Aug 5, 2021
Pain & Injury

Best Ways to Sit and Sleep with SI Joint Pain

Best Ways to Sit and Sleep with SI Joint Pain

Sacroiliac joint pain (or simply SI joint pain) can make some of our simplest daily activities much harder and far less comfortable than we want them to be. Because we sit for nearly half the day and sleep for another third (that’s about 20 hours of your day!), we’re going to help by sharing some of our favorite tips for the best ways to sit and sleep when you are experiencing SI joint pain.

What does SI joint pain when sitting or sleeping feel like?

SI joint pain when sitting or sleeping can present itself in several ways. Perhaps the most common symptom is a constant dull, aching pain felt in the lower back and upper buttocks region on the back side of the pelvis. This discomfort is typically felt more on one side of your back, between where your sacrum and ilium bones meet and together form the sacroiliac joint.

Some may also experience more of a sharp, stabbing pain within the SI joint that can be brought about by sudden movements while sitting or moving around in your bed. Motions such as getting up or turning over too quickly, or side bending or twisting towards the affected side may irritate and compress the joint space to cause this increase in pain.

Additionally, it is possible to feel sacroiliac joint pain refer sensations to other areas of the body. Pain may radiate down into the hips, groin, and back side of the upper thigh. Other ways to describe the pain caused by an unhappy SI joint include tightness, stiffness, burning, tingling, numbness, or weakness felt on the affected side.

Tips for SI joint pain relief when sitting

Here are 6 tips to help you get some relief for SI joint pain while sitting. Feel free to apply these suggestions in different sitting situations (e.g. driving, working at your desk, watching TV from the couch, etc.) to find out what works best for you.

1. Relax your hip flexors before sitting for SI joint pain relief

Tight hip flexors pull on the SI joint, pelvis, and lower back where it can cause irritation. Sitting engages the hip flexor muscles to help support you in an upright posture; however, asking an already tight muscle to perform more work may make it unhappy and become more painful.

Applying pressure to those tight muscles using a hip flexor release tool and performing a gentle hip flexor stretch can be the perfect combination to release some tension and reduce the tug on the sacroiliac joints when sitting.

The piriformis is another muscle that may pull on the SI joint and cause discomfort. Using a massage therapy ball to apply pressure followed by the Figure 4 stretch is a great pair of exercises to target this muscle and provide relief.

2. Maintain an upright and balanced sitting posture for SI joint pain relief

Being in good posture supports your body in its natural alignment. Here are a few cues to help:

  • Think about reaching the crown of your head up towards the ceiling and feel the muscles in your core, hips, and lower back region gently engage to help position your pelvis in a neutral position. Do your best to avoid excessively arching or rounding your spine.
  • Allow your breath to gently lift the center of your chest, as though there is an invisible string attached to the center of your breastbone, connected to the sky.
  • Stay balanced side to side, distributing your body weight evenly across your sit bones. Try to avoid leaning to one side, sitting with your wallet or phone in one of your back pants pockets, or crossing one leg over the other (unless you are doing a quick piriformis stretch). Each of these may place uneven pressure on the SI joints and cause discomfort.

3. Support your pelvis for SI joint pain relief

Using a lumbar pillow or a seat with built-in lumbar support can help align your pelvis and SI joints, helping to reduce pressure and relieve pain. Other options include wearing a SI brace or using kinesiotape to help stabilize the sacroiliac joints and help them heal. Each of these can be useful tools to help you manage your symptoms and get through a painful period, but are not ultimately addressing the root cause of pain.

4. Open the angle of your hips for SI joint pain relief

Sitting places the hips into more of a “closed” and shortened position, where the hip flexor muscles are more likely to become tight. Having your knees lower than your hips “opens” the angle of your hips, creating more length in the hip flexors. This lets them relax further and reduces the strain felt on the SI joints.

You can achieve this by raising the seat of your adjustable office chair, sitting on a cushion, or even tucking your feet underneath your chair (which can also serve as a nice quad stretch). You may also consider trying widening the position of your knees to open your hips into more external rotation to see if that helps.

5. Try sitting cross-legged for SI joint pain relief

Sitting in the tailor position may help open up your hips and provide some relief from SI joint pain while sitting. Starting on the floor, your bed, or even while seated on your couch, cross your legs together near the ankles. Have your heels as close to your body as is comfortable, while also making sure that the weight of your body is on your sit bones. Focus on relaxing and taking deep breaths.

Once you’ve settled into this position, try grabbing the front of your knees (or your shins) with your hands and gently pull your torso forward and upward to create a stretch in the lower back and hips. Think about spreading the knees apart from each other and bringing them closer to the ground to increase the stretch in the hips.

If this position is either too challenging to maintain or uncomfortable to get into, you may modify your positioning by sitting on top of a small cushion. This will allow your knees to be lower than your hips, opening up your hip angle and making the stretch easier to perform.

6. Take frequent breaks when sitting for SI joint pain relief

Sitting for longer periods of time without moving requires the hip flexors to work harder. When these muscles don’t get the chance to relax or recover as you repeat this pattern day after day, they become fatigued and tighten up where they may pull on the SI joints, causing pain.

Consider getting up from your desk about every 30 minutes to move around. Go for a quick lap around the office or do a few stretches to help get some blood flowing into the muscles and give the hip flexors a break from being in a shortened position for so long.

If you have access to a standing desk, switching between standing and sitting throughout the day could be helpful too. If a standing desk isn’t an option for you, alternating between sitting and a half-kneeling position could be great (plus you can stretch your hip flexors in this position while you work!).

Tips for SI joint pain relief when sleeping

Here are 4 tips to help you get some relief for SI joint pain while sleeping. Try these out so you can finally catch some Zzzzz’s and wake up the next morning feeling refreshed and ready to go.

1. Relax your hip flexors before sleeping for SI joint pain relief

Tight hip flexors can contribute to sacroiliac joint pain and other kinds of hip pain when sleeping. Establishing a pre-bed nighttime routine to help these muscles relax can make a huge difference between getting a good night’s sleep or tossing and turning with discomfort.

This routine may include a combination of muscle release techniques, stretches, and corrective exercises that are focused on relaxing tight and unhappy muscles while also improving the alignment of your pelvis and SI joints. Here is our favorite 3-step routine for SI joint pain relief that you can perform before getting to sleep tonight. It should only take you 10 minutes or less!

2. SI joint pain relief for stomach sleepers

Sleeping on your stomach tends to place most people into an over-extended position (or having too much arch) in their lower back and pelvis, which places added compression to the spine and the sacroiliac joints. You can adjust for this by placing a small pillow near the bottom of your abdominals and top of your pelvis. Doing so helps situate your spine and pelvis in more of a neutral position, thereby reducing the compression and strain felt in the SI joints.

3. SI joint pain relief for side sleepers

Sleeping on your side typically places more pressure on the bottom hip, so you may find relief by sleeping with the painful side facing up. As a painful SI joint may also refer pain into the groin area (even with the painful side facing up), you can try using a pillow and place it between your knees and ankles. Here is a video showing how this can help to open up the angle of your hip joints and set your pelvis into a better position, relieving some of your sacroiliac joint pain while sleeping.

4. SI joint pain relief for back sleepers

If your hip flexors are tight (which is common among people with SI joint pain), this may put your lower back and pelvis into an anteriorly tilted position. Again, this puts extra pressure on the joints in the lumbar spine and also the sacroiliac joints that can increase your pain. Placing a pillow underneath your hamstrings (where the top of the pillow is beneath your sit bones) can help to posteriorly tilt your pelvis back towards a neutral position and relieve some pressure on the SI joints.

Improving your SI joint pain long-term

Adjusting your sitting position and sleeping position can provide immediate short-term relief. Regularly releasing the hip flexor muscles Achieving longer-lasting improvement will require you to address the actual root cause of your SI joint pain.

Chances are that your sacroiliac joint pain has something to do with misalignment and instability of your pelvis. This can create either too much or too little motion in the SI joint (both of which may result in pain), and is commonly referred to as having a hypermobile or hypomobile SI joint.

When the supporting muscles and ligaments around the pelvis are strong, supple, and balanced they are able to hold the pelvis in its natural position (called a neutral pelvis). This allows for the sacroiliac joints to move and function as they are supposed to, pain-free.

Is the iliacus muscle a potential source of your SI joint pain when sitting?

While there are over 40 muscles that surround the SI joints alone, an often overlooked muscle as it relates to the alignment of the pelvis and SI joints is the iliacus. The iliacus, one of your hip flexor muscles, originates at the ala of the sacrum (upper corner of the sacrum), connects to the anterior sacroiliac ligament, and lines the iliac fossa (the inside surface of the ilium) as it passes over the hip joint and inserts into the lesser trochanter of the femur in the groin region.

anatomy illustration of how a tight iliacus causes SI joint pain

By understanding the anatomy of the iliacus, you may begin to see how tightness in this muscle would rotate the ilium forward and pull the pelvis into an anteriorly tilted position. This changes the alignment between the ilium and the sacrum, affects the ability of the sacroiliac joint to move and absorb force, and ultimately leads to pain and inflammation over time.

Using the Hip Hook for SI joint pain

Our favorite iliacus release tool that we’d recommend trying out is called the Hip Hook. Designed by a physical therapist, the Hip Hook has the ability to apply precise, angular pressure to this hard-to-reach muscle on the inside surface of your pelvis in a similar way that only a skilled practitioner could perform on your body. In just a few minutes per day, you can begin releasing tension in this muscle and help realign your pelvis, thereby reducing the strain on your sacroiliac joints.

woman using the Hip Hook iliacus release tool

Frequently asked questions on SI joint pain

How do you sit with SI joint pain?

Your hips and lower back should be relaxed and supported in a neutral position, such as with a lumbar support. Sitting with the hips higher than the knees can also be helpful to relax your hip flexor muscles, which may be pulling on your SI joint and creating pain in your lower back if you sit for extended periods.

Is sitting bad for SI joint pain?

Sitting for extended periods of time may cause your SI joint pain to flare up because it places your hip flexors in a shortened position and pulls on the SI joint. To help reduce your pain, it might be helpful to take frequent breaks to walk around and stretch to help the tighter muscles in the area to calm down and loosen up.

What is the best sleeping position for SI joint pain?

Using pillows to support your hips and pelvis in a better alignment can reduce your SI joint pain when lying down. For stomach sleepers, place a pillow underneath the lower abdomen. For side sleepers, have a pillow lengthwise between your knees and ankles. For back sleepers, have a pillow under your upper hamstrings. For longterm relief, release your hip flexors (psoas and iliacus) to alleviate tension on this joint.

What aggravates SI joint pain?

There are many muscles around the SI joint that can become tight and pull it out of alignment, such as the hip flexors, piriformis, and quadratus lumborum muscles. When these muscles are holding tension, it is more challenging to sit or stand for long periods of time. SI joint pain may also be aggravated by going from sitting to standing too quickly or twisting, bending, or laying on the affected side.

How do you prevent SI joint pain when sitting?

To prevent SI joint pain when sitting, it is important to teach your tight muscles to relax. Before sitting, consider doing some gentle stretching for your hip flexors (psoas AND iliacus), glutes, and lower back muscles. There may also be some muscle knots in these areas that need to be released with direct pressure with the help of specialized muscle release tools or a skillful practitioner.