SI Joint Exercises for Pain, Tightness, & Piriformis Syndrome

Do These Exercises to Prevent Hip and Leg Pain From Sitting

By Coach E

SI Joint Exercises for Pain, Tightness, & Piriformis Syndrome

If you have SI joint problems, piriformis syndrome, or other pain in the butt, this article will show you SI joint exercises for pain that will fix it for good.

This type of pain occurs in the upper region of the glutes. It can happen to one or both cheeks. Most people will describe it as burning, aching, or a “bit crampy.” We’ll also dive into the root causes and a great exercise while you’re sitting at your desk to prevent this type of pain from happening. 

You can also follow along with the video below that demonstrates how to perform each exercise.

Let’s start. 

Anatomy of the SI Joint

Sitting is the number one cause of SI joint pain. But why? 

If you look at the anatomy of the pelvis,  the sacroiliac joint (SI joint) sits right where the sacrum (the bottom of your spine) connects to the pelvis. It’s a very solid joint. Along the front, we have the psoas, a stabilizer muscle. We have the glutes in the back. 

sacroiliac joint - si joint anatomy

You can see how the glute max inserts close to the SI joint. Then another muscle called the piriformis goes just underneath the SI joint itself. 

What happens is that the glues shut off because we’re sitting on them all day. Our pelvis tucks in, so the psoas sticks in a shortened position. Then the piriformis has to do double duty to work and compensate for the glutes shutting off. 

That’s a lot for one muscle, but then it gets worse. 

What’s more, it can be tender and even painful because it has trigger points. 

There’s another structure we’ll get to a little later that plays a part in one of the studies we used as a foundation for this routine. 

This other structure involves the sacrotuberous ligament. Remember, a ligament attaches bone to bone. The sacrotuberous ligament stabilizes the pelvis and the sacrum where they connect. It’s a ligament that can become over-stressed. 

If the muscles aren’t doing their job of dynamically stabilizing the SI joint, the sacrotuberous ligament has to take over. That means even more stress on the tissue right when you’re sitting. 

Take a look at where the sacrotuberous ligament is. 

si join anatomy - sacrotuberous ligament

Sitting all day puts a lot of pressure on the ligament, which can lead to irritation. Plus, it won’t get much blood flow. A lack of blood flow means everything just doesn’t work as well. 

Thankfully, we can correct this stagnation. But if you are sitting for long periods, try to move around at least a few times an hour and consider a desk that allows you to adjust between sitting and standing. 

Next, we will show you how to do some function tests to give you an idea of your SI joint health. 

SI Joint Dysfunction Tests

When doing these tests, it can help to have a friend (who you don’t mind looking at your backside) gauge your range of motion. A mirror can also work in a pinch. 

Test #1

First of all, lie down on your back. Grab your knees and pull your knees up towards your chest. They should go straight up toward your shoulders. 

When you first do this, notice that your tailbone curls up off the ground. Lower your knees until you can flatten your tailbone on the floor. Then see how far up you can pull your knees without your tailbone curling up. 

si joint test 1 - eric and dr. b

See the difference between the two? Dr. B has a great range of motion. Coach E (admittedly) has some work to do.

What you just did tests the ability of your psoas (the muscle in the front of your hips) to stabilize your pelvis and hold it in an anterior pelvis tilt. The routine you’ll learn down below will help increase this range of motion. 

Test #2

The second test is whether you can keep your anterior pelvic alignment as your flex your hip in a standing position. In layman’s terms, can you lift your knee straight out in front without your pelvis tilting? 

What often happens is that when you flex your hip, just like when you were lying on the ground in the previous test, your pelvis would tilt underneath. 

Perform the test by placing both hands on the wall. Then raise one knee and have your friend see if you’re tilting your hips forward with the movement or not. You might see some curling of the thoracic spine too. That’s also a compensatory mechanism. 

si joint test 2 pelvis alignment

You can imagine how much stress will go through your SI joint, your lower back, and possibly your hip if you can’t maintain that anterior pelvic tilt as you’re moving. 

Maintain that anterior pelvic tilt. Don’t allow the tail to tuck under and the lumbar spine to flex whenever you go into hip flexion. 

A Quick Note on Common Remedies for Sacroiliac Joint Pain

Let’s say you decide that it hurts enough to go to the doctor. What are the common treatments that will be prescribed for you? 

Dr. B says:

“If you go to the doctor, they’re generally going to recommend that you ice your SI joint, take some anti-inflammatory medication, and rest. They may also suggest that you go to see a physical therapist, chiropractor, or massage therapist who can loosen up the muscles that are tight in your butt. 

A rather effective treatment can be a cortisone injection into the SI joint if all of those other treatments have failed. It often works very well, but again, it’s a temporary fix. 

We, Coach E and I, always really promote getting to the root cause, which is: what’s going on with the psoas? What’s going on with your glute? What’s going on with the piriformis muscle?

What can we do in addition to the massage, ice, and possibly cortisone to prevent your SI joint problem from progressing or from coming back?”

It’s always a good idea to talk to your doctor. We strongly recommend it. But we also want to give you the tools to activate sleepy muscles and address the root cause of the pain. 

ReBUT Technique

While you’re at your desk, on the couch, or wherever you enjoy sitting, give this a try to keep the blood flowing. 

We did a video a little while back showing an exercise that Coach E named The ReBUT Technique because you get your butt back. 

It is something you can do when you’re sitting at a desk. Doing it at least two reps every hour (more often is better for this) will help prevent these issues from happening in the first place. 

Prevention is the best medicine. Plus, it’s fun. 

rebut technique

Here’s how: 

  1. Sit on the edge of your chair with feet flat on the floor; don’t hyper-extend your spine
  2. Place your palms on the back of your head
  3. Activate your glutes to 100% – they’ll firm up and make you taller
  4. Maintain activation for one slow breath, then slowly release as you count to three

Give the ReBUT Technique (you can watch the full clip here) a try the next time you have low back pain or leg pain before turning to the painkillers. 

Exercise #1: ASMR Posterior Hip

The first place we always start is with active self-myofascial release. In this case, ASMR of the posterior buttock muscles capsule and ligament. 

We do this because we want to make sure that all of the muscles and the tissue can slide over one another effectively when we take the next step of turning them on. 

You need a ball for this. It should be something that’s firm and about the size of either a tennis or golf ball. Racquet balls offer a common choice for balls of about the right size and firmness. 

ASMR Posterior Hip

  1. Place the ball on the ground and position it under the area that hurts
  2. Use your hands to control how much weight you put on it as you sit on the ball – it should be tender but not painful
  3. Flex and extend your hip slowly by extending your leg straight out and back
  4. Reposition and repeat for about 1 minute
  5. Externally rotate your hip by holding your knee at a 90-degree angle and moving your knee toward the floor, then back up over the other leg
  6. Reposition and repeat for about 1 minute

1 minute per motion, per leg.

Remember to breathe. 

What you’re doing is you’re trapping some of the tissues and allowing the muscles to move around the capsule and the ligament. 

You may find that as you try to bring your knee across the front line of your body, it feels tight. This is a good sign because you will release the piriformis and the glute max from the posterior capsule and the sacrotuberous ligament. 

ASMR allows these muscles that you’ll use in the next exercise to turn on and work more effectively. 

Exercise #2: Hip Bridge

Now that we’ve released the posterior tissues, we want to turn on our glute max. 

The best exercise for activating the glute max is the glute (or hip) bridge. 

si joint pain exercise - hip bridge

  1. Lie on your back with your pelvis in neutral and feet flat on the floor
  2. Do a kegel and turn on your glutes
  3. Raise your hips
  4. Hold for 5 seconds and slowly lower
  5. Relax your kegel and glutes

1-2 sets x 5 reps – 5 sec hold

Maintain metatarsal pressure throughout the whole exercise, and you’ll have happy glutes when you’re finished. 

Exercise #3: Slumpy Psoas Activator

The Slumpy Psoas Activator works wonderfully for activating the psoas while it’s in the position where it’s normally shut off. 

When sitting, people often sit on their sacrum, which rounds out and shuts off the psoas. So it’s important for low back pain because the psoas provides stability in the lumber and for hip function. 

The psoas stabilizes our hips by contributing to the centration of the hip joint whenever you’re moving your leg up and down and around. It helps to stabilize and keep the head of the femur centered in the socket when you move. 

slumpy psoas exercise - si joint pain

  1. Sit on the edge of your seat with your back slumped
  2. Put one hand on the opposite knee
  3. Lift that knee against strong pressure from your hand
  4. Extend the lumbar spine and tilt the pelvis anteriorly (sit up straight)
  5. Hold for 5 seconds
  6. Lower your leg slowly, under control, and slouch down

1-2 sets x 3 reps per – 5 second hold.

Once again, remember to breathe. Activating the diaphragm during this exercise is key to building good breathing habits and getting blood flow during activation. 

One little tweak if you feel like you’re TFL (a muscle on the outside or lateral of the psoas) is working a little too hard, you can set up the same slouchy position and abduct your leg, moving the knee slightly away from your midline. 

From there, do the same exercise while focusing on sucking the lifted leg into your body. This way, you’re not only pressing up but sucking the leg into the socket to optimize the alignment there. 

Exercise #4: Hinged Knee Fl-Ex

The Hinged Knee Fl-Ex is one of those exercises that provides a ton of benefits, and there are lots of little details. We’ll cover the basic version today, but check out the Fundamental Precision Movements Program to take full advantage of it and seven other techniques. 

hinged knee fl-ex - si joint exercise

  1. Stand with your feet shoulder-width apart, pointing straight ahead, slightly bent knees
  2. Adjust your hips so you have a slight anterior pelvic tilt with a slight lumbar extension (point your butt out a little bit)
  3. Hinge at your hips, leaning your torso forward, maintaining neutral spine until you feel your hamstrings pull tight
  4. Hold the hinge and slowly activate the quads on one leg, pulling the knee straight
  5. Hold the activation for 5 seconds, deactivate the quad
  6. Slowly straighten up

1-2 sets x 3 reps per – 5 second hold. 

When Coach E was putting this routine together, one of the studies he found on SI joint pain held some interesting revelations. [1]

What they did was take a bunch of people with sacroiliac joint pain. The researchers then did a treatment that fixed a lot of them and looked at the ones who still had pain. 

They found several underlying reasons, which we’ve talked about previously. They had irritation in the sacrotuberous ligament, hamstring tightness, and glute max weakness. 

This is one of our favorite exercises because it addresses all three of those root causes. 

When you hinge over, you can lengthen the hamstring and sacrotuberous ligament. Then, when activating the quads and hinging back up, you’re turning your glute max on. 

It encapsulates the benefits that the study showed and the factors that the people in the study needed to address to get rid of their pain for good. It also had a whole other list of benefits that we get more info in the Fundamental Precision Movements.

In short, if you’re going to master one technique from this article, perfect this one. 

Exercise #5: Split Squat

The fifth and final exercise today to help you with SI joint pain or piriformis syndrome is the split squat. It’s similar to lunges that you might be familiar with, with a few key differences. 

split squat si joint exercise

  1. Stand with one foot forward and the other behind, like you’re getting ready to bend the back knee for a lunge; the stance should be comfortable
  2. Lower your back knee down, all the way to the ground if you can
  3. Slowly come back up
  4. Repeat then switch sides

1-2 sets x 6 reps per side.

The key to the split squats is knowing that it’s not a lunge. It’s okay for your front knee to travel beyond your foot. It’s actually great for ankle mobility, and you’ll use that function naturally to walk up stairs. 

Maintain metatarsal pressure throughout the exercise. Focus on good alignment through the spine and hips. 

Don’t allow your pelvis to roll under the way we’ve been talking about. Maintain a neutral or a slight anterior pelvic tilt. Sometimes people slip into hyperextension on the back leg side of the hip when they lower their knee. Try to avoid it. 

If you have problems with strength, it’s still a good idea to travel the full range. Use a stick, chair, or anything stable that you have to help with the strength and stability through the whole range of motion. 

A stabilizer will help you get a little more range. We want that range because the bottom of the motion is when you get good length through the hip flexors, quads, and rectus femoris. 

Most of the previous exercises work the muscles in a flexed position, except the hip bridge. We also need this exercise to lengthen that out to make sure we don’t get stuck. 

Final Notes

There you have our five SI joint exercises for pain, tightness, and piriformis syndrome. These will also help with other issues stemming from root causes of hip dysfunction. 

Don’t forget to use the ReBUT Technique while you’re sitting to help prevent these issues from happening in the first place. 

But we’ve also got something that’s a part of our course called the Foundation for Movement Longevity. In that, there’s a routine that we call the Hip Pocket Routine, and we’d like to give that to you for free since you stuck with us through the article today. 

Dr. B developed this particular routine because she noticed that when examining patients with femoral acetabular impingement (SI joint problems and low back pain), whenever she’d flex their hip up, there wasn’t any space for the femoral head to go into. As a result, people had to do a posterior pelvic tilt. 

Think of it like a baseball glove. You want that nice, deep pocket to catch and hold the ball. It’s like your hip pocket in that if there isn’t space for the ball of the femoral head, it throws the whole pelvis out of alignment, causing pain down the line. 

Click here for the free Hip Pocket Routine!

Thanks for sticking with us. Keep up the great work on your movement longevity journey. 

About the Author

Eric Wong (aka Coach E) is the founder of Precision Movement and has a degree in Kinesiology from the University of Waterloo. He's been a coach since 2005 and spent his early career training combat athletes including multiple UFC fighters and professional boxers. He now dedicates himself to helping active people eliminate pain and improve mobility. He lives in Toronto (Go Leafs Go!) with his wife and two kids and drinks black coffee at work and IPAs at play. Click here to learn more about Eric.

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