The sacroiliac joint (a.k.a. “S.I.” joint) is located at the junction where the spine meets the pelvis. Pain in this joint is often described as a shooting, stabbing, and occasionally burning. Pain may be felt in the back of the pelvis, buttock(s), groin, or inner thigh(s). Pain typically worsens with activities such as standing on one leg, walking, stair climbing, prolonged standing, rolling in the bed, and/or getting up from a low chair.

The pregnancy hormone Relaxin is responsible for increasing the laxity (looseness) of ligaments in order to accommodate the growing fetus and prepare the body for childbirth. Consequently, increases in this hormone can lead to instability in the joints. This instability may be more pronounced in women with already existing hypermobility. The altered biomechanics and muscle imbalances that occur during pregnancy further contribute to the symptoms listed above. Approximately 16-25% women experience pelvic girdle pain (PGP) during pregnancy, with some studies revealing rates as high as 76%. It is estimated that 93% of women with pregnancy-related pelvic girdle pain experience recovery six months postpartum[1].

POSTURES RELATED TO SI JOINT SYMPTOMS:

• Excessive anterior pelvic tilt

• Shallow breathing with flared ribs

• Forward head posture

• Jaw clenching

• Butt clenching

• Supinated or pronated foot/feet

• Sway forward

• Sway to one side

ROLE OF PHYSICAL THERAPY

• Prevention of the symptoms

  • Maintain good breathing pattern

  • Shallow breathing is a sign of inefficient diaphragm function

  • Maintain the strength in the core, hip and pelvic floor muscles

  • Maintain thoracic mobility

  • Avoid sudden and drastic change in the footwear or supports

  • Avoid single leg standing exercises especially if the SI joint symptoms start to appear

• Treatment

  • Patient education regarding the condition and prevention of the aggravating factors

  • Assessment of the breathing pattern and teach appropriate corrections

  • Guide the patient in proper muscle balance around the SI joint. Due to altered biomechanics, some muscles need to be activated whereas some may need to be relaxed or temporarily shut down while doing particular movements.

  • Foot assessment with subsequent arch strengthening and foot mobility exercise as they can have an impact on the hips and thereby influence the SI joint.

  • Manual therapy in the form of myofascial release and muscle energy techniques (MET) may be beneficial.

  • Use of SI joint stabilization belts have been shown to improve the symptoms[2].

  • Heat or ice packs for local pain relief.

If you are experiencing similar symptoms, please get in touch with a women's health physical therapist. Together, we can make your pregnancy a comfortable experience.

-Ishi Upasani, PT, MS

References

1. Kanakaris NK, Roberts CS, Giannoudis PV. Pregnancy-related pelvic girdle pain: an update. BMC Medicine.

2. https://www.ncbi.nlm.nih.gov/pubmed/16214275