I've been having problems with my low back/SI for the last 5 years. I LOVE Pilates, but feel that it's been making the pain worse and can't seem to find a solution. I have chronic, extreme tightness and pain running from 12th rib to hip on right side. Physios in my small town don't know what it is. We've tried strengthening glut med, stretching, traction, etc. Pain also radiates down TI and hip joint/femur is painful when side lying on right. Pull felt in kneecap both laterally and medially. Has anyone ever encountered this before? Help!! (also, laterally rotated and tilted; in balance in SI)

Sounds very familiar. I too have dealt with a lot of pain over the years. Happy to say that I am strong and pain free these days. Pilates was the key for me, but it has been a VERY long journey. Without working with your body specifically, the best advice I can give is to keep trying to find ways to use your body well. Let pain be your guide. It is unlikely that you will solve all problems quickly(long pain pattern means a long retraining process), but if you really focus on one piece at a time, you may find your way to less pain. My suggestion is to really try to work the abdominal obliques with special attention to the internal oblique. There is a good chance that both psoas and QL are hypertonic due to lack of stability. Working on feet may help too. Since they are the base when standing, it is crucial to have functional feet.

All that Sarah said is great advice. I might add a few things that have helped me with many of the symptoms you describe: SI joints issues may not like legs split >60° or so... for instance: single leg stretches (bent and straight) can be done but keep the extended leg high, avoid lunges, etc. Stretching hip flexors could be something like cobra/swan...try avoid anything involving legs split. If your SI pain is unilateral right, you might try this harmless and hopefully helpful MET (muscle energy technique): Lie on your back, legs in table top. Placing right palm near right knee and left hand behind left knee, create about 5 lbs. of pressure knee-to-hand, pulling the right knee opposing the right hand and pushing the left knee apposing the left hand. Hold for a slow count of 8. Relax for a few breaths and repeat 2 more times. Do this only on the right side (assuming that may be where your pain lies). That may reset the SI.

... continued:
If it does not feel helpful, you can try it on the other side instead. Also perhaps pay attention to hip strength, making sure that glut meds. are initiating and maintaining work in, for example, side-lying work.

Thank you for the advice! I will try the resetting of SI, Lyla. Also,will try keeping legs <60 (I tend to be hypermobile) and see whether that makes a difference.

Sarah -- good to know that you have conquered the pain; congratulations! I've been looking into myofascial release for QL and psoas hypertonicity. Stretching has certainly helped neither; I think that I am stretched enough and that this may be contributing to instability?

Hypermobility needs strengthening and limited range of motion........as a former dancer I know this all too well also! When I began Pilates I had to limit everything.....which was very difficlut. I've had acute SI pain many times and I love the re-setting that Layla has suggested too. This was a protocol suggested to me by a PT and I followed that......reduced pain in just a few days. Stretching....although intuitively feels good, isn't the best approach. Stability and alignment = reduced pain...which can lead to NO pain! Good luck!

I dislocated my pelvis a few years ago in a car accident and had SI pain for about a year after. The PT did the "resetting" that Layla described and it was extremely helpful. He also did another resetting with the abbductor/adductors. In fact, those were what finally brought me relief!! I also did many many of side lying exercises in small ranges of motion with a theraband around the thighs, adductor strengthening with a small soft ball btw the knees, and psoas stretching. Try to avoid stretching the low back too much (i.e. child' pose), avoid deep massage in that area (the ligaments are most likely already too lax) and limit all rolling exercises in flexion (teaser, roll up) until you have built the strength back up. Have patience and good luck!!

All these suggestions were wonderful! I have had a few clients over the last couple years with SI Joint issues.. not to mention mine flares on occassion, due to an old auto accident. I had heard of the MET tractions but it was all I really knew to do. And apparantly I have been doing alot of the wrong things! Its so appreciated to hear such great ideas and explanations from such experienced Instructors. As a fairly new instructor who is constantly looking for methods to help clients with these type of issues, the feedback is priceless here. I love PA! It would be great to get a class from either of you involving SI Joint issues!

It is great to get feedback from experienced instructors! I've been doing the resetting Layla described, as well as some of the Level 1/2 classes on PA that are listed as hip and back friendly. And I've noticed some small improvement already!! Last night I did a psoas stretching class and it felt SO GOOD; until this morning when my pain flared up in spades.

Francine, do you remember the abductor/adductor resetting? I've did side lying exercises with theraband for 2 years ... I've actually seen improvement since stopping. I think that I was overactivating IT band and QL as compensation for weak glut med. :(

Thank you all again for the great advice and feedback!!

Julianna-so glad you have found something that has helped somewhat. From my experience (and there can be MANY other scenarios that hold true, too), SI and hip instability are often linked. Side lying leg work can be irritate IT and QL as you have described. You might try giving that work a break for a 4-6 days, and when you do it next, first place your fingertips on the heart of the glutes (where the "hollow" of the butt lies) and get a good contraction BEFORE you move the leg. This contraction is not essential to accomplish the exercise, so it has to be a conscious and fairly unnatural firing pattern. Keep that contraction throughout the movement in both directions, and you may find that helps in reducing the load on QL and IT….. continued…