If you have been to a physiotherapist for sacroiliac pain, you probably came away with a sheet of exercises and the sense that they were rather simple for the amount of trouble the joint was causing. If you have not been yet, you may be wondering what they would give you and whether you could get started at home. Both are reasonable places to be. The exercises physios prescribe for SI joint dysfunction genuinely are simple, because the problem is usually a straightforward one of muscular support rather than anything exotic. What makes the difference is doing them properly, in the right order, and progressing them — which is exactly where clinical Pilates picks up. This guide walks through what a physiotherapy programme for the SI joint typically contains, why, and how it develops from a first-week handout into lasting pelvic stability.
Key takeaway: Physiotherapy for SI joint dysfunction follows a consistent pattern — confirm the joint is the source, calm it with gentle release, activate the gluteals, adductors and deep core, then stabilise the pelvis with bridges, clams, dead bugs, bird dogs and side planks before progressing to single-leg control. Clinical Pilates uses the same principles with more attention to precision, breath and progression.
Physiotherapy exercises for SI joint dysfunction typically progress through three stages: gentle release — knee-to-chest, supine figure-four stretch and pelvic tilts — to calm the irritated joint; muscle activation — glute bridges, clams and adductor squeezes with a ball between the knees — to wake the muscles that compress the pelvis; and stabilisation — dead bugs, bird dogs, side planks and eventually single-leg bridges and step-ups — to hold the joint steady under load. A pelvic belt or taping may support the early stage. Sophie Mercer, PMA-certified clinical Pilates instructor, designed an 8-week SI Joint Pain protocol of 32 exercises that follows and progresses this same clinical sequence.
Can physical therapy help SI joint dysfunction?
Yes, and it is the standard first-line approach. Clinical guidelines for low back and pelvic girdle pain consistently favour active, exercise-based treatment over passive care, and SI joint dysfunction is no exception. A good physiotherapy assessment does three things a home programme cannot:
- Confirms the source. A cluster of provocation tests — thigh thrust, distraction, compression, FABER, Gaenslen — helps distinguish SI joint pain from a lumbar disc, the hip joint, or gluteal tendon pain. Each has a different exercise plan.
- Identifies the pattern. Is the joint moving too much (the common picture) or genuinely stiff? Is one hip weaker? Is there a leg-length difference or a postural habit driving it?
- Sets the dose. How much, how often, and when to progress.
Manual therapy, taping, or a sacroiliac support belt are sometimes used for short-term relief, but they are scaffolding. The exercise programme is the building. Pain with leg numbness or weakness, bladder or bowel changes, fever, or a recent fall should be assessed by a doctor before any of this begins.
Stage one: release and settle
The first exercises on almost any SI joint handout are about calming an irritated joint and easing the muscles gripping around it. Once a day, or twice during a flare:
- Single knee-to-chest — 20–30 seconds each side, hands behind the thigh, other foot flat
- Supine figure-four stretch — ankle over opposite knee, draw the thigh in, 30 seconds each side, keeping both hips flat
- Pelvic tilts — 10 slow reps, flattening the low back then releasing to neutral
- Child’s pose with knees together — 30–45 seconds
Alongside these, a physio will talk about habits: knees together when rolling in bed, sitting to dress, a pillow between the knees at night, and avoiding the aggravators listed in SI joint pain exercises to avoid. The gentle stretches that are safe for this joint — and the popular ones that are not — are covered in stretching exercises for the SI joint.
Stage two: muscle activation
This is where physiotherapy for the SI joint differs from generic back rehab. The goal is to wake up the specific muscles that compress the joint — clinicians call this force closure — and teach them to switch on before load arrives. Slow tempo and attention to what you feel matter more than reps.
- Glute bridge — 2 x 10, 2-second hold, pressing evenly through both heels. Feel: the back of the hips, not the hamstrings or lower back.
- Clam — side-lying, knees bent, heels together, 2 x 12 each side. Feel: the side of the hip, deep. Avoid: the pelvis rolling backward.
- Adductor squeeze — a ball or cushion between the knees, 8 gentle 5-second squeezes. The inner thigh closes the front of the pelvis and is chronically ignored.
- Transversus and pelvic floor connection — exhale, gently lift the pelvic floor and draw the lower belly in about 30 per cent. 8 breaths. This deep cylinder is the foundation for everything that follows.
- Prone glute set — lying face down, squeeze the buttocks together for 5 seconds without arching the back. 10 reps. A useful “can you find it?” exercise when the glutes are slow to fire.
If the gluteals are the weak link — they very often are — my guide to glute strengthening exercises goes deeper.
Stage three: stabilisation under load
Once activation is reliable, the exercises ask the pelvis to stay still while the limbs move. This is the stage that produces lasting change, and the one most home programmes abandon too early.
- Dead bug — 2 x 8 each side, opposite arm and leg lowering slowly, low back gently in contact with the mat
- Bird dog — 2 x 6 each side, 3-second hold, reaching long rather than high. Avoid: the pelvis tipping toward the lifted leg
- Side plank from the knees — 3 holds of 15–20 seconds each side, hips stacked. Lateral pelvic control is the skill single-leg tasks depend on
- Bridge with march — at the top of a bridge, lift one foot an inch without the pelvis dropping. 6 slow alternating lifts
- Single-leg bridge — from around week 5 or 6, once the march is clean. 2 x 8 each side
- Low step-up — pelvis level, no push-off from the back foot. 2 x 8 each side
Progress only when the current exercise feels controlled and symmetrical. The full three-phase strengthening sequence, with week-by-week guidance, is in exercises to strengthen the SI joint.
What are the best 4 exercises for sacroiliac SI joint pain relief?
People ask this because they want the shortest useful routine, so here is my honest answer: figure-four stretch, pelvic tilts, glute bridge, clam. Two to release, two to stabilise. Done daily, slowly and symmetrically, they cover the essentials of stages one and two above and take under ten minutes. They will not get you to stage three on their own, but they are the right place to start and the right thing to fall back on during a flare.
How clinical Pilates progresses the physio programme
The overlap between a physiotherapy handout and a clinical Pilates programme is almost total — bridges, clams, dead bugs and bird dogs are Pilates exercises in everything but name. Where Pilates adds value is in what happens around them:
- Precision. Every exercise is taught with attention to pelvic position, rib placement and which muscles should be working — the difference between a bridge that trains the glutes and one that just arches the back.
- Breath. Exhaling on the effort coordinates the deep abdominals and pelvic floor with the movement, which is exactly what force closure requires.
- Progression. A physio may see you every two to three weeks; a structured programme tells you what changes each week, so you do not stall on the same six exercises for months.
- Whole-body integration. Once the pelvis is stable, Pilates reintroduces rotation, extension and single-leg movement in a controlled way, so recovery does not leave you afraid of moving.
This is also why Pilates works well alongside physiotherapy rather than instead of it: the physio assesses and directs, the programme supplies the daily, progressive practice. My comparison of Pilates vs physical therapy for back pain goes into that relationship in more detail.
How the SI Joint Pain protocol helps
Sophie’s 8-Week SI Joint Pain Program is a physiotherapy-style progression written out as a complete plan — 32 exercises across eight weeks that move from release and settle, through activation of the gluteals, adductors and deep core, to stabilisation under load and controlled single-leg work. Each week is laid out so you know exactly when to progress, which is the decision that most often goes wrong between physio appointments.
This article is for informational purposes only and does not constitute medical advice. Low back and pelvic pain can have several causes; if your pain is severe, radiates down the leg, comes with numbness or weakness, or doesn’t improve, please consult a physiotherapist or doctor before continuing.