Sacroiliac exercise



by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit




The sacroiliac joint is where the sacrum connects to the pelvis.

Information from the American Physical Therapy Association

The sacroiliac joints don’t allow much motion. One reason the sacroiliac joints can become irritated is through abnormal movement occurring on a repetitive basis.



Examples of this are sport-related activities where impact occurs through jumping and twisting.

The initial approach to treating sacroiliac joints is to support and protect the area, help the muscles relax, lessen the pain, and minimize any inflammation.



While exercise is appropriate for breaking down scar tissue once the area has healed, it may further irritate the area during the initial stages. Therefore, other methods such as ultrasound, massage, and gentle adjustments may be safely used to accomplish this early on in the injury.

Muscle stretching can be a very important part of the healing process for tightened muscles of the back. It is essential to lengthen any shortened muscle tissue in the back to help prevent further irritation. Muscle strengthening exercises will be important once the back irritation has subsided.



Back strengthening exercises help with stability.



The following back exercises should never be performed if they cause pain in the back while they are being performed! As each sacroiliac condition is different, always consult your doctor or physical therapist before performing any of these exercises to determine if these are right for your particular condition.



If you have any discomfort after performing any of these exercises, discontinue and immediately and consult a doctor to properly assess your situation.



Gluteus Stretch

Laying down on your back, bend your right knee, and place your left leg over the right leg, resting the outside of the left ankle slightly above the right knee. Place your right hand around the outside of your right thigh and place the left hand around the inside of your right thigh. Lock the two hands together. Now pull forward towards your chest to achieve a stretch in the left gluteus portion of your buttocks. Do the exact opposite to achieve a stretch of the right gluteus portion of the buttocks. Hold each stretch for a minimum of 30 seconds, any less than 15 seconds and the muscle will not conform to the new increase in length. Do 3 reps, 3-6 times a day. Any pain you feel with this exercise should only be a local stretching sensation to the back of your thigh and buttocks area, without aggravating your condition.



Piriformis Stretch

Laying down on your back, bend your right leg and pull up your right knee towards your opposite chest with your left hand. You should feel the stretch in the piriformis portion of the right buttocks. Do the exact opposite to achieve a stretch of the left piriformis portion of the buttocks. Hold each stretch for a minimum of 30 seconds, any less than 15 seconds and the muscle will not conform to the new increase in length. Do 3 reps, 3-6 times a day. Any pain you feel with this exercise should only be a local stretching sensation to the back of your thigh and buttocks area, without aggravating your condition.



Tensor Fascia Lata (TFL) Stretch

Start with stretching the TFL portion of the left hip and outside thigh. While standing, hold your left hand securely on a solid surface to support your body as you place your left leg past your right until you reach a maximum stretch. Follow this with tilting your upper back to the right side while simultaneously pushing the left side of the hip. Do the exact opposite to achieve a stretch of the right TFL portion of the hip and outside thigh. Hold each stretch for a minimum of 30 seconds, any less than 15 seconds and the muscle will not conform to the new increase in length. Do 3 reps, 3-6 times a day. Any pain you feel with this exercise should only be a local stretching sensation to the TFL portion of the hip and outside thigh, without aggravating your condition.



Calf Stretch

Start with stretching the right gastrocnemius portion of the right calf area. While standing, place your right leg in front of you and your left foot directly behind you. Place the toes of your right forefoot up against a door or other flat wall surface, keeping your heel down to the floor. Lean your upper body forward to place a stretch on the back of the calf. Do the exact opposite to achieve a stretch of the left calf area. Hold each stretch for a minimum of 30 seconds. Any less than 15 seconds and the muscle will not conform to the new increase in length. Do 3 reps, 3-6 times a day. Any pain you feel with this exercise should only be a local stretching sensation to the calf area of the leg, without aggravating your condition.



Psoas Stretch

Start with stretching the right psoas muscle. While standing, place your right leg in front of you and your left foot directly behind you as far as you can comfortably stretch it. Shift your lower body forward, while simultaneously pushing your upper body backwards with your arms. Do the exact opposite to achieve a stretch of the right psoas portion of your front upper thigh area. Hold each stretch for a minimum of 30 seconds. Any less than 15 seconds and the muscle will not conform to the new increase in length. Do 3 reps, 3-6 times a day. Any pain you feel with this exercise should only be a local stretching sensation to the psoas area of the upper thigh, without aggravating your condition.



Quadriceps Stretch

Start with stretching the left quadriceps muscle. While standing hold a solid surface for support and bend back your left leg. Grab your left ankle and pull that foot to your left buttocks while simultaneously pulling your left thigh backwards while keeping your back straight. Pulling your thigh backwards is a very important part of this stretch, as it will place the stretch in the mid-thigh instead of overloading the pressure on the knee. Do the exact opposite to achieve a stretch of the right psoas portion of your front upper thigh area. Hold each stretch for a minimum of 30 seconds. Any less than 15 seconds and the muscle will not conform to the new increase in length. Do 3 reps, 3-6 times a day. Any pain you feel with this exercise should only be a local stretching sensation to the quadriceps muscle area of the upper thigh, without aggravating your condition.

Regardless of the current situation your back is in, relaxing could be key to helping it heal. While meditation can always be useful for achieving this, yoga can at times be irritating if caution is not taken. Yoga is a series of slow movements combined with stretches and meditation to allow for an increase in flexibility and relaxation to the muscles and joints, as well as to help optimally integrate the connection between the mind and body. However, what might seem to be easy maneuvers should still be treated cautiously, as your individual situation may prohibit certain moves. One simple meditation practice is visualization... close your eyes and visualize yourself in the most happy and relaxing place you know of. Sometimes just taking the time to do this can be what you need to begin the healing process.

While walking is one of the overall best exercises for your health, the shoes you choose to stroll in may just be the difference between hurting your back and helping to keep it strong and loose. High heel shoes put your spine in extension. Lack of shock absorption will further hurt the joints with every step you take. Shoes that contain proper arch support can help take the pressure off those tired feet and help with shock absorption. Shoes with pressurized air or other cushioning chambers are necessary to protect the spine during the much harder impact a person will experience during exercise.

During standing, a proper balance is needed between both hips to keep the back in correct alignment. When one leg is slightly longer, or the hip becomes fixated in a higher position, it may be necessary to supplement the lower side of the hips with a heel lift. When the spine is tilting to the lower hip side, a lift may allow the spine to realign properly, and thus take pressure off the back.

A good mattress will protect the back for the many hours that you are in bed. A mattress that properly supports the body will also be a very important element in helping relieve stress on the muscles and joints of the back. The most important information needed for finding a correct mattress to support the back involves knowing what position you sleep in.

Whether you sit for minutes or hours, you can't underestimate the value of proper posture while sitting. It has been demonstrated that at times there can be as much as six times the amount of stress on your back when you sit than while laying down. Fortunately you can lower the amount of stress placed on the spine with proper back support. To accomplish this, first you must decide whether the chair you use presently is adequate for your needs. A good chair will be able to provide your lower back with proper lumbar pressure. This pressure will keep the curve of the spine in this area supported in the normal position. When a proper lumbar support is not provided with your chair, a lumbar cushion can accomplish this. The size of the cushion is very important, as too much lumbar support can compress and irritate the spine. A good working ergonomic type of chair can be adjusted to allow tilting and height control of the seat and chair back.



Here are some tips for adjusting your chair properly:

• Adjust the height of the chair to allow your feet to rest comfortably on the floor.
• Adjusting the tilt angle of the seat will change the position of your pelvis, thereby shifting the back towards or away from the seat back. Tilting the front of the seat downward will bring your lower back into extension and thus increase the lower lumbar curve. Tilting the front of the seat upward will bring your lower back into flexion and thus decrease your lumbar curve.
• Combine the seat angle tilt with the seat back tilt for optimal support of the back.
• If the seat back height can be adjusted, make sure the small of your back fits with the part of the seat back which curves outward to support the lower back.
• If these adjustments still do not support the spine properly, you will definitely need a lumbar cushion or more ergonomically correct chair. Lumbar cushions will need to have height adjustability to fit correctly. This is usually achieved with a strap that allows you to set the height of the cushion to the thickest part against the small of your back. Each person's spine curves differently, so another important feature that some back support cushions provide is the ability to adjust the size of the lumbar thickness to customize the fit.



Trochanteric braces can at times be useful to support the piriformis muscle and protect the muscle and pelvis from further injury. It is placed over the outside hip area, at what is called the trochanter.

Soft back braces can be useful in cases of sacroiliac joint dysfunction. They help compress and stabilize the sacroiliac joints. While soft back braces can be useful for support of fatigued muscles and allow temporary relief to the irritated tissue in the initial stage of injury, wearing any brace for prolonged periods can also weaken the musculature, as the muscles will rely on the brace to keep good posture. While too much movement of the back may exacerbate sacroiliac joint dysfunction, preventing movement of the area has been shown to hinder the healing process. It can be noted that the use of a brace while sleeping should not cause any of these problems, but many patients find that overusing the brace can become irritating to the area.

Caution should be taken when applying traction to any newly injured area, and should not be performed in these cases unless specifically recommended by your doctor. Lumbar (low back) traction can be accomplished through various products which keep the pelvis stationary while using gravity to force separation of the vertebrae and thereby open the spinal canals that the nerves exit through. However, the multifidous muscle which attaches to the lumbar vertebrae may not allow the separation of the vertebrae if the muscle is in too much spasm. Some types of traction allow for better separation when the multifidous muscle is in spasm.

In the earlier stages, light traction can provide an unloading of the spine, thereby releasing the nerve pressure between each segment created from a decrease in circulation and an increase of inflammation within the joint space. In later stages, traction combined with body movement may also help to break up scar tissue build up between the joints. When the muscles are in too much spasm to allow for this type of traction, upright types of traction units can enable a person to move their body during the therapy to avoid further muscle spasm, while providing a relieving therapy to the spine.

Home traction units may be beneficial in treating sacroiliac joint dysfunction. Caution should be taken not to apply too much traction too quickly to the back, as this may initiate a spasm to the surrounding musculature. Therefore, only traction units which can gradually increase the separating of the vertebrae and allow unloading of the spine without reaching too much drastic pull would be recommended.

Electrical stimulation is an effective way to reduce pain. This is accomplished though blocking the same pain receptors that cause the nerves to irritate due to sacroiliac joint dysfunction. Micro-current is a specific type of electric stimulation which has been shown to stimulate healing to the injured tissue. Some electric stimulation units can charge the muscles to contract when the intensity is raised or it is placed over a motor point of the muscle. At times, this contraction causes the muscles of the back to loosen up by fatiguing them, while other times it may cause further irritation to the tissue.



Ultrasound is an extremely effective way to stimulate proper tissue healing. Sound waves are generated from a crystal vibrating inside the head of the ultrasound wand and then transmitted through sound conducting gel to the tissue. This allows the sound waves to break down unwanted scar tissue, increase circulation to the area, and help relax the musculature. This can be extremely beneficial in the case where the sacroiliac joint dysfunction has caused soft tissue irritation to the back.

Ice can be used in the initial 72 hours of an injury to reduce inflammation and numb the pain associated with sacroiliac joint dysfunction. One potential problem with ice is that temporarily it will tighten the musculature even more. Also it should be noted that ice should not be used for longer than 20 minutes to an area, as it may actually worsen the injury. For low back inflammation we recommend using a combined brace and ice gel pad to put a more firm pressure over the irritated area. This will also provide support over the injured area while providing ice therapy.



Hot packs are useful for increasing circulation and thereby loosening up the muscle tissue. Waiting to use heat therapy until three days after the initial irritation of the sacroiliac joints will give the swelling a chance to go down. Heat applied too early increases the inflammation in the area. It is believed that moist heat is better than dry, as there more penetration to the muscles.

As previously mentioned, moist heat therapy is useful for increasing circulation and thereby loosening up the muscle tissue. In the case of a heated whirlpool, the heat will completely surround the area. Add to this the jet massaging action of a Jacuzzi and you have a great way to relax the muscles of the back. Wait until three days after the onset the sacroiliac joint dysfunction to use heat, as heat increases inflammation.

Many of the same benefits seen with regular massage can be accomplished with mechanical massage devices that penetrate deeply through a tapping action called percussion, and thereby disperse lactic acid in the soft tissue and increase circulation, giving an overall relaxing effect to the musculature. This can be very effective for the "knotted up" type of musculature. More superficial massage devices that just vibrate may serve to increase circulation to the tissue, but lack the other aforementioned benefits. It should be noted that stretching of the muscle fibers will not occur like it does with manual massage. Percussive massagers should be used on slower speeds when the soft tissue is very inflamed, as it is less irritating to the area.

Over-the-counter sprays, sports creams and ointments that have analgesic properties can be useful for pain control of the sacroiliac joint dysfunction.

Menthol is the active ingredient which works to block pain receptors and help relieve pain in the soft tissue and joints. The higher the menthol percentage, the stronger the formula. Some companies use as much as 16 percent menthol, but that much is not necessary to achieve results and can cause burning side effects. Menthol can be derived naturally from peppermint or be synthetically produced. Natural menthol penetrates the skin more effectively. Other ingredients such as capsaicin, peppermint and eucalyptus can also help to block pain. Use of these cayenne pepper derivatives can leave residual numbness and tingling in an area for days after each use. For a topical pain reliever to work effectively it needs to have a good transport mechanism (ability to let ingredients be able to pass through the first layer of skin down to the deeper tissues below).



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