Pilates and Sacroiliac Joint Dysfunction

In the illustration above, the SI joints (highlighted in red) are at the base of the spine, connecting it to the pelvis. These joints bear body weight and help the spine and legs move together smoothly. Because they only tilt or glide a little, they provide stability to the lower back and help absorb shock during activities.

What Is Sacroiliac (SI) Joint Dysfunction?

“Sacroiliac joint dysfunction” usually means the SI joint isn’t moving quite right (for example, too much or too little movement) and is causing pain. In practice this often shows up as pain in the lower back or buttocks near where the spine meets the pelvis.  The discomfort may stay on one side or both, and can sometimes radiate into the lower back, hips, or even down the legs.  Many people describe it as pain or stiffness just above the buttock that worsens with standing, walking or certain movements. Common symptoms include:

               •             Pain in the pelvis, lower back or buttock (often on one side) that may spread to the hip or leg .

               •             Pain that worsens after sitting, standing or lying in one position for a long time.

               •             Stiffness or a “giving way” feeling in the hips or lower back, and sometimes morning stiffness.

               •             Discomfort that may feel similar to sciatica or a pinched nerve (i.e. shooting pain down the leg).

People with SIJ dysfunction often report that certain movements (like getting up from a chair or climbing stairs) aggravate the pain. The condition can be acute (sudden pain after an injury) or chronic (ongoing pain lasting months….and this is just my case 😊).

Causes: SIJ pain can come from many sources. For example, arthritis (wear-and-tear of the SI joint) or inflammatory conditions can damage the joint, causing sacroiliitis and pain.  A sudden injury or fall can strain the SI ligaments.  Pregnancy causes hormones to loosen pelvic ligaments and adds extra weight, which often leads to SIJ discomfort.  Even walking unevenly (due to a leg length difference, scoliosis, or hip injury) can overload one SI joint and trigger pain. In short, anything that stresses the joint (poor posture, one-sided standing, repetitive motions, high-impact sports, etc.) can eventually lead to SIJ dysfunction.

How Pilates Can Help SIJ Dysfunction

Pilates is a mind-body exercise system that emphasizes controlled movements, posture and core strength. Core muscles are the deep stabilizing muscles of the trunk – including the lower abdominals, back muscles and pelvic floor – and they play a key role in supporting the spine and pelvis.  Pilates specifically targets these muscles.  In fact, research notes that Pilates “mainly trains deep core muscles (including transversus abdominis, diaphragm, abdominal oblique muscles, multifidus, and pelvic floor muscles) to enhance core muscle strength and endurance… to increase spinal control and improve stability” . By strengthening these deep core muscles, Pilates helps the body hold the pelvis and spine in a more stable, aligned position.

Many people with SIJ problems benefit because Pilates:

               •             Strengthens core and hip muscles.  A stronger core (deep abdominals and lower back) and stronger glute/hip muscles help stabilize the pelvis, taking stress off the SI joint.

               •             Improves posture and balance.  Exercises focus on maintaining a neutral spine and pelvis.  Over time this can correct imbalances: for example, a study of dancers found that adding Pilates training reduced postural misalignments and participants reported better pelvic alignment and core stability.

               •             Enhances flexibility.  Pilates includes gentle stretches that relieve tight hips, hamstrings and lower back muscles.  Looser muscles allow the joints to move smoothly, easing pressure on the SIJ.

               •             Reduces pain and improves function.  Importantly, clinical studies show that regular Pilates can lower back pain levels.  For chronic low back or pelvic pain, systematic reviews have found that people who do Pilates report significant pain relief and better function compared to those who do little or no exercise .

In short, Pilates helps re-train the body to move with better core support and alignment.  Stronger, balanced muscles around the hips and spine make it less likely that the SI joints will twist, tilt or overload, which in turn can reduce pain. Several studies suggest that people with chronic low back/SIJ pain feel better after a program of Pilates exercises.

Sample Mat Pilates Exercises for SIJ Health

Many gentle, mat-based Pilates moves can be safe and helpful for SIJ pain. Here are a few examples often recommended by therapists (always work within pain-free range, and stop or modify any move that hurts):

               •             Bridges (Pelvic Tilts): Lie on your back with knees bent and feet flat. Tighten your lower abs and gently lift your hips off the mat, forming a straight line from shoulders to knees. Hold a few seconds, then lower down. (This “bridge” move works the glutes, hamstrings and lower back without heavy strain) It strengthens the muscles that support the sacrum and helps stabilize the pelvis.

               •             Opposite Arm/Leg Lift: Start on hands and knees in a neutral spine. Keeping your back flat, slowly extend one leg straight back and the opposite arm forward (thumb pointed up). Hold briefly and return, then switch sides. This move challenges the core and back muscles to stabilize the spine as you move limbs, which teaches the SI area to stay steady.

               •             One Leg/Double Leg Stretch: Lie on your back. Gently draw one knee at a time (or both knees together) toward your chest, wrapping hands around your shin. Hold the stretch briefly, then release. This relaxes tight hip flexors and lengthens the lower back. Therapists often include knee-to-chest as a mobility exercise for SIJ pain.

               •             Hip Abductions (Clamshell): Lie on your side with hips stacked and knees bent. Keeping feet together, lift the top knee up (as if opening a clamshell) while keeping pelvis still. Lower gently. This strengthens the outer hip/glute muscles that help keep the pelvis level.

Each exercise should be done slowly and with control, focusing on keeping the pelvis neutral (not twisted) and engaging the powerhouse muscles.