Let’s be Frank About: Pelvic Pain & SI Joint Pain

Pelvic Pain is characterized by pain and discomfort in the pelvic region, particularly around the pubic bone and sacroiliac joints. Pelvic pain (including SIJ Pain) is common during pregnancy due to good ol’ relaxin hormone increasing the laxity of our ligaments which support and stabilize our joints. You can imagine that your pelvis isn’t pumped when all this relaxin is challenging its sturdiness while there’s also a growing load (aka. a baby) resting right above it challenging it further.

Let me quickly introduce you to the concepts of Form vs. Force Closure:

• Form Closure: refers to a stable state of a joint with close fitting articular surfaces. I.e at rest, how sturdy a joint is just from its articular shape.

• Force Closure: the state where lateral force results in joint compression, and allows the joint to withstand a vertical load i.e all the muscles that help stabilize a joint.

So in other words — as a result of relaxin, form closure is reduced (increased laxity in the joint), and more form closure is necessary.

~ did you just read that and feel so smart? ~

Okay so back to the point — What I most commonly notice in prenatal people with pelvic pain is that there’s a combo of muscle tightness and weakness in the muscles surrounding the pelvis. As if there’s a lack of strength helping with force closure, and whatever muscles are working, are working HARD to keep things feeling sturdy. This mix of weak vs. tight can make it sometimes tough to treat but when you understand what pieces are contributing to your pain, a lil homework goes a long way.

Here are the main candidates that are part of the pelvic pain puzzle:

• The Adductors: all those inner thigh muscles attach onto either side of the pubic bone and can pull on/annoy the pubic symphysis joint.

• The Glutes: the muscles along the back side of your pelvis play a big role in stabilizing that sacroiliac joint area

• The Hip Flexors: iliacus & psoas major run along the inside of the pelvis and are so commonly tight during pregnancy due to your changing posture.

• The Core Muscles: these guys attach all the way around the pelvis and help provide stability from above.

Here are a few suggestions to explore if you’re someone who has pelvic pain and are looking for sweet relief:

1. Physio! Physiotherapists, specifically pelvic floor PTs, are trained to assess your joints & muscles to determine what exactly is contributing to the imbalance in your pelvis. These assessment don’t need to include an internal pelvic floor assessment although this option shouldn’t be ruled out if you’re not getting to the bottom of the problem. It’s veryyyy common to have some pelvic floor muscle tightness contributing to the your pelvic pain.

2. Pillows: We’re all aware of the pillow forts pregnant people can have in their beds but honestly it’s for good reason. The specific game changer is for side sleepers who need something under their top leg - (Imagine that leg up 90 degrees, knee bent - cuddle position.) Having a pillow under that knee can help keep your leg stay in line with your hip joint, reducing the amount of muscle strain on those hip muscles and helping you start the day off on a better foot (leg?).

3. Explore your body: I typically don’t find a bunch of long stretches to really help pelvic pain as much as ball release and strength work. This sometimes doesn’t make sense because so commonly when we have pain, a little stretching goes a long way. But if you think about how relaxin is already creating more mobility in the body (reducing joint stability), the ache will more likely be relieved by more strength in the muscles that can stabilize (force close) those joints instead. Frank is obviously the exact place you should look for prenatal specific strength workouts ;) but if you’ve got your own thing going on - I’d definitely recommend prioritizing: bridges, bear planks, some form of hinge (squat or deadlift), and some inner thigh strength.

4. Adjust your irritating activities: Once your pubic symphysis or SI joint is irritated, it’s important to reduce any movements that are irritating or causing inflammation, at least until the irritation settles. The most common irritating movements include:

   • Standing single leg movements, including tabletop hydrants that are so common in group classes. Focus on two legged, symmetrical positions that don’t create any unnecessary torque on the body.

   • Wide wide legged movement - especially stepping out of a car, side lunges, walking around like a sumo wrestler… it can be helpful to just stick with movements that have your legs hip/shoulder width apart.

   • Fast & long walking - honestly, shortening your stride, pace, and length can make a huge difference.

   • Prolonged sitting or standing (especially with bad posture). Stand up tall, try not to clench your butt, and if sitting, sit on a wide butt, with a lil pillow behind your low back.

5. Pelvic Belts: SIJ belts such as this one can be a great additional support for you to remain as active as possible. I don’t generally recommend that people wear these belts all the time, but instead use them to do the activities that are usually limited by your pain; walks, works, going out of the house. These belts provide external compression of your pelvis, essentially acting as the muscles that were suggesting you develop.

All in all - be rest assured that pelvic pain fluctuates throughout pregnancy and most commonly resolves once that lil baby is out of your body. But don’t forget the professionals out there who can help ease your pain with manual therapy, soft tissue work, and strength recommendations.

k thanks bye!

By Rachelle Bonneville - Founder of Frank