Core Strength and Sacroiliac Joint Pain in Women

As women, we all know that a strong core is very important not only for the cosmetic benefits, but more importantly is live a life free of pain. Pregnancy certainly influences our core strength as our abdominal wall stretches and our pelvis separates during delivery. Caesarean section is no detour, as you’ll cut through the abdominal wall during delivery. It’s not uncommon for women to suffer from low back pain and/or sacroiliac joint pain both during pregnancy and post partum. A strong core is essential to prepare for the anatomical stressors of pregnancy, but to also help us recover too. Improving core strength can seem like a daunting task, particularly when we evaluate anatomical characteristics that set us apart from men.

Topping the list of pathologies that are both common in women and a result of core weakness or muscle imbalances is sacroiliac joint pain. Sacroiliac joint (SIJ) pain is thought to cause about 15% of low back pain symptoms.2 The SI joint is often overlooked as there is still much discrepancy over how a small joint with such little movement can be the source to a person’s intense low back pain. You may tell or hear friends remarking that your SI joint is “out of whack” or “flared up”. But what really is your sacroiliac joint and how does it play such a huge role in our daily functional tasks such as sitting, standing, and walking? How does a strong core assist your SI joint pain and help in providing further stability?

The sacroiliac joint connects your pelvic bone (ilium) to the lowest part of your spine (sacrum). There are two SI joints (right / left) that can act independently of one another creating a variety of movements. Together your SI joints act as shock absorbers to help ease forces of standing, walking, running, and jumping. There are also 35 muscles that surround the SI joint and include your glutes, hamstrings, hip flexors, and piriformis muscles. Each of the 35 muscles play a vital role in movement and stabilization at the pelvis and hips. Several ligaments surround the SI joint, providing added stability. These ligaments, which are said to be the body’s strongest, are the same ligaments that become lax during pregnancy and even more so during the birthing process. Increased laxity allows the pelvis to separate, ultimately placing asymmetrical strain on the SI joints. Unfortunately, two-thirds of women who experience back pain during pregnancy will continue to for up to one year post partum.1 Several factors can increase your risk of developing SIJ pain, including leg length discrepancy, age related changes, arthritis, rheumatoid arthritis, gout, spine surgery/pathology, and trauma/fall. Women are eight to ten times more likely to experience SIJ pain than men due to the primary factor for SI joint pain: pregnancy.1 Multiple pregnancies can compound laxity and increase your risk for reoccurring low back pain. Women are at further risk for SIJ pain anatomically. With wider hips than their male counterparts, women are less stable.

A hormone, relaxin, is released during the birthing process that purposefully decreases the stability in the female pevlis. The hormone allows for the separation of the pubic symphysis and opening of the birthing canal. Doing so increases the strain to the SI joints.

Diagnosing SIJ pain usually occurs through an evaluation by your doctor or physical therapist. Diagnostic images (x-rays or MRI’s) are fairly useless. A battery of special tests can determine if your pain originates from your SIJ or another area. Ignoring SIJ pain can lead to persistent pain and disability. Early treatment during pregnancy, shortly thereafter, or at any time when pain accompanies trauma can help prevent chronic symptoms. Once diagnosed, performing exercises to either mobilize or stabilize the SIJ can not only manage symptoms, but also cure them. Muscle energy techniques and strengthening exercises can help improve alignment, flexibility, and stability. Improving pelvic floor strength and muscle control can also improve pelvis, hip, and spine stabilization. It’s important to recognize your needs. Performing cookie-cutter exercises may increase or worsen your symptoms.

Looking for a jumping off point? Achieving a basic understanding of proper core activation throughout the day could not only alleviate your symptoms, but prevent them from worsening. Basic core activation goes hand in hand with working on your posture throughout the day. Post partum or not, most of us have core weakness and poor sitting habits. Both of which can be a significant piece to your low back pain pie. Upright sitting decreases lumbar disc pressure and engages core musculature when compared to that of slouched sitting. Improvements in post partum pelvic girdle and SIJ pain is best achieved when the exercises include the entire spinal musculature (think core) and when the program is individualized to the patient’s abilities.4 This is all the more reason why physical therapists play such a crucial role in improving your core strength and addressing specific impairments leading to pain. According to Richardson et. Al, contraction of your transversus abdominus, a deep muscle of the abdominal wall, increases SIJ stiffness and decreases ligament laxity. This provides a great jumping off point early in the rehab process. A step progression of isolating and targeting specific muscles, followed by combination exercises involving limb movements and progressing to a functional based program can fix the root cause of symptoms and prevent their reoccurence.3

Low back and SIJ pain do not have to occur just because you are a woman, pregnant, or have given birth several times. Learning how to stabilize or mobilize your sacroiliac joint through selective strengthening and stretching is imperative for long term health and avoiding reoccurrence.


1. Berg, G et al. Low Back Pain during Pregnancy. Obstetrics and Gynecology. 1988; 71 (1): 71-75. Cohen, S et al. Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment. Anesthesia and Analgesia. 2005; 101: 1440-1453.
2. Cusi, M. Paradigm for assessment and treatment of SIJ mechanical dysfunction. Journal of Bodywork and Movement Therapies. 2010; 1-10.
3. Richardson, C et al. The relation between the transversus abdominus muscles, sacroiliac joint mechanics, and low back pain. Spine. 2002; 27 (4): 399-405.
4. Stuge, B, Holm, I, Volestad, N. To treat or not to treat postpartum pelvic girdle pain with stabilization exercises. Manual Therapy. 2006; 11: 337-343.



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