In our last article and newsletter, we discussed the sacroiliac joint, also known as the SI joint, and its role in pelvic pain and dysfunction. To refresh your memory, the sacroiliac joint is where the sacrum and ilium, or the triangular bone at the end of the spine and the pelvis, join together–for your reference, this is located just beneath the two dimples in your lower back. This joint is not only frequently overlooked as a source of pain of the pelvis, but also pain and dysfunction during pregnancy. Like in many cases of pelvic pain, the ligaments that strengthen and reinforce the SI joint and form the pelvic girdle (a bowl shaped area of the pelvis that protects and supports urinary, reproductive and some digestive organs and connects the spine with the legs) may be the source of lower back and pelvic pain in pregnant women.

These ligaments are typically very strong and sturdy, keeping the sacroiliac joint from moving too much or incorrectly and keeping the pelvic girdle functioning and moving correctly too.During pregnancy, a hormone called relaxin is produced. As its name implies, relaxin is an important hormone as it relaxes the SI joint, its ligaments and ligaments of the pelvic girdle to make room for the growing bambino, which is essential! During this time, the uterus and pelvis also enlarge from the release of pregnancy hormones, further stretching core pelvic muscles and straining the SI joint. At first glance, this may be beneficial. Relaxed pelvic ligaments and stretched and lengthened SI joints can help to ease the process of childbirth, but can have painful effects on pregnant women in the meantime. Due to postural and musculoskeletal imbalances in some women, relaxin can wreak havoc for the mom as it can cause excess strain in these ligaments. About half of all pregnant women experience lower back or pelvic pain due to relaxin causing their joints to move more than usual. We are used to our bodies functioning with “locked” pelvises and SI joints, meaning that they are in a stable position while we move and transition between lying down, sitting and standing. Relaxin causes joints of the lower back and pelvis to become “unlocked”, or less stable and irritated as we perform these movements. SI joint related pelvic pain often manifests in pregnant women as a concentrated pain on one side of the buttocks, back and/or pelvis. This pain may switch sides and radiate down through the legs and hips, causing weakness. This pain commonly begins by the eighteenth week of pregnancy and may only intensify as the pregnancy progresses, possibly even becoming a chronic problem after giving birth.

Relaxin and its effects may help to ease your baby through your pelvis during childbirth. However, it is important to make sure that its not so helpful effects don’t linger after you give birth, as the SI joint and its ligaments may be left in an unnatural position and unhealthy state. To restore strength and functionality to the sacroiliac joint, the musculoskeletal imbalances need to be addressed and the pelvic floor may also need some attention and fine tuning. This is where a physical therapist who specializes in disorders of the pelvic floor like those at Rebalance can help! A Rebalance therapist will perform a hands-on exam to evaluate these imbalances and improve the strength and mobility of your pelvic floor and sacroiliac joint. They will help you create an exercise plan that focuses on the strength of the pelvic girdle and the stability of your trunk. They will also use pain relieving techniques that complement these exercises including myofascial release to ease muscular tension or mobilization of the hips, pelvis or back. This technique helps to correct improper positioning and structural issues of any joints in these areas of the body including the SI joint. They will also suggest ways to avoid pain during your daily movements and activities, such as avoiding sleeping on your back after the 19th week of pregnancy and transitioning from a sitting to a standing position by leaning slightly forward and pressing yourself up with your arms while your back is straight and your abdomen is pushed in. This helps to keep the pelvic joints in proper alignment and avoid strain on the pelvic and SI joints.

Are you pregnant or have you recently given birth and are worried that your sacroiliac joint may be “relaxin'” just a bit too much? Contact Rebalance physical therapists to put your mind at ease and realign your SI and pelvic joints post-pregnancy.

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