actually one of Dr Stuart McGill’s “Big 3” exercises featured in his book “Back Pain Mechanic”.

This reason this exercise works so well for activating the glute max is that it provides you with complete control and added stability of your pelvis to generate hip extension. The four point position is the most stable position for the hip and also the shoulder allowing you to use your glutes to their full potential without stability being compromised. However, by far the most advantageous part about this exercise is that it reduces any compression into the SIJ as you are horizontally loaded.

Adding a cable or rubber tubing to the foot forces much more strength and core stability than just a bodyweight exercise and to gain full value of the exercise you must do this.

The second exercise is the single leg hip extension and this is a fantastic test to use to reveal any hidden weakness or compensation. This is a lot harder than it looks, and I suggest to have a partner help you with this to guarantee you do it correctly. This is a great way to ensure you maintain a neutral pelvis throughout and avoid any shifting laterally.

You should feel a strong contraction in the glute area in combination with your core bracing the just prior to your lifting the foot off the ground. This is where you often see the person shift to one side before they even lift the foot. This indicates poor stability. It is hard to confirm that it is only the glutes at fault here for it could be several reasons for this. But one thing is for certain is if that happens on this exercise it will be much worse on the more complex standing ones about about to come. Do not progress any further until you pass this test.

You should be able to do at least 5 reps on each side without any compensation. If you start to feel the contraction moving out of the gluteals into the hamstrings, and maybe even cramping the hamstrings, it’s time to rest, as this is a sign that your butt is fatigued.

We are now at the point where I would introduce the standing exercises and this is where you will make the biggest difference. One of the best ways to do this is with the deadlift exercise, in particular, the Romanian deadlift where the hips are predominately used. The deadlift is by far the most effective exercise for correcting all types of hip and lower back dysfunction and it has a lot to do with HOW you complete the movement. 

For more detail on the various version of the deadlift make sure you read this article - Which Deadlift Version Is Best For You

In some cases people were already using the deadlift when I first met them, and some were lifting incredible loads too, but their technique was the big problem. I had to encourage these people to "sit back" with their hips and lengthen their butt. This allowed the head of the femur to glide deep into the acetabulum as it is meant to for optimal stability and centration of the joint.

When they were about to lift the best instruction was to say "push the ground away" and "stand tall" as opposed to squeeze your glutes hard. Standing tall is a great way to encourage the position that lengthens the body into its optimal stabilizing position.

*NOTE: It may be necessary to use blocks to assist finding neutral pelvic and spinal position.

Why People with FAI Hip Impingement Are Likely To Have SIJ Problems

I mentioned earlier there is a real danger in completing glute strengthening exercises poorly or even excessively. Quite often I see people who have SIJ problems also have FAI (femoral acetabulum impingement) more simply known as hip impingement. Both of these injuries are linked to serious problems at the glutes and in many cases the strategies a person uses to correct the SIJ injury leads to the progression of the hip impingement.

Cues to over-activate the glutes at the end range and squeeze hard during deadlift and hip extensions have a direct impact on your ability to centre the head of the femur within the hip socket. Take a look at the picture below where the image on the left (a) has the head of the femur right in the middle when you lift your leg. The picture on the right (b) shows how the head of the femur is unable to stay in the centre of the socket when you lift your leg and begins to move forward and eventually pinch the front of the hip.

If this faulty movement is not addressed soon over the course of time it will continue to worsen and create damage to the hip joint. The tightness in the front of the hip becomes a sharp pain that will radiate into the groin. Squatting in the gym can go from being your favourite exercise to the most painful and even lifting your leg to put your pants can become a problem.

Now you will have a serious problem on your hands as you will not be able to strengthen your legs at all! While it is important to strengthen the glutes you must pay attention to perfect technique and avoid the excessive squeezing and poor choices of exercise.

Watch the video below about butt gripping to see examples of this.

Integrating Movement & the Posterior Sling

Once you have started making progress with the deadlift it is time to progress to the single leg stance and integrate with the upper body. Remember the SIJ’s purpose is to transfer the weight of the upper body to the lower limbs so in order to finish the job we must use exercises where this role is performed.

The single leg stance will activate the glutes much more effectively than the bilateral stance of the deadlift. We needed to use the Romanian deadlift earlier to educate how to move the hips into extension without compromising stability of the lumbar spine, but to take the glutes to the next level we must use a single leg stance.

Once again I start with very simple exercises before progressing to much harder ones. The first one I like to use is the Toe Touch Drill shown below. The video to the right explains why the arm swing is also a critical component to hip stability that reduces the compression forces being pushed into the SIJ.

There is 3 key things I look for.

  1. Poor leg alignment - You should have a straight line from the ankle, knee and hip. Any deviation in this indicates there could be weak glutes and foot stability. It could also be a result of tight hips and ankles. Or it could be all of the above. With more testing and close observation you can begin to narrow the energy leak to where the real problem lies.
  2. Poor postural alignment – This indicates there may be poor abdominal and pelvic stability and thoracic stiffness.
  3. Poor range of motion - This indicates lack of strength with the stance leg and possibly lack of mobility in the moving limb with the hip.

Once you master the toe touch drill it is time to move to the single leg deadlift or single leg squat. Both of these exercises require considerable strength and stability and will test most people to the limit of their ability. While it is very similar to the toe touch drill, the main difference is now you trying to use your ankle and knee significantly more forcing greater activation of many other muscles.

Both of these exercises are rated as the king of glute exercises by most trainers and sports coaches all around the world. I have placed a video of each below so you can see them in action and perfect your form.

Now that you have the single leg stability down and you will have increases your strength considerably by this stage we can finally integrate the upper body by using the posterior sling. To refresh your memory this is where the glute max of one hip works with the latissimus dorsi of the opposing side to create tension in the lower back region called the thoracolumbar fascia. The action of these muscles along with the fascial system is to prevent rotation of the pelvis when we walk and enable you to store energy to create more efficient movement.

Posterior Sling Examples

Below is a video with examples of four exercises I might use to enhance this sling. The second video to the right provides you with a detailed explanation of all the four slings of the body.

Do Not Ignore How You Move During the Day

Before we wrap this article up I would like to stress one more very important point. One of the most important things I try to teach people from the very first session is how important it is to change HOW they move during the day.

Sometimes we can get caught up in prescribing exercises and thinking of all the corrective strategies and forget to really drill home to the client that they must change how they move in life. I used to spend huge amount of time providing home exercises, stretches, stability drills for the client to do and after a few weeks the person had not changed much with their pain.

Why?

In 99% of these cases the trigger that is causing their pain was still at play and I had not educated them as to what these were and what to change it to. In almost all cases it is a DAILY ACTIVITY they think nothing of. Any of the corrective work we have done in the gym is instantly wiped out when the person continues to move with poor postures, motions and methods they had before.

Dr Stuart McGill refers to this as "picking the scab" where if we cut ourselves our body will form a scab to heal the wound. If we keep picking the scab off every day the wound will never heal, if anything it will become infected and progress to a more serious problem.
This is a great analogy and exactly how I explain to people why it is so important to practice the exercises I show them that will change their movement. It also reminds them to become aware of how often they move poorly during the day.

Pay attention to how you sit, how you walk, how you sleep, how you stand and all the little movements of bending and standing and try to change them to the movement you are practiceing in your exercises. If you can do this you will go a long way to making all your efforts a permanent change.

To read more about this check out the article – Getting rid of back pain is all about moving well

Do You Need More Help?

Before jumping straight into a corrective program make sure you have seen a qualified Health professional for an accurate diagnosis and assessment of your condition. I cannot stress this enough as self-diagnosing can potentially lead to more problems. We often refer out to Doctors, Chiropractors, and Physiotherapists before implementing our program to know exactly what we are dealing with. Being certain on where to start is crucial to the success of the program.

If you have seen a health professional and are now looking at implementing a series of exercises and stretches this article will provide you with many great ideas on how to do this. As many people struggle to implement this into a gradual progression I created a detailed step by step program called Back Pain Secrets that includes a 85 page Ebook and 90 minute video with exercises, stretches, mobilizations and in an easy to follow format. This can be done at home or in the gym and we cover everything about your condition in great detail from eliminating the cause to best strength exercises, even nutrition to speed up the healing process!

Click here or on the image below to get a copy.

Summary

There is no doubt sacroiliac joint pain can be very painful and can disrupt your entire life. Simply resting or using anti-inflammatory medication is not going to do anything. While stretching can help to some degree it will not resolve the underlying problem which is always how you move, and the weakness in the glutes and abdominal stabilizers. By implementing many of the things we have discussed in this article you will go a long way to finally restoring your body to normal and getting out of back pain for good.

For more ideas and information on specific topics I may not have covered in detail be sure to check out our INDEX PAGE on the website that has over 200 of our best articles. These are all sorted into categories for quick reference so you can find what you are after more easily.

If you do need specific help with your exercise program please feel free to reach out to me for help and we can set you up with your individualised program.

About The Author

Nick Jack is owner of No Regrets Personal Training and has over 15 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specialises in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.

References:

  • Functional Anatomy of the Pelvis and the Sacroiliac Joint - By John Gibbons
  • The Vital Glutes - By John Gibbons
  • Movement - By Gray Cook
  • Corrective Exercise Solutions - by Evan Osar
  • Back Pain Mechanic - by Dr Stuart McGill
  • Diagnosis & Treatment Of Movement Impairment Syndromes - By Shirley Sahrman
  • Low Back Disorders - by Dr Stuart McGill
  • Ultimate Back Fitness & Performance - by Dr Stuart McGill
  • Core Stability - by Peak Performance
  • Athletic Body in Balance - by Gray Cook
  • Anatomy Trains - by Thomas Meyers
  • Motor Learning and Performance - By Richard A Schmidt and Timothy D Lee
  • Assessment & Treatment Of Muscle Imbalance - By Vladimir Janda
  • How To Eat, Move & Be Healthy by Paul Chek
  • Scientific Core Conditioning Correspondence Course - By Paul Chek
  • Advanced Program Design - By Paul Chek
  • Twist Conditioning Sports Strength - By Peter Twist
  • Twist Conditioning Sports Movement - By Peter Twist