Sacroiliac Joint Pain After Delivery
Written by Dr. Karah Charette, PT, DPT, RYT
Many new mothers and parents experience pelvic discomfort and pelvic pain post-delivery, and one of the most common issues is sacroiliac (SI) joint pain.
In this blog, you will learn why SIJ pain occurs after childbirth and how a somatic approach to pelvic floor physical therapy can alleviate this pain.
You will also learn 3 ways you can start to change your SIJ pain today!
Postpartum individuals experiencing pelvic and low back pain do not have to suffer or just “put up” with this pain. There are solutions!
What is Sacroiliac Joint Pain?
When new moms and parents complain of back pain, they often think it is their low back or spine. However, oftentimes when they point to the place on their back that is painful, it is commonly lower than the back. This joint that is all too often overlooked is called the sacroiliac joint.
The sacroiliac joint (SIJ) is technically a joint of the pelvis and is classified as pelvic pain when dysfunction occurs here. This is important because how we view and then treat this type of pain may differ when we categorize it as pelvic pain.
This joint consists of the sacrum (wedge shaped bone at the base of the spine) and the ilium (pelvic bone). This joint plays a key role in providing stability for the spine and pelvis, as well as load transfer from the feet and the core.
When you have SIJ pain after delivery, you may notice pain that is localized to the lower back, hips, or even deep buttocks. It can stay local or even radiate down the leg or inner thighs. SIJ tends to be more aggravated by movements like walking, standing, getting in and out of bed, and standing on one leg.
How Childbirth Contributes to SIJ Pain
Contrary to popular belief, pain in this region has less to do with “instability” in the joints or ligaments, and more so to do with how highly sensitized the area is. During pregnancy, your brain cares a lot about protecting the area that is growing and holding your baby (the pelvis). It has been shown that the nervous system actually places more sensory and pain receptive fibers in this part of your body in order to increase perception and therefore protection of the area. This defensive response is well-meaning, and it can also contribute to more sensation and pain in this area during and after birth. The nervous system is adaptive and reactive, so the more inflammation and stress (physical and emotional) that is occurring in the body, the more likely this type of pain becomes. The good news is, with time, good mechanics, and a nervous system informed approach, these pain patterns are malleable and can change.
Postural shifts during pregnancy can also contribute to SIJ after delivery. Your body has to make accommodations in your center of mass and how pressure is distributed during pregnancy. There can often be changes in how you place weight in your feet, the strength of your hips, and the coordination of your core. All of these changes can contribute to inefficient mechanics at the SIJ that can increase sensitization and pain.
Delivery-related strain can also affect SIJ pain. Whether you gave birth vaginally or via cesarean, the core and pelvic floor are still affected. In vaginal deliveries, especially if assisted, there can be mechanical stress on the pelvic floor. If there are tears, this can lead to scar tissue and tight pelvic floor muscles. Pelvic floor muscles insert directly onto the sacrum and can affect the SIJ when tight by not letting it move properly or get the blood flow it needs to nourish the nerves in the area.
If you had a c-section, the SIJ can still be affected because the pelvic floor was still working throughout the pregnancy and you now have scar tissue at the abdominal wall. Scar tissue decreases fascial movement and blood flow, making it harder for your core to fire properly which can place too much load and pressure on the SIJ.
Diastasis rectus (DR) can also contribute to SIJ pain post delivery. DR is a normal accommodation the body makes to create room for your baby. The problem is if this does not close or regain strength appropriately postpartum, your core is once again non-optimally managing pressure and that can sensitize the SIJ.
Your doctor may tell you these are “normal” aspects of the postpartum period, but that does not mean you just have to put up with it. The body is resilient and does begin to recover on its own, and pelvic floor physical therapy can ensure that you heal optimally during the critical window of recovery in the first 3-6 months of being postpartum. Individualized skilled care can make all the difference.
Bodyful Techniques for SIJ Pain
At Bodyful, we pride ourselves on our unique method of treatment. We combine the best of manual therapy techniques, evidenced based exercise, and somatic informed styles of care to create the best possible outcomes for our clients in a shorter amount of time.
With manual therapy, some key aspects we might assess and treat would be areas beyond just the SIJ in isolation. The SIJ is affected by the core, and your core is more than just your six pack abs. Your core is made up of 3 key muscles: your respiratory diaphragm, pelvic floor, and transverse abdominus. At Bodyful, we will assess your breathing strategies and the fascia of your diaphragm. If there are restrictions here, it will affect pelvic floor and SIJ.
At Bodyful, we are also trained in techniques to assess and treat your pelvic floor muscles. If your pelvic floor is too tight, weak, or uncoordinated, it can contribute to SIJ pain.
You can learn more about pelvic floor therapy and internal assessments in this blog here.
We are also trained in unique core coordination techniques based on the work of DNS. This approach to core strength and pressure management can make a big difference for SIJ pain because it focuses on how to use the core to decompress the spine. The SIJ connects to the lower part of the spine and how load transfers through that area can dictate whether or not you have symptoms. DNS focuses on integrative exercises based on developmental kinesiology to help your motor system learn more efficiently through patterns you once moved through as a developing baby.
Gluteal strengthening is also essential for SIJ pain after delivery. We live in a society with “dead butt syndrome” because we sit for much longer periods than we are designed to. Because of this, your glutes can actually get neurologically inhibited (meaning the brain starts to turn them off) due to the lack of use. Your body has great ways to compensate for the glutes by using other muscles, but in the long term these compensatory patterns are inefficient and can lead to pain patterns. At Bodyful, we implement a gluteal protocol founded by Dr. Chris Powers, PT, PhD that has been proven to increase cortical activity and maximally activate the gluteus maximus fibers. Your glutes can be strong and still not be coordinated. This specific protocol can change that quickly.
Lastly, we will always integrate all motor training to your functional activities. If you are currently strengthening and still having pain, part of the reason can be because you are not training specific muscle groups to turn on in various planes of motion or with other muscle synergy patterns. Training muscles in isolation can create a plateau in progress. Our integrative approach will help your motor system generate new neural pathways so that optimal motor organization quickly becomes the path of least resistance for your body.
3 Ways You Can Change Your SIJ Pain After Delivery Today!
1. Mindful Movement: Next time you bend over and pick something up and there is pain, notice if you are holding breath. Instead, try to stay connected to your breathing throughout the movement. You can even pause, place your hands on your ribs, and breathe into that space 2-3 times before performing the movement. Try this a few times and notice what sensations you feel in your body during and after. Are there any differences?
2. Band Resistance with Glute Exercises: If you are already doing some glute exercises, see if you can add a theraband around your thighs. Adding some resistance in this plane of motion can increase abduction (legs opening out to the side) which increases gluteus maximus and medius fibers. You can even try placing a strong theraband around your thighs while you walk or bend over and see if the pain pattern changes for you with this action.
3. Sleep Position: You can do all the right exercises but if you sleep in a non-optimal position for the ideal 8 hours a night of sleep you are getting, it may be hard to completely change your pain. Most recommended positions for sleeping would be on your side or on your back. If you are a stomach sleeper, it would be good to try to slowly train your body to be comfortable with a more side lying position. If you are already on your side, make sure you have pillows between your legs as well as underneath your side waist. When you lay on your side, your spine ends up in a curve or sidebend that can place pressure on the SIJ over time. Try these pillow tips out and see if you notice a difference when you wake up!
When to Seek Professional Help From a Skilled Pelvic Floor Physical Therapist
Pelvic Pain Specialist
If your pain becomes persistent for more than 3 months and/or affects your quality of life, it is time to consult with a professional physical therapist. If you continue to let your body “put up with the pain” without intervention this can cause sensitization to the nervous system that can contribute to pain lasting longer. The patterns can still change, it just might take a longer time to see that change.
It is important to see a skilled pelvic floor physical therapist because of the expertise we have in the pelvic girdle, pelvic floor muscles, and core as a whole. If you have seen other providers or PTs in the past, but have not had a specific assessment performed by a pelvic floor physical therapist, there is still hope.
It is never too late to seek care.
Once postpartum- always postpartum!
Ready to start healing your SIJ pain today? Book a free discovery call to speak directly with one of our pelvic specialists and get the care you need and deserve.
Do you also have pain with sex postpartum? Pelvic PT can help! Read more here.
Bodyful Physical Therapy and Wellness is located in Oakland, CA and can help anyone in the Bay Area with an in person visit. Telehealth is a great option for those in the state of CA who cannot come in person. Virtual Somatic Wellness visits are available to folks outside of CA.
