Runners' Pain Point #1: SI Joint

Ahh…the dreaded SI Joint…a common source of pain for runners and a common source of controversy for rehab professionals.

If you’ve been looking around for solutions to SI pain, it’s likely that you’ve seen a lot of varying opinions. SI joint problems tend to get overcomplicated, which can make things very confusing for you. Hopefully this post can help clear things up and provide some treatment strategies that resonate…

What is the SI Joint?

You have two Sacroiliac (SI) joints. They form the connection points between your pelvis and tailbone (sacrum). The joints are secured by a number of strong ligaments, and represent perhaps the most heavily ligamented areas of your body.


The joints themselves move very little, which lead some professionals to disregard them during treatment. Others feel that the joints can get misaligned or “out of place”, and thus require hands-on intervention to alleviate symptoms.

Here’s how I see it…

  • Ligaments are intended to provide reinforcement and security for movement…there wouldn’t be as many ligaments around the SI joints if they weren’t intended to move. Do they move a lot? No. Is their movement important for reciprocal and alternating function of the hips? I think so.

  • Given that it takes two people with hammers and chisels to separate a cadaver SI joint, there is NO CHANCE that your SI joint “pops out of place”. There is even less of a chance that a PT or chiropractor can “put it back in”. Even though manipulations can reduce pain, that’s not the mechanism by which it works.

What we tend to see more in runners with SI issues is movement asymmetries and muscle imbalances in the hips…and we’re able to help people achieve great long-lasting results by fixing them.

Postural Effects On the SI Joints:

Our bodies are inherently asymmetrical, and as humans, we naturally have a tendency to favor our right side (regardless whether we are right or left handed).

Most people are left-brain dominant (left brain controls the right side). We have a big 3-4 pound liver on our right, and a small 6-14 ounce spleen on our left. Our right diaphragm is larger and has a much stronger attachment to the spine vs. the left. Our liver boosts up the right diaphragm while our heart weighs down the left.

Over time, if we fall too far into a right-dominant pattern (which can happen for any number of reasons), muscle asymmetries develop in the hips, and can lead to SI issues.

We attack those asymmetries a little different depending on whether you have right and left sided pain. Here are some recommendations…

Treatment For Right SI Issues:

Left Sidelying Resisted Right Glute Max:

​90/90 Hip Shift with Right Glute Max:

Hooklying Hip Shift with Right Glute Max:

Left Supported Stance Right Glute Max:

Quadruped Belly Lift with Left AF IR and Right Glute Max:

Treatment For Left SI Issues:

Left Sidelying Knee Towards Knee:

90/90 Hip Shift Scissor Slides:

Left Sidelying Left Flexed Adduction with Right Abduction:

Right Sidelying Respiratory Adductor Pullback: ​

90/90 Supported Left Hip Shift with Respiratory FA IR:

Things to Consider:

  • SI joint pain is often overdiagnosed…for whatever reason it tends to be a “sexy” diagnosis. It’s important to make sure that you really hone in on whether it is a true SI joint issue, or if your pain is coming from the lower back.

  • The exercises above represent our starting point for most runners who come in with true SI issues. To truly return to 100%, it is often necessary to move on to higher level exercise progressions, specifically those that target more global movement patterns.

  • The exercises above are based on typical patterns we see clinically. This is not a protocol that works for everyone. The best way to get to the true root of your SI pain is to seek someone who is an expert in movement assessment.

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Hope this helps!

Dr. Mike

Please feel free to reach out with questions. You can comment below, or email me at

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(We never take credit for ideas that aren’t ours. The content of this article is heavily influenced by the Postural Restoration Institute).