By Bizz Varty and
Rehab – How can I be BFFs with my SIJs?
Disclaimer: While I have lots of personal and professional experience helping people heal their SIJs, I am NOT, in fact, a doctor. If these exercises help you, that is wonderful, but if they do not or if your pain gets worse, PLEASE see a medical professional – ideally one who has experience working with dancers.
I’ve provided a number of options for each step because I’ve found that every SIJ joint issue has a personality of its own, and different bodies respond better to different therapies. I recommend giving all of them a try to find which ones whisper the sweet nothings that your SIJs need to hear. The best course of defence against future issues in the SIJs is to do a little work on them every day, from a minimum of 5 up to an ideal-world 20 minutes, either all at once or a few times a day, as needed. Once you become familiar with the exercises and with the difference between the way a functional and dysfunctional SIJ feels, you’ll know what your body needs and when, and you can address any weird twinges before they throw off your alignment and set off a zigzag effect throughout your body.
Step 1: Loosen Up
Since so much SIJ drama is caused by tension, the first order of business is loosening the f#$% up (something most over-achieving dancers prefer not to do) (note from Monika- HAHAHA! So true).
This is as much mental as it is physical – you need to get into your happy place so that you can let go of the anxiety that pain and injury cause. In extreme cases, I often recommend a glass of wine to promote relaxation (you gotta do what you gotta do!).
Bouncing: with your feet parallel and shoulder width apart, bend your knees slightly making sure they point over your second toes, and simply bounce gently up and down, letting go of tension throughout your body. You can let your head roll side to side as you bounce, and try bouncing on one leg at a time while you stack your joints over one another from your feet to your head.
Pelvic Tilt: laying on your back with your feet hip width apart on the floor and your knees bent, gently tilt your pelvis towards your head, rocking your tailbone up off the floor and slightly flattening the curve in your low back. This is a subtle movement that wakes up your deep muscles, so you need to keep it small. Your obliques, transverse abs and adductor magni can rock your pelvis, but only if you relax your glutes and try not to push with your legs.
Step 2: Align
The second most important thing you can do to improve your SIJ function is to embrace inward hip rotation.Turnout is not your enemy, but over-reliance on turnout muscles is, so do yourself a favour and learn to love parallel feet, hip width apart. In yoga, the opposite of turnout is called ‘inner spiral’. A balance of inner and outer spiral appropriate to the body’s position is the key to SIJ stability. A great way to learn to use inner spiral is to use an image I call the “pelvic smile.”
Pelvic Smile: When you activate your pelvic smile, you turn on your deep abdominals and activate your inner spiral while releasing your outer rotators. To do it, imagine that you are able to look at a cross-section of your body, as though you were cut in half just below your navel at the level of your ASISs (the bony points at the front of your pelvis). A top view from here would reveal the two halves of your pelvis connecting at the SIJs in something like a semi-circle.
If you make your index finger and thumb into a semi-circle on each hand and connect them at the tips of your thumbs, you can simulate this image. Without proper alignment, your hip bones can feel (and your hands will look) kind of like a ‘W’. We want to make them into a ‘U’ or smile shape. To accomplish this, there are three main actions:
First, you will imagine widening across the back of your pelvis, pulling your low belly muscles in towards your sacrum (pulling your thumbs out to make a rounder shape) Next you’ll use your deep abdominals to narrow your ASISs (hip points) towards each other in the front of your pelvis (pull your index fingertips towards the centre to make your fingers perpendicular to your thumbs). The third action deals with the body in space. When you are standing, the pelvic smile (fingers and thumbs) should be parallel with the ground, and when you lie on your back the ASISs will point up towards the ceiling. When on your stomach, the pelvic smile forms a bridge from one hip point to the other, with the sacrum at the apex. When you are moving through space, the pelvic smile should move with you, maintaining its position between your head and your feet.
Once I experienced the magic of pelvic smile, I couldn’t help but do it everywhere – in the shower, while washing dishes, grocery shopping…. it works wonder to get you in alignment, and you’ll find that after a little practice, you’ll develop a smirk on your face to go along with it, one that says “bet you can’t guess where I’m smiling right now ;)”.
Step 3: Warm Up
Developing a mental picture of your pelvis by using imagery (such as the pelvic smile) will help you to understand what does and doesn’t work for your body. If the pelvic smile doesn’t work for you, there are lots more options – ask around or check out Donna Krasnow’s dancer-saving Conditioning with Imagery.
Muscles, like people, have trust issues, and when dancers focus all their attention on the outer rotators, the inner ones will weaken and retreat, sulking in a corner and refusing to do their jobs. Being an especially touchy and stubborn kind of joint, the SIJ responds better to attempts at realignment once it’s been flattered with a little attention, so be sure to warm up before you try any of the release techniques.
You will find the exercises below described in my free workout video “The Pilates Quick Fix” on youtube (or visit my website to order a DVD). Here is a quick list of the most important exercises to improve your relationship with your SIJs, so if you don’t have time for the 25 minute video, you can choose the exercises you need the most.
Glute medius and Adductor magnus: Hip release
QL & Latissimus dorsi: Back extensions
Ilio-psoas: Hip fold
Step 4: Release
Retraining involves three things: releasing tense and spasmed muscles, strengthening weak ones, and then stretching and massaging to lengthen the short ones. Because SIJ dysfunction affects so many parts of the body, it would be inefficient to try and strengthen the weak muscles without first putting things back into place.
Releasing is not the same as stretching. While stretching involves pulling on the ends of a relaxed muscle to make it longer, releasing places the body in a position that brings the ends of a tense or spasmed muscle closer together so that the muscle can relax. It’s important to release before you strengthen (and before you stretch), because it will help maintain your alignment as you retrain your body.
Some people hold more tension in their piriformis, while others focus theirs in the glute medius or QL. Releases are best held for 3 minutes, but the longer you stay, the more your muscles will remember what it feels like to loosen the f$%# up.
Outward rotation (releases glute max & piriformis)
Laying on your stomach with feet hip width apart, bend the knee of the affected side so the shin is perpendicular to the floor. Take the bent knee out to the side, about 30-45 degrees from the midline of the body, and place the knee on top of a pillow or cushion. Now allow the foot of the bent leg to drop towards the straight leg, passively rotating outwards. You need to relax the entire leg on the affected side, so you’ll want to prop the foot against something so you don’t have to use your hamstrings to keep the leg bent. I like to do this in a doorframe or near a table, but a chair or stack of heavy books would also make a decent foot-stopper. Once you’re there, focus on breathing deeply and relaxing the outer rotators on each exhale. I also like to reach back and use my hand to give the butt muscles a good jiggle to make sure they’re loosening up. This one is way easier if you get a friend to help, but it can be done on your own when necessary.
Inward rotation (releases glute med & IT band)
Laying on your side (with the affected side on top), make sure your body is in one straight line from head to toes. Bring your top knee forward, at an angle of about 45 degrees to the body and place the entire shin on a pillow or bolster. Roll forward slightly so that your weight rests on the cushion (you might like to cuddle a pillow to your chest as well). Make sure the foot and shin of the bent leg are at the same height as the knee. Once again, breathe deeply and go to your happy place, and add a little jiggle if necessary.
Seated fourth (releases glutes, piriformis and IT band)
This one is a great quick release you can do just about anywhere, no props required. Sit in fourth position with the affected leg behind you (bend the unaffected leg in front of you as though you were going to sit cross-legged, with the unaffected leg curled around behind you near your butt). Align your upper body with the thigh bone of the back leg, and lean away from the leg and rest on your hand or elbow. While relaxing the glutes and thigh muscles of the back leg, massage the piriformis and glute med. I often twist and wiggle around some in this position to find the ideal spot for release.
Bolster release (SI and QLs, etc)
For this release you’ll need a prop that is at least 8-12” in length and not much wider than your SI dimples. A foam roller will do but you can also use a tightly-rolled yoga mat or a bolster if you want something softer. The roll will line up with your spine, and you will lay on it with the bottom at your tailbone. If your prop isn’t as long as you spine, you’ll want to cushion your head and upper body above its end. Once in position on top of your roller, bring the soles of your feet together and your knees out to the side. Place your hands on your hip bones and rock them gently side to side while thinking soft and happy thoughts about your glutes. You may feel a clunk or a shift, or you may not feel anything move, but either way this is a VERY effective release for the SI joint once the muscles surrounding it have chilled out.
Step 5: Strengthen
Now comes the business of strengthening those tense, weak inward rotators so that they feel equal to the outers and start doing their jobs. Don’t skimp on this part – you have probably spent more hours ignoring your inner muscles than you care to admit, and this is your chance to make it up to them. Although joints can be replaced these days, you can’t just trade in the ones you’ve got for ones that trust you more, so you and your SIJs might as well start talking about your feelings and working through your issues now.
Pilates is a very effective way to strengthen your deep core muscles and facilitate neuromuscular repatterning. Make sure to use your pelvic smile! Instructions for the exercises below can be found in my Quick Fix video.
Abs: Tic tocs, Ab curl
Multifidus: Back extensions
Glute medius: Clam shell
Adductor magnus: Butterfly
QL & Latissimus dorsi: Swimming, Arm & leg reach
Ilio-psoas: Hip fold (*try it with a straight leg, too)
Step 5.1 Re-release
In the beginning stages of retraining, old habits could pop up during strengthening and cause a spasm in the outer muscles. If this happens, don’t stress, just go back to step 4 and re-release them before you stretch.
Step 6: Stretch/Massage
Stretching and massaging is about balancing the resting length of your muscles. You need to lengthen your outer rotators to balance them with your inner ones so your SIJs can rest easily between the two. Because the SIJ’s range of motion is small and controlled by deep ligaments, muscles and fascia, stretches won’t be able to get at all the structures that need attention. Massage (using props for those hard to reach places) will dig down into them, basically reverse-stretching them in the way you would roll out a pie crust.
Yoga is a great way to stretch while maintaining proper alignment and activation of your postural muscles. You will find instructions for most of these poses in my Hippy Hippy Shake videos (or see YogaJournal for step-by-step basics). And don’t forget to use your pelvic smile!
Chair pose (with twists)
High and low lunge (with twists)
As for massage, a pair of hard rubber bouncy balls are ideal for getting into the deep structures around your SIJs (tennis ball size is good, but I find tennis balls themselves to be too soft and slippery). (Note from Monika- You can get a lacrosse ball for four bucks from Canadian Tire). Place them on either side of your spine and roll up and down against a wall for a nice deep massage. You want to avoid rolling over your spine, instead focus on the muscles and tendons. Make sure you get down into the glutes, and even turn sideways to get the entire glute medius and the IT band.