Sacroiliitis is a word that gets used on the web for two very different things, and this confusion is the first reason why so many people end up doing the wrong exercises.
On one side there is sacroiliitis in the strict sense: inflammation of the sacroiliac joint documented by imaging, which is the distinguishing sign of a family of rheumatological diseases. On the other there is sacroiliac pain of mechanical origin, the kind that is usually described as pain in the sacrum, or sacral pain, the kind that appears after a pregnancy, a trauma, a period of unusual load. The two things cause a similar discomfort in the same place, but they follow different paths.
And there is a second problem, even more uncomfortable: it is by no means certain that the pain you feel back there really comes from that joint. On this the literature is much more cautious than the story going around online would suggest. Let's see what it says, because it changes quite a lot what makes sense to do.
⚠ Important: read this before continuing
The exercises and advice in this article are general guidance and may not suit your situation. Every person has a unique clinical history: what works for others could be counterproductive for you.
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🚩 Before the exercises: when pelvic pain should go to a doctor
This section is at the top and not at the bottom because some causes of sacroiliac pain are not solved by stretching, and delaying them costs. Those who arrive looking for "exercises for sacroiliitis" often already have an idea of what is happening to them: it is worth checking it before lying down on the mat.
See a doctor without waiting if the pelvic pain comes with fever, chills or a general feeling of being unwell, if it appeared and got worse within a few days, if you cannot put weight on the leg or stand. The sacroiliac joint can become infected: that is a sacroiliitis that is treated in hospital, not at home.
Ask for a rheumatological assessment if your back pain resembles this profile. A group of international experts (ASAS) identified five features that best distinguish inflammatory-type low back pain:
- it improves with movement;
- it hurts at night;
- it started gradually, not with a specific tweak;
- it appeared before the age of 40;
- it does not improve with rest.
When at least four out of five are present, these criteria recognised inflammatory pain with a specificity of around 92% in the development group and 72% in the validation cohort. They are not a diagnosis, they are a serious reason to send the person to a rheumatologist: behind it there may be an axial spondyloarthritis, of which sacroiliitis is precisely the radiological sign. If you recognise yourself in this picture, the starting point is ankylosing spondylitis and related conditions, not an exercise programme found online.
Other signs that deserve a visit before any exercise:
- loss of strength in a leg, tingling that does not go away, problems controlling bladder or bowel (in this case it is an emergency);
- unexplained weight loss, or a personal history of cancer;
- a fall or a major trauma, especially if you have osteoporosis or have had long courses of cortisone: the sacrum can fracture even with modest trauma;
- pain that wakes you systematically and finds no position, which is worth looking at together with the other causes of night-time back pain.
In pregnancy and the postpartum period pain in that area is frequent and generally of a mechanical nature, but it still deserves a dedicated assessment: we discuss it in the article on pelvic girdle pain in pregnancy.
🔬 What research really says about sacroiliitis
No clinical test can tell you "it's the sacroiliac joint"
It is the point that overturns half of what you read about sacroiliitis. The sacroiliac joint is estimated to be responsible for between 10% and 25% of persistent mechanical low back pain located below L5, with estimates that in the various case series range between 10% and 62% depending on the setting. The same systematic review is clear on one point: no single element of the clinical history, physical examination or radiology is enough to establish the diagnosis, which today can be made only with controlled anaesthetic blocks.
Provocation tests (the ones the physiotherapist does in the clinic, pushing and rotating the pelvis to reproduce the pain) were evaluated in a meta-analysis published in the Journal of Orthopaedic & Sports Physical Therapy. The result deserves to be read in full: assuming a prevalence of 20%, a positive group of tests gives the clinician about a 35% probability of having correctly identified sacroiliac pain. The authors conclude that these tests are not accurate enough to confirm that the source is the sacroiliac joint. The certainty of the evidence, according to GRADE, is very low.
There is, however, useful news in the same work: when the tests are negative, the clinician can conclude with about 92% certainty that the sacroiliac joint is not the source of the pain. In other words, those tests serve more to rule out than to confirm. A 2023 systematic review in EClinicalMedicine, which compared the tests available in general practice for disc, facet joints and sacroiliac joint, reaches compatible numbers: the combination of provocation tests and the absence of pain on the midline turn out to be informative, but with likelihood ratios of around 2.4, weak signals, not proof.
An MRI "positive for sacroiliitis" does not close the matter
Here comes the finding that surprises most. A study published in Arthritis & Rheumatology had pelvic MRIs of different groups of people read blind. Among 47 healthy volunteers, with no current or past back pain, 11 (23.4%) had an MRI positive for sacroiliitis according to the ASAS definition. Among regular runners it was 3 out of 24, and among women with postpartum back pain 4 out of 7, a very small group, to be taken with a pinch of salt.
The correct reading is not "the MRI is useless": in the same study the extensive, deep bone lesions were found almost only in patients with axial spondyloarthritis (42 out of 47). The correct reading is that a report with the word "sacroiliitis" does not by itself prove that this is the cause of your pain, and it must always be put together with the clinical history and the tests. Those who get frightened reading a report should keep this in mind before reorganising their life around a word.
And do the exercises work?
Here the answer is: yes, but not in the way it is usually told, and not on their own.
A meta-analysis of 12 randomised studies on 1,407 patients with pelvic girdle pain of sacroiliac origin measured the effect of motor control exercises, that is, exactly the kind of stability work that everyone prescribes for sacroiliitis. The result: motor control exercises alone were not shown to be effective in reducing pain in the short term. When instead they were combined with other musculoskeletal therapies, the reduction in pain and disability was significant and clinically relevant, above all in the period around childbirth.
If instead, after childbirth, the pain has stayed concentrated on the pubis more than on the sacroiliac joint, the course is a chapter of its own and has its own numbers: how long pubic pain lasts after childbirth.
On the more general side, the Cochrane review on exercise in non-specific chronic low back pain (249 randomised studies) finds moderate-certainty evidence that exercise is more effective than no treatment, usual care or placebo, with a mean difference of 15.2 points out of 100 on pain at the first reassessment. The same authors had set the threshold of clinical relevance at 15 points: we are just above it, and it is honest to say so. Exercise helps, but it is not the spectacular lever it is made out to be.
One thing that is instead not demonstrated and needs to be cleared away: none of these studies shows that exercises "reduce inflammation" of the joint. If a real inflammation is there, it is tackled by other means. In axial spondyloarthritis, for example, the international ASAS-EULAR recommendations put non-pharmacological management and NSAIDs as the first choice, with targeted drugs reserved for those who do not respond: exercise is part of the management, it is not the anti-inflammatory. And if the anti-inflammatory is doing nothing, what that means is not that you need something stronger.
How to use this information
It is not an invitation to give up. It is an invitation to change your expectation, which is the thing that really makes the difference:
- Moving is worth it anyway. Even when it is not possible to establish with certainty which structure hurts, exercise remains one of the best-supported interventions for persistent back pain.
- Do not expect the "right" exercise to sort everything out. There is no magic movement for sacroiliitis: what counts is consistency and the progression of load, not the choice of a single position.
- If after weeks nothing moves, the problem is not that you are stretching too little. It is time to question the starting hypothesis, not to increase the repetitions. And it is the reason why an assessment is worth more than any programme sheet downloaded.
Sacroiliitis: how pelvic pain presents
The pain is typically located low down, to the side of the spine, often on one side only, above the buttock, in a spot that people point to with a finger. It can radiate to the back of the thigh and to the groin, and sometimes reach the knee, which is why it is confused with sciatica.
It gets worse in some typical situations: standing still for a long time, climbing stairs, getting up from sitting, turning over in bed, putting weight on one leg to get into trousers. These are all movements that ask the pelvis to transfer load asymmetrically.
Some people with sacroiliitis report a feeling of instability or giving way, as if the pelvis were "going away". It is a real and unpleasant sensation, but it has to be said that it does not necessarily correspond to a joint that moves too much: often it is an experience of low confidence in loading, and in that case gradual strengthening (not immobility) is the path that makes most sense to try.
Morning stiffness, which many associate with sacroiliitis, should instead be weighed carefully. It is not among the five features identified by the ASAS experts, but the context in which it presents is: if you loosen up by moving and rest does not give you relief, and it hurts at night, you are in the picture described above, and it is a matter for the rheumatologist, not for stretching.
An important piece of advice: before trying these exercises, make sure you have received a correct diagnosis. Often people think they have one problem, but the real cause of the pain is another. Doing the wrong exercises can make the situation worse instead of better.
What else can hurt in exactly that spot
The first thing that appears on reports is sacroiliac osteoarthritis, often described as bilateral. It is another word for the same area, but it says something different from sacroiliitis: it describes wear of the joint, not an inflammation. As with all osteoarthritis, finding it written down does not in itself establish that the pain comes from there, and in practice the path changes little.
Given how hard it is to confirm the sacroiliac joint as the source, it is worth keeping in mind its neighbours, because they change the exercises:
- Piriformis syndrome, which causes deep pain in the buttock and can run down the leg: you will find it explained in the article on the piriformis.
- Gluteus medius tendinopathy, with more lateral pain, on the side of the hip, which gets worse lying on that side and climbing stairs: the full picture here.
- The hip, which often sends pain to the groin and thigh more than to the pelvis.
- The lumbar spine, disc or facet joints, which in the 2023 review turned out to be still the most studied source in persistent back pain: if the picture is more like that, the reference is the lumbar area.
- Gluteal pain of another nature, which is worth telling apart: we discuss it in pain in the buttock.
Exercises for sacroiliitis: how to set them up
First a note of honesty about the numbers. There is no validated dosage of sets and repetitions for sacroiliac pain: no study has established how many times or for how many seconds. The precise figures you read around are conventions, not results. What follows is therefore an adjustment criterion, not a recipe:
- Pain during the exercise can be there, as long as it stays tolerable and does not force you to compensate with your whole body.
- The next day is the real test. If in the morning you are the same as before or better, the load was right. If you are worse and stay worse, it was too much.
- You increase when the previous set has become easy, not according to the calendar.
Sacroiliitis, mobility exercises: getting pelvis and hip moving again
They are the starting point in the more irritable phases, because they ask for little.
Knees falling to the side. Lying on your back, knees bent and feet on the floor, slowly let both knees drop to one side and then the other, staying within a comfortable range.
Cat-cow. On all fours, alternate arching your back upwards with lowering it downwards, following your breathing. It mobilises spine and pelvis without loading.
Leg swings. Standing, holding on to a support, swing one leg forwards and backwards and then sideways. The hip and the sacroiliac joint work together: freeing up the first takes demands off the second.
Standing pelvic circles. Hands on hips, draw slow circles with the pelvis in one direction and the other. Simple, and useful as a warm-up before the rest.
Stretching: where it makes sense and where it does not
Stretching does not "free up" the joint and does not reduce inflammation. It serves to be more comfortable and to gain range where it is actually lacking, which in sacroiliitis is often the hip.
Piriformis and glutes. Lying on your back, knees bent, cross one ankle over the other knee and pull towards your chest. You should feel a pull in the buttock, not a pinch in the groin.
Hip flexors. In a lunge with one knee on the floor, bring the pelvis forward keeping the glute active. If you sit for many hours, this is probably the direction you have lost.
Adductors. Sitting, soles of the feet together, knees dropping outwards, trunk slightly forward with a long back.
Posterior chain. Lying on your back, raise one straight leg towards the ceiling helping yourself with your hands behind the thigh, keeping the other leg on the floor.
Child's pose. Kneeling, sitting on your heels, trunk forward and arms stretched out. It is an offloading position: use it when the area is irritated and you just want to breathe a little.
Hold the position until you feel the tension soften, without bouncing and without reaching pain.
Strengthening: the part that counts most
This is where tolerance to load is built, and it is the part that people with sacroiliitis tend to skip for fear of getting worse.
Glute bridge. Lying on your back, knees bent, lift the pelvis pushing with your heels and squeezing your glutes, then lower with control. If you feel mostly the lower back working, bring your heels closer and reduce the height.
Clamshell. On your side, knees bent, feet together, open the upper knee like a shell keeping the pelvis still. It works the gluteus medius, which is the key stabiliser of the pelvis in the frontal plane: if you want to take care over the technique, here is the dedicated guide.
Bird-dog. On all fours, extend an arm and the opposite leg together keeping the back neutral. It is the movement that trains the pelvis not to rotate when a limb moves: exactly the demand that hurts when you walk.
Dead bug. Lying on your back, arms towards the ceiling and knees bent, slowly lower one arm behind your head and the opposite leg, keeping the lower back in contact with the floor. Then switch sides.
Wall squat. Back against the wall, go down and hold the position for the time you can control. It strengthens thighs and glutes without asking range of the pelvis.
The step almost everyone skips: returning to load
Floor exercises are the means, not the end. Sacroiliac pain bothers you standing, on stairs, walking: sooner or later the programme has to go back there. Add progressively walking, step-ups, single-leg support, and then increasingly asymmetrical loads. It is the bridge between the sheet and life, and if you skip it the pain tends to come back as soon as you resume normal activities. It also applies to chronic low back pain, where the principle is the same.
Sacroiliitis: exercises not to do, and the mistakes I see most often
Put the way someone in pain searches for it: which exercises should you not do with sacroiliitis? The honest answer is that there is no list of forbidden movements. There are three families of movements that an irritated joint tolerates badly: sudden twisting of the trunk, heavy loads on one leg (deep lunges, single-leg deadlifts, jumps and landings) and positions held for a long time, standing still as well as sitting lopsided on one side. None of these is forbidden for ever: they are the first to take out and the last to bring back.
And then there are the mistakes, which weigh more than the choice of exercise.
Stopping at rest. It is the most costly mistake. Prolonged inactivity reduces tolerance to load and feeds fear of movement, while the best evidence on persistent back pain goes in the opposite direction.
Doing only stretching. It is the most pleasant part and the least decisive. If your programme for sacroiliitis is made almost only of stretches, the piece that builds is missing.
Looking for the asymmetry to correct. Many spend months chasing a "crooked" pelvis to put back in place. Given how weak the tests are that are supposed to identify the sacroiliac joint as the source, building a theory of correction on top of them is a flimsy bet.
Progressing too fast after the first improvements. The moment when the pain drops is the one when people relapse, because they suddenly go back to doing everything.
Sudden twisting and sudden loads. Not because the pelvis is fragile, but because an irritated tissue responds badly to jumps in load. The problem is the abrupt change, not the movement itself.
Sacroiliitis: how to organise the exercise week
Little and often is better than one long session now and then: it is frequency that builds the habit, and nobody keeps up for months a programme that takes up half the evening.
Many people with sacroiliitis feel better doing the mobility part in the morning, when the area is stiffer, and the strengthening later in the day, when the body is already "switched on". In the irritable phases you stay on mobility and gentle stretching; as soon as the pain leaves room, you go back to strengthening, which is the part that changes the course.
What to put alongside the exercises for sacroiliitis
Heat and cold are tools for momentary relief: if they make you feel better, use them without worry, but do not treat them as therapy and do not expect them to change the course.
Pelvic belts. They compress the ring of the pelvis from the outside, and on the sacroiliac joints the mechanical effect has actually been measured; on pain, however, the best evidence comes from pregnancy and remains of low quality. If you are thinking of buying one, where you put it matters more than which model you choose: the precise point, centimetre by centimetre, is in how to position a pelvic belt and what to expect.
Manual therapy. It makes sense as an accompaniment, not as an alternative. It is consistent with what the meta-analysis on motor control found: on their own exercises were not enough, but combined with other musculoskeletal therapies the result on pain and disability became clinically relevant.
Medication. It should be discussed with the doctor. In axial spondyloarthritis NSAIDs are the first pharmacological choice according to the ASAS-EULAR recommendations, but in mechanical sacroiliac pain the aim of the drug is only to let you move: it is not the treatment.
How to free up the sacrum on your own
First a clarification that changes expectations: the sacroiliac joint does not "lock" and does not get "put back in place". It moves very little by design (millimetres) and is held together by some of the strongest ligaments in the body. The feeling of being locked is real, but it is the surrounding muscle stiffening as a defence, not a bone out of place.
So the right question is not how to put it back in, it is how to make the defence let go. On your own, in order:
- Remove the reason. Staying still for a long time in the same position and asymmetrical loads (the bag always on the same shoulder, the leg always crossed on the same side) are what keeps it switched on.
- Move without load. The gentle mobilisations on this page, done lying down or on all fours, give movement without asking the pelvis to bear weight.
- Then load. Glutes and deep abdominals are what stabilise the pelvis: it is the part that gives the result that lasts, and it is also the one everyone skips because it is the least immediate.
⚠️ What you should not do on your own: have your pelvis "freed up" with sudden twists found in a video. There is nothing to put back in place on the sacroiliac joint, and a manoeuvre done badly on an already irritated joint makes it angry for days.
When to review the plan with a professional
Besides the warning signs we talked about at the start, there are three situations in which it is better to get seen instead of carrying on by yourself: if after a few weeks of regular work nothing has changed, if the pain moves or changes character, if new symptoms appear in the leg.
A physiotherapist can do two things that a guide cannot: reasonably rule out the other sources (and we have seen that provocation tests, weak at confirming, are fairly good at ruling out) and calibrate the progression of load on your case. It is also the moment when, if the label "sacroiliitis" does not hold, the hypothesis is changed instead of insisting on the same programme sheet.
Telerehabilitation as support
Work on sacroiliitis is made largely of exercises done at home, repeated for weeks, corrected when needed. It is exactly the type of programme that lends itself to being followed remotely: with Ri-Hub a physiotherapist assesses your situation, sets up the programme and checks how you perform it by video call, adjusting the loads as things change. Without travelling, which with pelvic pain is never the most comfortable part of the day.
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Sources
- New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS), Annals of the Rheumatic Diseases, 2009
- A systematic evaluation of prevalence and diagnostic accuracy of sacroiliac joint interventions, Pain Physician, 2012
- Diagnostic Accuracy of Clusters of Pain Provocation Tests for Detecting Sacroiliac Joint Pain: Systematic Review With Meta-analysis, Journal of Orthopaedic & Sports Physical Therapy, 2021
- Magnetic Resonance Imaging of the Sacroiliac Joints Indicating Sacroiliitis According to the Assessment of SpondyloArthritis international Society Definition in Healthy Individuals, Runners, and Women With Postpartum Back Pain, Arthritis & Rheumatology, 2018
- Low back pain of disc, sacroiliac joint, or facet joint origin: a diagnostic accuracy systematic review, EClinicalMedicine, 2023
- Effectiveness of motor control exercises versus other musculoskeletal therapies in patients with pelvic girdle pain of sacroiliac joint origin: A systematic review with meta-analysis of randomized controlled trials, Journal of Back and Musculoskeletal Rehabilitation, 2022
- Exercise therapy for chronic low back pain, Cochrane Database of Systematic Reviews, 2021
- ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update, Annals of the Rheumatic Diseases, 2023
Sources last checked: August 2026.
