Sacroiliac (SI) joint pain affects the joints connecting the base of the spine to the pelvis and is common during and after pregnancy. This discomfort, often felt as a deep ache in the lower back or buttocks, is part of pelvic girdle pain (PGP). Nearly half of all pregnant women experience PGP, leading many to wonder if the pain will disappear after delivery. While the prognosis is favorable, the pain can persist for a significant period for some individuals, making it a major postpartum concern.
Understanding the Postpartum SI Joint
The persistence of SI joint pain after delivery stems from lingering physiological and biomechanical changes that began during gestation. The primary hormonal factor is the continued presence of relaxin, which softens the ligaments holding the pelvic joints together to prepare for childbirth. This ligamentous laxity increases the mobility of the SI joint, causing instability and discomfort even after hormone levels begin to drop.
The mechanical stresses of labor and delivery can further strain these loosened structures. Weakened core and abdominal muscles following pregnancy also contribute to pelvic instability, placing greater shear forces across the SI joints. The body requires time to rebuild stabilizing muscle strength and for the ligaments to regain their pre-pregnancy firmness.
Typical Recovery Timeline and Persistence
For most individuals, sacroiliac joint pain is self-limiting and resolves within the first few months after giving birth. Many women experience a significant reduction in pain within the first six weeks, and the pain usually resolves within the first four months postpartum.
However, a notable percentage of women experience pain that lasts much longer, leading to chronic postpartum pelvic girdle pain. Studies suggest that in approximately 20% of women, the pain may persist for up to three years following delivery. A smaller subset, around 8% to 10% of women with PGP, continue to report pain one to two years after childbirth.
The severity of the pain experienced during pregnancy, particularly if it limited function, can predict a longer recovery period. A history of low back pain or pelvic girdle pain before pregnancy also influences the duration of postpartum symptoms. Subsequent pregnancies may increase the severity and duration of the pain. Resolution depends on hormonal stabilization, ligament tightening, and dedicated muscular rehabilitation.
Self-Management Strategies for Relief
Actionable steps can be taken at home to manage daily SI joint discomfort while the body naturally heals. Utilizing an SI joint belt provides external compression and stability to the pelvis, immediately reducing strain on loosened ligaments. Applying heat therapy can relax tight muscles, while cold packs may help decrease inflammation in the painful area.
Lifestyle Modifications
Lifestyle modifications are important for minimizing stress on the joint during recovery. Avoid asymmetrical loading of the pelvis, such as keeping the legs together when getting in or out of a car or rolling in and out of bed. Maintaining a balanced posture, especially when carrying or feeding the baby, helps prevent uneven forces from irritating the SI joint. Limit prolonged periods of sitting or standing, taking frequent short walks or movement breaks to prevent stiffness.
When Professional Intervention is Necessary
It is appropriate to seek professional medical attention if the SI joint pain persists beyond three months postpartum or worsens despite consistent self-management efforts. Functional impairment, such as difficulty walking, standing, or sleeping due to pain, is another sign that a clinical evaluation is warranted. A healthcare provider will perform a physical exam using provocative tests to confirm the SI joint as the source of the pain.
Physical therapy (PT) is typically the first-line professional treatment for postpartum SI joint dysfunction. A specialized PT program focuses on strengthening the deep core muscles, gluteal muscles, and pelvic floor to create internal stability for the pelvis. Manual therapy techniques, such as joint mobilization or soft tissue massage, may also be used to alleviate muscle tension and restore proper alignment. In severe or chronic cases that do not respond to conservative management, targeted injections may be used to confirm the pain source and provide therapeutic relief.