PILATES FOR SACROILIAC JOINT ISSUES
Pilates is an ideal solution to help rehabilitate the problematic sacroiliac (SIJ) joint.
The SIJ is the joint that connects the sacrum with the left and right iliac bones.
Although still up for debate, it is believed that there is a small amount of movement evident at the SIJ. The main functions of this joint are to help with shock absorption, help transmit forces between the upper and lower body and help coordinate movement between the spine, the pelvis and the hip.
Typical dysfunction is noted as having either too much motion (hypermobile) or too little motion (hypomobile). Signs and symptoms of sacroiliac dysfunction are more commonly found unilaterally. A dull aching feeling in the low back or at the area where the PSIS’s live (posterior superior iliac spine) is most common but the SIJ is also able to refer down through the buttocks or into the groin.
Most often, clients tend to report to their Pilates teachers that they have been told they have an unstable SIJ. Considering one of the main focuses of practicing Pilates is increasing the tension and therefore support around the central region, an unstable SIJ may respond very well to Pilates rehabilitation.
The close packed position of a joint is where the bones have the most contact with each other making it the most stable position for the joint. The close packed position for the SIJ is when either the ilia are posteriorly rotated (like a flatter back) or the sacrum is nutated (the top of the sacrum is pushed forward). This will be the better position to actively work an unstable SIJ when first beginning exercise.
Structures and principles to consider when designing exercise for an unstable SIJ:
Muscles that help support the SIJ and may need some attention are the inner unit and the gluteus maximus muscles. Teaching proper weight bearing through the feet, proper activation of the psoas, less activation of the rectus femoris, and helping someone be able to differentiate the movement between their pelvis, lumbar spine and hip are further points to consider.
Listed below are some guidelines to use when first working with someone who has an unstable SIJ:
Begin with the body in a supported position (supine, prone or in side lying)
Progress to bilateral standing or on knees
Use a split stance with the unstable SIJ as the front leg (this puts the unstable side in a close packed position)
Add in upper extremity loading
Further progress to unilateral work
Although there are many exercises to help with SIJ dysfunction, below will show a few examples.
Hip/Pelvis Differentiation
Side lying Cadillac feet in straps with pillow support beneath the waist
The left pic shows a client on their side holding their greater trochanter (end piece of bone on the outside of the leg). In the center pic they swing their leg forward keeping their hip and spine in neutral and pelvis still. This bone will not feel as if it is rolling up and down and their fingers will stay in the same position. If they allow their hip to rotate, their fingers will change position shown in the right hand picture.
Working the Gluteus Maximus
At first, stay out of end range of motion (hip extension, or back of femur higher than buttocks) which puts the SIJ in a less stable position.
Engaging the Psoas while releasing tension through the Rectus Femoris
Working the psoas in a range where rectus femoris has less advantage. This happens with greater than 90 degrees of hip flexion. Cue the psoas and lower belly muscles to help down train the overactive rectus femoris muscle.
Using a Functional Movement
Upper body engagement assists stability of whole body and allows performance of a functional movement with good alignment. This is shown in the picture below.
