The Best Low-Impact Exercises for Lower Back Pain From SI Joint Dysfunction

Lower back pain is no walk in the park. And it can make that walk in the park seem as difficult as hiking Everest. While there are a number of causes of lower back pain, one common reason is sacroiliac joint dysfunction.

The sacroiliac joint, also called the SI joint, sits at the bottom of your spine and makes up the rear portion of your pelvic girdle. The human body actually has two — one sits at the left side of the pelvis and the other sits on the right.

Dysfunction of this joint can cause excruciating low-back and leg pain. So physical therapists design therapeutic exercise protocols based on the type of dysfunction. Low-impact aerobic exercise, muscular strengthening, stretching and heat and ice can all be effective ways to manage or improve the pain. Below are some of the best exercises for SI joint problems.

The term sacroiliac dysfunction refers to joint hypo- or hypermobility. Hypermobile SI joints have too much movement, and hypomobile SI joints are locked and immobile.

Traumatic injuries, biomechanical muscle imbalances, inflammatory diseases or hormonal issues may affect the sacroiliac joint. Additionally, pregnancy causes joint laxity in preparation for the birthing process, and this laxity may cause SI joint hypermobility.

Due to its position at the base of the spine, the SI joint is especially susceptible to the impact that physical activity can create. The key is to find forms exercises that don't place a lot of stress on the low back. Here are some options to consider.

Aerobic exercise increases blood flow throughout the body, which aids in muscle tissue repair. The endorphins that are released during cardiovascular activity also act as an analgesic, which will help to lessen SI joint pain.

Try swimming, walking or exercising on an elliptical machine. And aim for at least 150 to 300 minutes of moderate-intensity aerobic exercise a week, according to the Physical Activity Guidelines for Americans. That works out to about 20 to 30 minutes every day.

Physical therapist Richard Dontigny designed a series of exercises to realign the SI joint and engage the core muscles, which are essential for sacroiliac joint stability. Some are extremely subtle and may involve a considerable amount of concentration before you can feel them working. Start with this one:

1. Sit upright with your knees bent and your feet flat on the floor.
2. Without moving your feet or upper body, contract your abdominal muscles and push one knee forward while pulling the other knee back.
3. Repeat, alternating direction.

Strengthening the muscles in your low back encourages stability of the SI joint, making it stronger and less susceptible to pain and injury. Try this hypermobile sacroiliac joint exercise, called a glute bridge, to strengthen your low-back muscles:

1. Begin by lying on the floor with your knees bent and your feet flat on the floor.
2. Slowly raise your hips off the floor while tightening your abdominal and gluteal muscles.
3. Hold this position for at least 10 seconds, and slowly lower your hips back to the ground.
4. Start with 5 reps and gradually work up to 20.

Physical therapists at the Ohio State University Medical Center use pillows, small exercise balls and resistance bands to strengthen the muscles that support the SI joint. Here are two SI joint hypermobility exercises:

‌Move 1: Adductors‌

1. Lie on your back with your knees bent and your upper body propped up on your elbows.
2. Place a pillow or a small exercise ball between your legs.
3. Contract your inner thighs as you squeeze the ball or pillow.
4. Perform 10 reps.

‌Move 2: Abductors‌

1. Next, wrap a resistance band around your outer thighs.
2. Lie supine and press your thighs out against the band's resistance.
3. Perform 10 reps.

Increasing the flexibility of low-back muscles may help to relieve tightness and discomfort caused by SI joint pain. A knee-to-chest stretch is an effective way to release tension in the muscles of the low back.

1. Begin by lying on your back on a firm surface.
2. Bring one knee toward your chest, grasping your hands behind your knee and pulling your leg in close to your body.
3. Hold this position for 30 seconds, then release.
4. Repeat 5 times on each leg and gradually increase to 15 reps.

Some Pilates exercises may alleviate the symptoms of SI joint dysfunction, according to Jennifer Adolfs, author of ‌Pilates Relief for Joint and Back Pain‌.

1. Begin by lying on your back and draw one knee toward your chest.
2. Hold for two counts, then release.
3. Perform 10 reps on each leg.
4. Then, lower both feet to the floor with bent knees and let your arms rest comfortably by your sides.
5. Keeping your heels and both hips flat on the floor, gently sway your knees from side to side. You'll feel a stretch across your lower back.

Other Pilates exercises also help stabilize the sacroiliac joint.

1. Lie supine with your legs extended.
2. Bend one knee, and bring it toward your chest.
3. Keep both hips firmly pressed into the floor as you circle the bent knee.
4. Perform 4 clockwise and 4 counter-clockwise circles on each leg.
5. When you complete both sides, roll over on to your stomach.
6. Bend one knee to create a 90-degree angle.
7. Lift the lower leg from the floor and perform 6 clockwise and 6 counter-clockwise circles. Keep both pelvic bones pressed into the floor.
8. Repeat on the other leg.

Physical therapy, where you'll do exercises like the ones above, is likely your best treatment option for SI joint dysfunction, according to experts. After an initial sacroiliac joint assessment, your doctor may prescribe some preliminary, non-surgical treatments for symptom relief. Relieving some pain will allow you to perform physical therapy exercises in relative comfort.

Ice and heat are both effective agents in treating the pain associated with SI joint dysfunction. Ice is best used immediately after the onset of pain, as it reduces blood flow and inflammation, according to the Cleveland Clinic. Apply ice for no longer than 15 minutes.

Heat packs are also an effective for managing pain; they can even be used prior to exercise to help muscles relax but should be avoided if inflammation is present, according to the Cleveland Clinic. Apply a heating pad or warm compresses for up to 20 minutes. Try alternating between heat and ice for maximum therapeutic benefit.

If you're experiencing significant inflammation, your doctor may prescribe anti-inflammatory medication. And people who are pregnant and have hypermobile SI joints may need to work with a physical therapist who specializes in SI joint dysfunction.