Hurts to Sit with Sacroiliac Joint Pain? Here’s How to Feel More Comfortable
Learn what can make sitting with sacroiliac joint pain comfortable and how to treat it with tips from physical therapists.
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Sacroiliac joint pain, or low back or butt pain, can be — well, a pain in the butt. It can make walking, climbing stairs, sitting, sleeping, running — everything — uncomfortable if you don’t know how to treat it. Although sacroiliac (SI) joint pain can be challenging and inconvenient, you don’t have to just live with it. It’s very treatable, and it’s more common than you may think, affecting as much as 30% of people with low back pain. “It’s pretty common, especially among my pregnant or postpartum patients,” says Heather Broach, PT, DPT, a physical therapist at Hinge Health.
SI joint pain can be related to a lot of factors, including pregnancy, ankylosing spondylitis, and more, and it can affect people's lives in a lot of different ways. The most common effect it has on people, though, is how uncomfortable it can be to sit with SI joint pain. And if you have to sit for long periods of time — say, for work — this can make for a long day.
Here, learn what you can do to manage SI joint pain with sitting and how to prevent it from interfering with your day.
Nuestros expertos de Hinge Health
Dr. Heather Broach, PT, DPT
Jonathan Lee, MD, MBA
Maureen Lu, PT, DPT
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Common Causes of Sacroiliac Joint Pain
Sacroiliac joint pain, also known as sacroiliitis, is due to inflammation and pain in one or both of your sacroiliac joints. These are the joints that connect your sacrum (the base of your spine) with your ilium (the top part of your pelvis). They support your trunk and upper body when you stand or walk, and help take pressure off of your spine.
There are many things that can cause inflammation of the sacroiliac joint. Some of the most common ones include:
Pregnancy. “When you’re pregnant, your body releases a hormone called relaxin that relaxes your muscles, joints, and ligaments during pregnancy,” explains Dr. Broach. This helps your pelvis widen and opens your birth canal so baby can come out. So relaxin is a very good thing, but it does stay in your body for a while after pregnancy, which leaves your pelvis more mobile than usual, Dr. Broach adds. “This means that normal postpartum movements like leaning over a crib to pick your baby up or toting them around on your hip puts more pressure on the SI joints because your ligaments are still a little loose.”
High-impact sports. SI joints are strong and can handle a lot, but high-impact activities can put extra strain on them and contribute to inflammation in some cases. “We see this a lot in gymnasts and cheerleaders,” notes Dr. Broach. It can also happen from an impact injury: “You fall and land on one leg, and that impact puts a lot more force on the SI joint than it’s used to.”
Arthritis. Different forms of arthritis — including osteoarthritis, ankylosing spondylitis, and psoriatic arthritis — can affect the sacroiliac joints (among others). In the case of osteoarthritis, the cartilage that cushions joints gradually changes and loses volume, which may contribute to pain in the SI joint for some people. In other instances, arthritis can cause inflammation in the SI joint or the joints of the spine and contribute to low back and hip pain or stiffness.
Sitting With SI Joint Pain
You may notice SI joint pain when sitting. Maybe you only notice it when sitting, or perhaps your symptoms just become more noticeable in a seated position. It may get worse if you sit for a long period of time, or if you move from a sitting to a standing position. “You sit on your sacrum (just above the tailbone), which often pushes on one side of the pelvis more than the other. This allows the other side to drop down and can put some added strain on ligaments,” explains Dr. Broach.
There’s no right or wrong way to sit, but if you have increased SI pain when seated, there are a few things you can try to help ease the pain:
Get a little lumbar support. An easy way to do this is to roll up a towel and prop up the sore side of your body with it, says Dr. Broach. Another option is to use a lumbar pillow which supports your low back and can help prevent and alleviate pain.
Adjust the height of your chair. If you work at a desk, it may help to adjust the height of your chair so that your hips sit level with or just slightly higher than your knees. This can reduce back discomfort for many people.
Use a footstool. This allows your feet to rest on something, so they don’t dangle which may increase strain on the SI joints. It also makes it easier to switch positions while you sit. You can alternate between propping your feet up and resting them on the ground, which can give some muscles a break and prevent soreness from setting in.
Use a cushion. If you like to sit on the floor — or find yourself there frequently — a cushion can help. You could also come to a kneeling position, resting the backs of your thighs on your calves with a cushion between the two. This helps you sink back and rest on your sit bones (bottom of the pelvis) and lengthen your spine for a good stretch.
Keep it moving. Sore joints love movement since it helps prevent pain from setting in, and it alleviates joint aches if you get sore from being in the same position for a long time. Try to get up periodically to stand or stretch. (Note: It helps to distribute your weight evenly across both feet when standing up or sitting down to avoid irritating an already inflamed SI joint.) If possible, a standing desk can help a lot, or you can prop a laptop on a cabinet for a few hours of your day. Even shifting how you’re sitting can make a big difference.
Standing With SI Joint Pain
While sitting can aggravate SI joint pain for some people, standing may have the same effect on you. “Standing can definitely irritate SI joints, especially if you have to do it for a long time or tend to consistently put more weight on one side of your body,” says Dr. Broach. This is particularly common with new parents who get used to holding a baby on their hip. “This can affect the balance of the SI joint, especially if the ligament is very lax, say, shortly after delivery,” explains Dr. Broach.
There’s no right or wrong way to stand, but if you have worsening SI joint pain while standing and you also tend to bear most of your weight on one side of your body, consider whether you’d be able to stand with your weight evenly balanced across both feet for a period of time. If you notice that helps, how might you make a plan to be mindful of your standing habits? It also helps to try and change your position frequently so that you’re not standing one way for too long, Dr. Broach advises.
Sleeping With SI Joint Pain
You may notice that your SI joint pain gets a little worse at night. This is usually because you put weight on the SI joint when lying down, or because changing positions in your sleep irritates it, says Dr. Broach. Another factor: You're not active in your sleep, so inflammatory chemicals can pool in the joints and make you feel stiffer when you first wake up, before you start moving around. This is particularly true for some people with arthritis.
If you notice worsening SI joint pain when sleeping, here are some tips you could try:
Avoid lying on the side of your body that’s affected. This can put extra stress on the affected SI joint and make it more challenging to get on top of your pain when you wake up. Try to sleep on your less painful side if possible. If you find that you roll to your affected side in your sleep, you can place pillows behind your back to prevent that. Some people also find that placing a pillow between the legs decreases back discomfort when they wake up.
Pump up the pillows. If you’re a back sleeper, rejoice. Research shows that back sleeping can be a very friendly position for people with SI joint pain — it tends to put less pressure on the joints. Placing a pillow underneath your knees and thighs may put even less pressure on the SI joint.
Consider your mattress. Everybody is different. Some people with SI joint pain do really well with a softer mattress; others prefer something more firm. Generally speaking, most people with SI joint pain shoot for the Goldilocks rule: not too soft and not too hard, but just right. Not sure if your mattress is working for you? Try placing a piece of plywood under your mattress or putting your mattress on the ground. If you notice an improvement in your pain, you may do better with a firm mattress. To test whether you do best with a softer mattress, sleep with a mattress topper for a few nights.
Keep in mind that you may have to go through a little bit of trial and error to find the best sleep position that works for you and your SI joint. “It can change, too: You may find that what worked for you last week isn’t working so well this week,” says Dr. Broach. “But once you find the right position, it’s like floating in water — it feels comfortable and easy.”
Simple Exercises to Relieve SI Joint Pain
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