SI Joint Pain

Protection → Controlled Motion → Return to Function

What SI Joint Pain Is

Your SI joints are where your sacrum (the base of your spine) meets your pelvis — one on each side. They barely move; they're built for stability, transferring load between your spine and your legs with every step. So SI pain is usually a load-transfer problem: the muscles that should 'lock' the joint aren't doing their job, and it gets irritated by uneven loads — standing on one leg, stairs, rolling over in bed, getting in and out of the car.

Primary — Load-transfer / control-related — one-sided pain low and to the side of your low back (often near the dimple of your pelvis) that flares with uneven, single-sided loads. Most common, and this protocol is built for it.
Secondary — Laxity-related — a looser, less stable pelvis, often around pregnancy/postpartum or after a fall onto the buttock. It responds to the same stability work, sometimes with extra support.

Involved tissues: The sacroiliac joints and their strong ligaments (the joint's own 'form closure'), and the muscles that compress and lock it — the deep core, the glutes, the pelvic floor, and the lats through the back fascia (the 'force closure' you can train).

The two pillars for the SI joint: first, build force closure — the deep core, glutes, and pelvic floor that squeeze the joint tight and stable (this is the part you can actually train); second, move your pelvis as one unit and avoid the uneven, one-sided loads that irritate it while it settles. Lock it down with muscle, and stop shearing it.

Lock it with muscle (force closure)

The SI joint gets its stability two ways. 'Form closure' is the joint's own shape and ligaments — you can't change that with exercise. 'Force closure' is the muscles that wrap and compress the pelvis — the deep core, glutes, pelvic floor, and lats — squeezing the joint tight and stable exactly when you load it. That's the part you CAN train, and it's the whole game for SI pain: build those muscles to lock the joint, learn to move your pelvis as one unit, and avoid the uneven single-sided loads that shear it until it's strong. (The joint-mobilizing and pelvic-alignment work is your therapist's job — this protocol builds the stability side.)

⚠️ Screen Before You Start — Get Assessed First If You Have:

●Numbness in the saddle/groin area, or changes in bowel or bladder control — this is an emergency, get seen now
●Progressive weakness in a leg, or numbness or pain in both legs
●Fever, chills, unexplained weight loss, or feeling generally unwell with the pain
●Significant trauma (a fall onto the buttock or an accident), or night pain that won't ease in any position
●New, severe pelvic pain in pregnancy or postpartum that isn't settling — check with your provider

This is education, not a diagnosis, and doesn't replace hands-on care.

🌡️ Finding your stage

Take your movement temperature before each session. Sharp, guarded, painful with small single-sided movements (rolling in bed, standing on one leg) = Protection. Settling and tolerating even, two-sided loading = Controlled Motion. Ready for progressive single-leg and asymmetric load = Return to Function. The win for the SI joint is tolerating one-sided loads — stairs, single-leg stance, walking — without a flare. Re-check every session.

Phase 1 · Acute

Protection Phase

🌡️ Sharp / guarded · flares with one-sided loads

Goal: Calm the irritated joint, protect it from the uneven loads that shear it, and start gently switching on the muscles that lock it.

Manual treatment: Pain-relief modalities and positioning that keeps the pelvis even and comfortable.

Frequency: Little and often — short, gentle, pain-free sessions.

A. Calm & Protect

SoftWave Therapy

Video coming soon

Dose: As scheduled in clinic
How: Applied to the irritated joint and surrounding tissue to calm symptoms and stimulate healing.
Watch for: The anchor of the early phase — settles the joint so you can start the stability work.

Protect & Move as One Unit

Video coming soon

Dose: Ongoing
How: Avoid the aggravating one-sided loads for now — big steps, crossing your legs, standing on one leg. Keep your knees together when you roll in bed or get in and out of the car, so the pelvis moves as one unit.
Watch for: Uneven, single-sided loads are what shear and flare the SI joint. Move symmetrically while it settles.

SI Belt (if very unstable)

Video coming soon

Dose: As needed
How: If the pelvis feels very unstable (common postpartum), a snug SI belt gives temporary external support — 'force closure' from the outside — while you build it from the inside.
Watch for: A helpful short-term aid, not a permanent fix — the goal is to build your own force closure.

B. Gentle Activation — Start Force Closure

Deep Core Draw-In (Transversus Abdominis)

Video coming soon

Dose: 10 gentle holds · 5 sec
How: Gently draw your lower belly in and up toward your spine — a low, quiet contraction, breathing normally.
Watch for: The deep core is a key part of the 'inner unit' that compresses the joint. Keep it gentle — skill, not strain.

Gentle Glute Squeeze

Video coming soon

Dose: 2 sets · 10 reps · 5-sec holds
How: Lying or standing, gently squeeze the glutes and release — waking up the muscles that help lock the pelvis.
Watch for: The glutes are major players in force closure. Start gentle and pain-free.

Pelvic-Floor Activation

Video coming soon

Dose: 10 gentle holds
How: Gently engage the pelvic-floor muscles (a soft 'lift') alongside the deep-core draw-in.
Watch for: Part of the inner unit that compresses the joint. Gentle and coordinated with your breath.

Protection-phase precaution: move your pelvis as one unit — keep your knees together when you roll in bed or get out of the car, and avoid big single-leg loads for now. If it's very unstable (for example postpartum), an SI belt can give temporary external support while you rebuild the muscular lock.

✅ Ready for the next phase when:

The sharp pain settles, and single-sided movements like rolling over or briefly standing on one leg are tolerated better.

Tracking Your Progress

The weekly stability check: am I better, the same, or worse than last week?

Better

Stay the course; progress toward single-leg and loaded work as one-sided loads stop flaring it.

Same

Change something — the drill, the dose, or the load. Make sure the glutes and deep core are actually doing the locking.

Worse

Drop back a phase and reassess. Return to symmetric loading, move as one unit, and if any red flags appear, get seen.

The Rules That Govern This Protocol

1Build force closure — the deep core, glutes, and pelvic floor that lock the joint.
2Move your pelvis as one unit and keep it level.
3Avoid uneven, single-sided loads until the joint is stable — then reintroduce them gradually.
4The universal rule: no lasting increase in pain after a session.

Movement You Love Is Therapy. This protocol is general education based on course rehabilitation materials and standard principles. It is not medical advice, diagnosis, or treatment, and does not create a provider–patient relationship. If pain is severe, worsening, or unexplained, see a licensed provider.