Pelvic Symmetry

Sacroiliac (SI) Joint Dysfunction

The sacroiliac joint connects the sacrum to the iliac bones of the pelvis. Hypermobility, hypomobility, or pelvic torsion causes localized pain near the "dimples" of the lower back, often referring into the groin and buttock.

CLINICAL PRESENTATION

Common Symptoms

One-sided lower back pain right over the PSIS dimple above the buttock
Pain aggravated by single-leg tasks (climbing stairs, putting on pants, getting out of car)
Stiffness or ache radiating into the groin or upper lateral thigh on the affected side
Difficulty sitting comfortably without shifting weight to the unaffected side

CRITICAL CAUTION

Movements to Avoid

✗ Asymmetrical deep lunges or aggressive single-leg stretches
✗ Forced rotational twists with feet locked in place

💡 CLINICAL PHYSICAL THERAPY PEARL

Rebuilding symmetrical isometric activation of the gluteus medius, transverse abdominis, and hip adductors creates a muscular "force closure" that locks and stabilizes the SI joint.

STEP-BY-STEP SEQUENCE

Prescribed Exercise Protocol

7 EXERCISES

PIRIFORMIS / SCIATIC RELEASE

🎯 Deep Gluteal Tension

Nerve Glide 3 mins • 30s

Reclined Figure-4 Piriformis Stretch

Releases the deep piriformis muscle to relieve sciatic nerve impingement and glute ache.

L4-L5 L5-S1 Piriformis Gluteus Medius +1

Guide

GLUTE & PELVIC STABILITY

🎯 Posterior Chain

Strengthening 3 mins • 3s

Glute Bridge Pelvic Stabilization

Activates inhibited gluteals and posterior chain to remove excessive load from lumbar extensors.

L3-L4 L4-L5 Gluteus Maximus Hamstrings

Guide

MCGILL CORE STABILIZER

🎯 Rotational Control

Strengthening 3 mins • 5s

Bird-Dog McGill Stabilization

One of the "McGill Big 3" exercises that strengthens the lumbar stabilizers with minimal spinal load.

T6-T7 T7-T8 Multifidus Erector Spinae +2

Guide

ANTI-EXTENSION CORE

🎯 Deep Transverse Core

Strengthening 3 mins • 3s

Deadbug Anti-Extension Core Rehab

Re-trains the deep transverse abdominis to protect the lumbar spine during extremity movement.

L1-L2 L2-L3 Transverse Abdominis Internal Obliques +1

Guide

PSOAS & HIP DECOMPRESSION

🎯 Anterior Hip Flexors

Desk Relief 3 mins • 30s

Half-Kneeling Psoas & Hip Flexor Stretch

Decompresses the lumbar spine by releasing chronically shortened iliopsoas muscles caused by prolonged sitting.

L1-L2 L2-L3 Iliopsoas Rectus Femoris +1

Guide

GLUTEUS MEDIUS STABILITY

🎯 Pelvic Symmetry

Strengthening 3 mins • 2s

Side-Lying Clamshell Pelvic Stabilizer

Isolates the gluteus medius to stabilize the sacroiliac joint and prevent pelvic drop during walking.

L4-L5 L5-S1 Gluteus Medius Gluteus Minimus +1

Guide

LATERAL QL STRETCH

🎯 Quadratus Lumborum

Desk Relief 2 mins • 25s

Standing Lateral Spine & QL Stretch

Decompresses the Quadratus Lumborum and side waist to relieve asymmetrical pelvic and lower back tightness.

T11-T12 T12-L1 Quadratus Lumborum Latissimus Dorsi +1

Guide

CLINICAL QUESTIONS & ANSWERS

Frequently Asked Questions about SI Joint

Q How do I know if my pain is SI joint or lumbar spine?

SI joint pain typically concentrates right over the posterior superior iliac spine (the dimple on one side of your lower back) and does not usually radiate below the knee, unlike classic lumbar sciatica.

Q Can glute bridges fix SI joint instability?

Yes. Bilateral symmetrical glute bridges engage both gluteus maximus heads and create pelvic force-closure across the sacrum without putting asymmetrical rotational torque on the pelvis.

SCIENTIFIC LITERATURE

Peer-Reviewed Evidence & Guidelines

•
"Force-Closure and Pelvic Stability in Sacroiliac Joint Rehabilitation" — Manual Therapy & Postural Rehabilitation (2023).