SI joint pain. I remember it all too well!  I experienced it during the last part of all three of my pregnancies.  It can literally make staying active during your pregnancy a pain in the butt!!

So that you can keep up with your workouts and continue feeling strong, I want to talk about ways in which we can try to relieve that annoying pain both during and after pregnancy.  We will cover a few ways to relive SI joint pain both during and after pregnancy; but first, a little anatomy lesson…

What and Where is the SI joint? 

The sacroiliac joints are very strong joints made of thick ligaments and connective tissue.  These joints connect the sacrum (triangular bone at the bottom of the spine) with the pelvis (iliac bone that is part of the hip joint) on each side of the lower spine. They help to transmit weight and forces between the upper body and legs as well as act like shock-absorbing structures for the body.  You can locate your SI joints by looking for the little dimples on the inner edge of each buttock.

During pregnancy and early postpartum (or as long as breastfeeding continues), we have a lot of hormonal fluctuations going on within the body, causing the connective tissues and joints to be a bit looser and less stable than normal.  This can cause pain and discomfort to flare up big time within these joints.

Because the joints of the pelvis are a bit looser, another thing that can occur is that the muscles around the pelvis will try to pick up the slack, so to speak, and become shortened and tight in order to create more stability for the pelvis.  Oftentimes, the piriformis muscle is one of those muscles that works to pick up the slack. It can become chronically tight and inflamed both during and after pregnancy.  When the piriformis is tight and/or inflamed, it can cause flair-up in the sciatic nerve. 

Lastly, something else that can play a role in your SI pain during pregnancy is that baby may be in a low position and putting pressure on the sciatic nerve.  This is much more common the further along you are in your pregnancy.

SI joint pain can be felt in the lower back, hip, glute, and backside of the upper-leg region. Stretching the lower back, upper legs, and hamstrings, and opening up the hips will help relieve pain and tension.  It’s also incredibly important to keep up with our strength training both during and after pregnancy so that we can offset the instability that is happening in the pelvis (by creating more stability through strength training).

If you are currently dealing with SI pain, let’s go over some stretches, exercise programming pointers, and everyday solutions to help relieve the pain and discomfort, and get you feeling more like yourself.  Just keep in mind though that not all of these stretches and pointers will necessarily work for everyone.  They can even make the issue worse in some cases.  Just be sure to consult with your healthcare provider before trying any these moves.

 

II.  Stretches to Relieve Sciatic Pain

 

A.  Soft Tissue Hip Release

This one was created by Jill Miller, author of The Roll Model and co-founder of Tune Up Fitness Worldwide.  You will need a pair of Yoga Tune Up balls or something similar to it.  This exercise will take you a few minutes to perform:

1. Roll over onto your back. Place your Yoga Tune Up balls on your SI joint (those dimples that we talked about earlier).  Go ahead and prop yourself up on your forearms if you feel too uncomfortable being flat on your back.
2. Now begin to slowly shimmy your hips from side-to-side and along the piriformis muscle. You will find that your glutes will push the balls out of position.  Just go ahead and reposition them underneath your SI joints again.
3. You can drop one knee out to the side as you shimmy the balls back and forth to get deeper into the piriformis muscle. Continue to slowly shimmy the balls back-and-forth against your pelvis for about 2-3 minutes.

 

 

B.  Elevated Pigeon Stretch

I love the pigeon stretch to really help open up the hips and stretch the glutes/piriformis. This one is great for pregnant mamas who are farther along in pregnancy and may be finding it difficult to get in-and-out of stretches (because of the belly).  It’s also good for those who just simply don’t have the mobility and flexibility to get into a full blown pigeon stretch. 

1. Get as close to a table or high box as you possibly can with your supporting leg. Lift your opposite leg up onto the table and bend it at a 90 degree angle. Inhale, then exhale, and hinge forward from the hips as much as your body will allow.  Stay in this stretch for 2 minutes on each side.

 

 

1. Another option is to try the double pigeon pose where you are seated on the ground and have one leg stacked on top of the other one. Again, inhale first, and then exhale and hinge forward at the hips.  Stay in the position for 2 minutes and then switch legs.  DO NOT force the stretch.  Make sure that you are sitting with your tailbone untucked.  You may need to sit on a pillow or blanket to untuck the tailbone.

 

 

 C.  Elevated Hamstring Stretch

Tight hamstrings can also contribute to lower back and hip pain.  We also need to stretch the other muscles surrounding the piriformis. 

1. You will need a tall box or table for this one as well. Back away from the box a bit and then extend one leg directly out in front of you.  Keep your hips squared towards your elevated foot.  Inhale and then exhale, and hinge forward from the hips as much as you can.  Let your hands rest on either side of your leg.  Keep your foot flexed.  Stay in this stretch for 2 minutes on each leg.  If you are pregnant, you may need to accommodate the bump and angle yourself away from the table and turn out the foot of your supporting leg.

 

 

D.  Lat Stretch and Hip Opener

This stretch will not only help to open up your hips; it also helps to open up your inner thigh and back as well. 

1. Set yourself up similarly to the elevated hamstring stretch. This time, however, you will move closer in towards the table or box.  Have one leg elevated on the table with the foot flexed. Move your hips away from the table a bit.  Inhale and then exhale, and hinge over towards your leg on the table, reaching over the table with your outside arm.  Make sure that you keep your hips squared and your chest open, but not thrusting the ribs up.  Relax and hold on each side for two minutes.

 

 

1. You can also perform this exercise seated on the ground. Just make sure that you are not sitting on your tailbone.

 

 

 

II.  Programming Considerations

 

 A.  Get Your Alignment Right

While I’m putting this under programming considerations, getting your alignment right is something that I want you to keep in mind for everyday life, not just when you are in the gym.  What do I mean by alignment? Alignment is how your body is stacked on top of itself -especially how the bones of your torso are stacked on top of one another. Get your rib cage to sit overtop of your hip bones, let your upper body sit in front of your glutes, and get your glutes to be behind the rest of your body.

During pregnancy, your posture will take on some changes to accommodate for that growing belly.  It can be extremely common for pregnant mamas to allow their glutes to tuck under as a way of compensating for the extra weight sitting in front and pulling their frame forwards.  This causes the upper body to shift back behind the glutes, which causes the pelvis to be tucked under even more.  This posture shift can also happen postpartum (since we have a tendency to carry baby out in front of us a lot)!

Do your best to avoid carrying your baby out in front. Allow your glutes to relax and keep the tailbone untucked.  This will place less stress on the lower back and pelvis, as well as set the glutes up in a more optimal position to support the pelvis.

B.  Focus On Your Breathing

Breathing. Sounds simple enough, right? However, it is a common mistake for women to overlook the importance of proper breathing while working out.  We need to make sure that we are breathing well during exercise to help create more stability in the core and manage intra-abdominal pressure to protect the muscles of the core and pelvic floor, as well as our pelvic organs (this is especially important for prenatal and postnatal mamas!).

When we exhale, the muscles in our deeper core recoil and contract to produce stability through the pelvis and spine.  So, we want to be sure that we are both inhaling AND exhaling during each repetition of exercise.  We generally want to be exhaling on the hardest part of an exercise (i.e. standing up out of a squat or the bottom of a deadlift) to provide more support to the pelvis. 

However, this doesn’t always feel as comfortable for women, or it doesn’t feel as supportive.  So, there are a few ways you can play around with your breathing and see which method feels best for you:

1. Let’s continue with our squat and deadlift example. Inhale as you are lowering down into a squat or deadlift. Then as you go to stand up out of these exercises, start to exhale and continue exhaling until you finish the lift.
2. If you feel like you might need a bit more support, then exhale as you both lower into and stand up from the squat or deadlift. At the top of each of these movements, take an inhale breath and then continue on with your next repetition.

C.  Should I Continue Strength Training Or Walk Instead?

I am a big fan of leisurely walking, especially during postpartum. This helps lower those stress hormones.  Leisurely walking can also be a very effective and gentle method of aerobic conditioning for pregnant mamas -for the most part.  However, when you are experiencing nagging SI pain during pregnancy (as I did and as some of my coaching clients have), leisurely walking doesn’t always feel so great.  Women begin to “waddle” late into pregnancy, which causes a lot of shearing forces on the SI joints, thus ramping up SI joint pain.

If walking continues to feel fine for you as you progress into your pregnancy and early on postpartum, then by all means keep up with it.  However, if you are experiencing a lot of SI pain after walking around for long periods of time, then let’s back off on the total amount of walking you are doing at one time.  Focus more on your strength training sessions; they can often be less irritating for your SI joints.  One more note: Be mindful about how you are feeling through your SI joints while doing any sort of hinging, split stance, or single leg work (these can sometimes be more irritating on the joints).

D.  Work Those Glutes -But Not Too Hard

I’ve mentioned before that during the top of any squatting or hip hinging movements (e.g. deadlifts, glute bridges, hip thrusts), I want you to be using your glutes to help you fully extend the hips. 

When I say use those glutes to help you extend the hips, I want you to think of squeezing the glutes to stand tall and opening the hips all the way.  What I don’t want you to do is squeeze the glutes so hard at the top of these movements that your tailbone then tucks under and the pelvis goes into posterior pelvic tilt.  Another cue that might help you is to be sure that you let your glutes stay behind the upper back at the top or end position for these movements.  Don’t place extra stress and force on the pelvis and lower back by overextending through the hips and excessively squeezing the glutes.

 

 

E.  Resistance Bands/Mini Bands For The Win

Another way we can load the glutes without adding more stress to the SI joints is to use mini bands.  Mini bands are small, flat, circular bands that you place either above or below your knees to provide some resistance.  If performing more of the traditional exercises like weighted squats, deadlifts, hip thrusts, and glute bridges irritates your SI joints, then there are a few things you can try:

• Try placing a mini band around your legs either above or below the knees when your workout calls for the exercises I just mentioned above. Sometimes having the band around your legs will help provide a bit more stability to the pelvis by recruiting the glutes more and make these movements more comfortable for you.
• If this approach doesn’t work, then simply get rid of the weight and opt for using only the mini bands for these movements. Believe me. You’ll still get a great workout!  You can also use these mini bands to ramp up the intensity of other glute building exercises (e.g. clamshells and side lying straight leg raises).

 

Did you experience sciatic pain either during or after pregnancy?   What did you do to help relieve the pain?