Sacroiliac (SI) joint pain during pregnancy: tips and exercises

Pregnancy brings incredible changes to your body — from your growing belly to the new ways you move each day. Some people experience aches in their lower back, and it isn’t always just about extra weight or posture changes. A lesser-known source of discomfort during pregnancy is something called sacroiliac (SI) joint pain.

The sacroiliac (SI) joints are located where your pelvis meets your spine, and they play a key role in supporting your body and allowing comfortable movement. During pregnancy, the SI joints can experience added strain, which may lead to lower back pain and other symptoms. In fact, research shows that SI joint issues account for up to 80% of low back pain during pregnancy.

Even though SI joint pain is very common during pregnancy, there’s a lot you can do to manage it and get relief, such as gentle exercises and stretches and small changes in your daily routine and movements.

Here, learn more about what causes SI joint during pregnancy, and how to prevent and treat it — especially with exercises from Hinge Health physical therapists.

What is SI joint pain?

SI joint pain is discomfort caused by irritation or inflammation of the sacroiliac joints. This often results in aching or sharp pain in the lower back, pelvis, or buttocks, typically on only one side.

You have two sacroiliac (SI) joints. They connect your sacrum (the lowest part of your spine) to the iliac joints in your pelvis — hence the name “sacroiliac” joints. Their main job is to transfer weight and forces from your upper body to your lower body while keeping you stable. When SI joints get irritated or inflamed, it can lead to a condition called SI joint pain (also called sacroiliitis), which often presents as one-sided low back and butt pain. SI joint pain can make walking, climbing stairs, sleeping, getting dressed, and other daily activities uncomfortable.

Causes of SI joint pain in pregnancy

SI joint pain during pregnancy can be related to many factors, including increased pressure on your SI joints, higher levels of the hormone relaxin (which loosens ligaments and can make the pelvis less stable), changes in posture, and changes in your abdominal muscles, among others. Here’s more on the causes of SI joint pain during pregnancy:

• Pressure and mobility changes in the sacroiliac (SI) joints. Just like any other joint in your body, the SI joints can be more or less mobile. During pregnancy, the extra weight and pressure from your growing uterus can increase these mobility changes, leading to irritation, inflammation, and discomfort in the SI joints. 

• Increase in relaxin. Your body produces more of a hormone called relaxin during pregnancy. It helps loosen (or relax) pelvic ligaments in order to prepare your body for childbirth. This can make your pelvis less stable, which can impact SI joints and lead to SI joint pain in pregnancy.  

• Posture changes. During pregnancy, your center of gravity shifts forward to accommodate your growing baby, which often leads to an increase in the arch of your lower back (lumbar extension). This change places extra tension on the SI joints and surrounding muscles, making them work harder to support your body. As a result, your buttocks and abdominal muscles may weaken, while your lower back, hips, and pelvic floor muscles may tighten. This combination can increase pressure on the SI joints and raise the risk of pain during pregnancy, explains Holly Tipp, PT, DPT, a Hinge Health physical therapist.

• Weaker abdominal muscles. Your expanding uterus can cause the core muscles along the front of your abdomen to separate, creating a gap down the middle. This is called diastasis recti. This can reduce support for your pelvis and spine, which can lead to SI joint-related back pain.

• Lifting differently. As your baby grows, it can become harder to lift or carry things. You may find that you need to carry things on your side instead of in front of you — which can strain your back and contribute to SI joint pain. 

• Stress. Normal stress of pregnancy and daily life can make back muscles tense. “Increased stress can also play a role in pelvic floor muscle tension,” explains Dr. Tipp, “which may contribute to muscular imbalances that pull on the SI joint and cause pain”

• Previous SI joint pain. If you had SI joint pain before pregnancy, it can increase your risk of SI joint pain during pregnancy.

Symptoms of SI joint pain in pregnancy

SI joint pain during pregnancy typically causes discomfort in the lower back, buttocks, or hips. While SI joint pain falls under the umbrella of “back pain,” some key characteristics set it apart. It can include:

• Back or hip pain with specific movements, such as getting in and out of bed or a car, rolling over in bed, or bending to pick something up from the floor.

• Pain in the lower back, upper buttocks, or back of the hip that may feel dull and achy or sharp and stabbing

• Stiffness, tightness, or tension in the lower back, hip, buttock, groin, or upper thigh

• Pain that worsens with weight-bearing activities, such as standing or walking for long periods, standing on one leg (like when putting on pants), or lying on your side.

Is SI joint pain the same as sciatica during pregnancy?

No, SI joint pain and sciatica are not the same, though their symptoms can sometimes overlap during pregnancy. 

• SI joint pain is caused by irritation or inflammation of the sacroiliac joints, which connect your spine to your pelvis. This often leads to pain in the lower back or buttocks, usually on one side. 

• Sciatica refers to pain from irritation or injury of the sciatic nerve, the longest and thickest nerve in your body — often resulting in sharp, shooting pain that travels from the lower back down through the buttock and leg. 

While both SI joint pain and sciatica can cause discomfort in similar areas, they have different causes and sometimes require different approaches to treatment. If you’re unsure which type of pain you’re experiencing, discuss your symptoms with your healthcare provider.

When to see a doctor

SI joint pain during pregnancy is usually related to musculoskeletal (MSK) issues and often improves on its own with simple management or at-home treatment. However, SI joint pain can sometimes be mistaken for general back pain, which can be a warning sign of certain pregnancy complications, such as preterm labor or a urinary tract infection. If your pain is severe, getting worse, or causing difficulty with daily activities, see a healthcare provider. You should also see your doctor if pain occurs with:

• Vaginal bleeding or a change in vaginal discharge

• Fever

• Contractions

• Changes to normal bladder or bowel function

• Pain that feels new and cyclical

“One helpful way to tell musculoskeletal pain apart from something more serious is that, with MSK pain, there’s usually a position or movement that brings some relief,” explains Dr. Tipp. “If you can find a posture where your pain eases or goes away, that’s a good sign it’s related to your muscles or joints rather than a ‘red flag’ medical issue.”

Treatments for SI joint pain 

SI joint pain during pregnancy can often be managed with a combination of regular exercise, physical therapy, heat or massage therapy, and certain pain relievers. (Always consult your provider before continuing your usual workout routine or starting a new one, and before taking any medications during pregnancy.) Here’s more on how these approaches can help:

• Try physical therapy and targeted exercise. Targeted exercises can help strengthen and stabilize core and low back muscles to help support your pelvis and relieve SI joint pain. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit. (See physical therapist-recommended exercises below.)

• Stay active. The ligaments and muscles in your low back and pelvis can stretch during pregnancy — in part due to the effects of pregnancy hormones on your joints. Exercise can help stabilize your back and pelvis to improve SI joint symptoms. A recent review found that regular exercise can help manage low back and pelvic girdle pain during pregnancy and improve everyday function. Yoga, swimming, and walking can help ease low back pain in pregnancy. 

• Heat and ice. Applying a hot water bottle, heating pad, or taking a warm shower can increase blood flow to your back, helping to relax tense muscles and ease pain. Ice packs can also help reduce inflammation and provide relief from SI joint discomfort. Always avoid placing ice or heat directly on your belly, and check with your OBGYN before using heat therapy during pregnancy to ensure it’s safe for you.

• Complementary treatments. Talk to your provider if you’re interested in trying alternative treatments for SI joint pain relief during pregnancy, such as massage, acupuncture, or chiropractic care. Chiropractic adjustments can help improve alignment and movement in the SI joints, which may relieve pain and discomfort. Massage can help ease muscle tension and promote relaxation. Be sure to consult your healthcare provider and look for practitioners experienced in working with pregnant individuals.

• Over-the-counter pain relievers. Acetaminophen (Tylenol) is safe to use for pain relief during pregnancy in most cases, but always check with your provider before you use it. Avoid NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen (Advil, Motrin) or naproxen (Aleve), due to risks with these medications during pregnancy.

Physical therapy for SI joint pain in pregnancy

Physical therapy is a key treatment for SI joint pain during pregnancy, focusing on safe movement, targeted exercises, and stretches to help relieve discomfort and support your changing body. The goal is to strengthen muscles that tend to get weaker during pregnancy — like your glutes and abs — and to stretch muscles that often become tight, such as your hip flexors, back, and pelvic floor, says Dr. Tipp. “Targeted exercises and stretches can help maintain range of motion and muscle strength to better support pregnancy-related body changes and help ease SI joint pain symptoms,” she explains.

A physical therapist (PT) can assess your movement patterns to customize a strengthening and stretching program that’s right for you. They can also suggest ways to modify your everyday activities to minimize symptoms and empower you with tools and tips to help reduce pain. Recommendations may include adjusting your sleep position, wearing a support belt, or trying relaxation techniques.

You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit. Some exercises they may recommend can be found below.

These exercises are recommended by Hinge Health physical therapists to help relieve SI joint pain during pregnancy. Seated cat cow improves mobility in your lower spine, relieves pressure in the SI joint, and stretches tight lower body tissues. The hip flexor stretch targets the muscles at the front of your hips and core, helping to ease tightness that can result from postural changes during pregnancy. Abdominal bracing works to strengthen your lower abs, providing greater stability for your pelvis and SI joints. Glute stretches loosen the glute muscles, which can reduce tension and discomfort in the lower back and SI area, while the bridge exercise activates both your core and glutes to enhance strength and stability around the SI joint. 

By focusing on stretching areas that tend to tighten and strengthening muscles that support your pelvis and lower back, these exercises help reduce tension on the SI joints, improve comfort, and support your body as it adapts to the physical changes of pregnancy.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Is walking bad for SI joint pain in pregnancy?

Walking is generally not bad for SI joint pain during pregnancy and is often encouraged, but it depends on your individual symptoms and comfort level. For many people, walking can help keep the muscles around the pelvis and lower back strong and flexible, which may actually support SI joint health and ease pain.

If walking makes your SI joint pain worse or you notice increased pain, limping, or instability during or after walking, listen to your body and adjust your activity. Sometimes, modifying how far or how long you walk, or wearing supportive shoes or an SI belt (learn more about this below), can help.

7 tips to relieve SI joint pain in pregnancy

You can help relieve SI joint pain during pregnancy by staying active, making small adjustments to daily activities, avoiding pain triggers, choosing supportive footwear, adjusting your sleep position, wearing a support belt, and practicing relaxation techniques. Here’s how these practical tips can help:

1. Stay active. “Physical activity can look different for everyone — and every bit of movement counts,” says Dr. Tipp. Regular movement helps keep the muscles supporting your pelvis and SI joints flexible and strong, which is important for reducing strain on the SI joints during pregnancy. If it’s more challenging to do your usual workout routine, swimming, water aerobics, walking, and prenatal yoga are all great options. Resistance training is also recommended during pregnancy. Use light weights, resistance bands, or your body weight for resistance. Ask your healthcare provider or physical therapist for activity suggestions and exercise considerations for each trimester.

2. Make small adjustments to everyday activities. Simple changes in how you move and position your body can make a big difference in easing SI joint pain. For example, standing with a wider, two-footed stance helps distribute weight more evenly, reducing pressure on the SI joints. When sitting, using chairs that support your back or adding a lumbar pillow can relieve stress on your pelvis and lower back. Lifting objects by keeping them close to your body and using your legs, instead of bending at the waist, helps protect your SI joints from extra strain. These small adjustments help minimize irritation and support healthier movement patterns throughout your pregnancy.

3. Modify activities that aggravate SI joint pain. Take stairs one at a time, for example, or go sideways. To get out of the car, pivot your hips toward the door before getting up. If standing for long periods bothers your back, try taking frequent sitting breaks.

4. Skip high heels (and certain flats). Shoes with a low heel and good arch support are better for pregnancy-related back pain than flat shoes with no support (like many flip-flops or ballet slippers) or high heels.

5. Adjust your sleeping position. There’s no single best sleeping position for SI joint pain relief. But many people find it helpful to avoid sleeping on their back, since this can put extra pressure on the lower back and pelvic joints. Many healthcare providers recommend sleeping on your side after about 20 weeks of pregnancy. “To help minimize SI joint pain, sleep with your legs stacked and a pillow between them,” suggests Dr. Tipp. “This can keep your SI joint in a comfortable position and help prevent your hips from twisting.”

6. Consider an SI support belt. Worn around your hips, an SI support belt can provide extra support for your SI joints and help ease SI joint pain during pregnancy. Talk to your healthcare provider to see if an SI belt is a good option for you get guidance for how to wear it.

7. Try relaxation techniques. Meditation and breathing exercises can help calm your mind and relax your pelvic floor and other muscles. While these practices may not directly relieve tension in the SI joint, they can help lower overall muscle tension in your body, which may help ease SI joint pain in pregnancy.

PT tip: Move (even just a little) more

Staying in one position too long can add to SI joint pain. “Movement is medicine during pregnancy,” says Dr. Tipp. She recommends taking “movement snacks” — short, active breaks spread throughout the day — to ease discomfort. Interrupt long stretches of sitting or inactivity with quick movements and position changes. “These small breaks help keep muscles flexible, improve joint lubrication, and can reduce pain and stiffness,” says Dr. Tipp.

How Hinge Health can help you

If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

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3. Fiani, B., Sekhon, M., Doan, T., Bowers, B., Covarrubias, C., Barthelmass, M., De Stefano, F., & Kondilis, A. (2021). Sacroiliac Joint and Pelvic Dysfunction Due to Symphysiolysis in Postpartum Women. Cureus, 13(10). doi:10.7759/cureus.18619

4. Filipec, M., Marinela Jadanec, Kostovic-Srzentic, M., van, & Matijevic, R. (2018). Incidence, pain, and mobility assessment of pregnant women with sacroiliac dysfunction. International Journal of Gynaecology and Obstetrics, 142(3), 283–287. doi:10.1002/ijgo.12560

5. Kandru, M., Zallipalli, S. N., Dendukuri, N. K., Linga, S., Jeewa, L., Jeewa, A., & Sunar, S. B. (2023). Effects of Conventional Exercises on Lower Back Pain and/or Pelvic Girdle Pain in Pregnancy: A Systematic Review and Meta-Analysis. Cureus, 15(7). doi:10.7759/cureus.42010

6. Raj, M. A., & Varacallo, M. (2019, May 12). Sacroiliac (SI) Joint Pain. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470299/

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