How to Train Clients with SI Joint Pain in Pregnancy

By Jessie Mundell
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Sacroiliac joint (SIJ) pain can be a common experience for pregnant moms. This discomfort is felt on the back side of the pelvis. We have a sacroiliac joint on both the left and right side of the pelvis, where the hip bones (the ilium) meet the tailbone (the sacrum).

These are robust joints supported by strong connective tissues.

SacroiliacJoint

For some moms, SI joint pain is present immediately in pregnancy, leading to the assumption that it could be a hormonal change causing the sensation of pain. Whereas, for others, the discomfort can build as pregnancy progresses, perhaps meaning that the baby’s growth is pulling on the connective tissues of the pelvic bones and causing stress in the body.

It is most often possible to keep moving, even with SI joint pain. That being said, there can be instances when irritation and pain increase with exercise and physical activity, so as coaches of pregnant fitness clients, we need to have strategies to help our clients manage this.

1. Start or Continue Strength Training.

Strength training is so useful in keeping expecting moms active because we can modify exercises, loading, and the body position to help alleviate symptoms.

Here are some ways your strength training programming can help keep the SI joints pain-free or help your client manage their pain:

Cue your client to distribute the load throughout the body.

For example, in a deadlift variation, ensure that your client is feeling the tension through the glutes, hamstrings, back muscles — really, the whole body — and not feeling the exercise solely in the SI joints. Physiotherapist Antony Lo refers to this as “spreading the load.”

Use good exercise technique when under load.

It’s important to note that “good form” in exercise looks a bit different for everybody, and that is normal and fine. I strive to teach my clients to lift and move in a “neutral” body position, with the rib cage stacked over the hips.

It isn’t bad to be in body positions other than neutral. In fact, it is a great thing. We simply want to ensure that the client can lift loads well and efficiently in an alignment in which the body is “stacked.” This position tends to feel most stable and supported, and can give the deep core and pelvic floor system a good opportunity to generate tension.

Pictured above: rib thrust (left), bum tuck (center), ribs over hips (right).

Use breathing strategies to help the core and pelvic floor do their job.

There are different strategies to breathing in exercise and no single correct way.

What I have found to be helpful with my pregnant clients is to ensure that they continue to breathe as best as possible while performing an exercise. There are likely going to be times when they are holding their breath for short durations, both in their workouts and in life, but, in general, cue them to keep breathing throughout. This will help them feel more “in their body” and stable while lifting.

Additionally, matching the exhale breath to the toughest part of the exercise movement might help the body, belly, and pelvis feel more supported. I cue this as “exhale on exertion.” Most people will feel an increase in abdominal muscle tension and, if focusing on it, a lift and engagement of the pelvic floor muscles.

Note: The degree of core engagement on the exhale breath, or in a particular exercise rep, does not need to be extremely strong or aggressive.

Sometimes when clients are trying so hard to “work their abs” in exercises it can ramp their symptoms up. It sounds counterintuitive, but discourage your pregnant and postpartum clients from gripping and sucking in their abdominal muscles to try to support their pelvis. Instead encourage more relaxation and a natural response to loads!

2. Troubleshoot walking.

The common physical activity advice given to pregnant women is to walk, walk, and walk some more. This is great advice if you enjoy it and if it feels good on your body. Unfortunately, for many pregnant women, walking can often irritate the SI joints.

Here are my recommendations if your client’s symptoms are flaring up when she goes for a walk:

Shorten the distance.

Do her symptoms ramp up at a certain time during her walk? Have her try going for multiple, shorter walks throughout the day if that feels better. If your client enjoys going for a daily 30-minute walk but is noticing that at the 15-minute mark the SI joints start aching, she can stop the walk at that point and try for another 15-minute walk later in the day.

Play with the pace and step length.

If a client is typically a fast walker and is noticing symptoms, suggest walking at a slower, more leisurely pace. Walking at a slower pace can also be incredibly relaxing and can help balance stress hormones.1,2 She can also try shortening her step length, taking shorter steps instead of stepping far in front of her body to see if that helps reduce symptoms.

Lean slightly forward when walking.

Cue your client to move her body into the direction she wants to go. She should try to get her body into a slight forward-leaning position, instead of walking completely tall and upright. This is a small shift and should not make her feel like she is going to fall on her face.

3. Specific Strength Training Modifications

Your clients might have specific issues come up with certain patterns of movement in their workouts. Commonly, this occurs in unilateral and lateral exercises.

Examples of unilateral exercises are split squats, lunge variations, step-ups, or upper body exercises such as standing rows and chest presses done in a split stance position.

Examples of lateral exercises are lateral step-ups, lateral band walks, and lateral farmer carry variations.

Your client’s symptoms might increase with all of these types of movements or with only a few. Test these exercises out with bodyweight loading, and see how she responds physically to them.

If the above exercises are troublesome, your workout programming might need to include a lot of lower body bilateral exercises. Here are some examples of movement categories and variations you could use:

  • Squat: Bodyweight, goblet, front, back, offset
  • Deadlift: Romanian, band, kettlebell, dumbbell, barbell, elevated, conventional, sumo, trap bar
  • Glute bridge: Bodyweight, mini band, 1-leg (potentially)
  • Hip thrust: Bodyweight, mini band, superband

As always, I encourage you to refer your clients out to other health professionals who are skilled in treating prenatal body aches and pains. You might refer out to a pelvic health physical therapist, musculoskeletal physical therapist, or chiropractor who is skilled in Webster’s technique.

Most importantly, do not stress about your workout programming being perfectly balanced with all movement variations. It’s OK to double up on upper body exercises and include only a few variations of squats and deadlifts for lower body training because those are pain-free movements. Focus on helping your client continue moving and staying strong, healthy, and comfortable throughout her pregnancy.

Keep your pregnant and postpartum clients safe, healthy, and strong.

85% of women will have a baby at some point in their life. If you work with women, you work with pre- and postnatal women.

Whether your clients are currently pregnant or have already had their baby, they’ll have questions about everything — how to exercise safely in each trimester, which foods they should and shouldn’t eat, how to exercise the right way post-pregnancy.

And they’ll look to you for the answers.

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About the author:  Jessie Mundell

Jessie Mundell is a certified kinesiologist and a Precision Nutrition Level 1 coach, as well as an author and mother. She specializes in pre- and postnatal exercise and corrective exercise. Learn more about Jessie on her website and connect with her on Twitter.

References

  1. Bratman GN, Daily GC, Levy BJ, Gross JJ. The benefits of nature experience: Improved affect and cognition. Landscape and Urban Planning. June 2015; Vol. 138: 41-50. http://www.sciencedirect.com/science/article/pii/S0169204615000286
  2. Bratman GN, Hamilton JP, Hahn KS, Daily GC, Gross JJ. Nature experience reduces rumination and subgenual prefrontal cortex activation. Proceedings of the National Academy of Sciences of the United States of America. July 2015; 112(28): 8567-8572 http://www.pnas.org/content/112/28/8567.abstract

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