Sacroiliac joint dysfunction is a common injury which is often misdiagnosed. The sacroiliac joints are formed in the posterior (back) of the pelvis between the sacrum and the ilium (your hip bones). It is a very small joint with very little movement, but when you have either excessive or lack of mobility in this joint it can lead to a lot of pain and discomfort. The pain is usually localized to one side of the sacrum (but can also be both) and may also cause alignment issues and discomfort at the pubic symphysis. The pain is usually aggravated by unilateral activities which increase load through the hip/pelvic region such as running, walking and climbing stairs.
Altered alignment at the sacroiliac joints leads to a functional leg length discrepancy where one leg will appear longer due to a rotation at the pelvis. It is often the result of asymmetries in muscle length and strength in the muscles surrounding the pelvis. This can occur from a number of things that alter your biomechanics when walking and running. Alignment at the pelvis can be corrected by a Physical Therapist and maintained with rehabilitation exercises addressing flexibility and strength.
Here are some basic alignment and strengthening exercises I use to help maintain and address issues in my sacroiliac joint and pubic symphysis so i can keep running!
1. For pubic symphysis alignment:
a. Lie on your back with your knees bent and soles of the feet pressing firmly into the ground. Place a yoga block (or foam roller, folded towel etc) between the knees. As you exhale, squeeze your thighs and knees into the block as you draw your navel in and up to activate your pelvic floor. Hold for 5-10 seconds and release. Repeat 3-5 times.
2. Pelvic floor and transverse abdominis activation:
a. In a kneeling position (option to also sit on a yoga block), sit up tall with hands placed on your knees. Draw the shoulder blades down and back and relax the shoulders. On your inhale relax the abdomen and muscles around the pelvis. As you exhale contract your transverse abdominis and pelvic floor by drawing the navel inward and upward (think about that motion of your navel to help activate the muscles). Continue relaxing and contracting as you breathe. Start out by trying to perform for 1 minute.
a. Lying on your back, bent both knees and walk the feet towards the glutes. Arms are by your sides. Knees are inline with 2nd/3rd toes. Knee stacked over ankle. Even weight through the toes and heel of each foot. Exhale as you engage the abdominals and lift the hips by pushing through the heels of the feet. Aim to feel this primarily in the gluteals. You will also feel some engagement through the quadriceps and abdominals and a slight stretch through the front of the hips.
4. Static lunges:
a. Sagittal plane (Anterior lunge): Start in a split stance 3-4 feet apart with the feet hip distance and pointing straight ahead. High on the ball mound of the back foot, front knee is bent. Bend into the front knee so it stacks the ankle ensuring hips stay aligned to the front. As you exhale, engage the abdominals and hold this alignment as you bend the back knee and sink the hips towards the ground. Push through the heel of the front foot to rise back up. Feel activation of your front glute and back quadricep.
b. Frontal/transverse plane (Curtsy lunge): Step your left foot back and behind the right (almost at a 45 degree angle). High on the ball of the left foot, right foot is pointing straight forward, hips are square to the front of the room. Slowly sink the hips towards the ground while maintaining hip alignment and abdominal engagement. The front knee should stay stacked above the ankle in line with the 2nd/3rd toes. Feel engagement of the front glute muscles.
Written By: Paula Lamont, PT, DPT, CAFS, RYT