Returning to Training After Persistent SI Joint Issues — Looking for Guidance

Medical Q&A [Moderated]
1

Hi everyone,

I’ve been dealing with persistent SI joint pain for about 3–4 months now. It was extremely bad in the beginning but has improved quite a bit since then. I went to physiotherapy here in Germany, but honestly didn’t feel like it helped much — most of the information I got was similar to what I could have figured out on my own through resources like ChatGPT or YouTube.

I’ve been trying to understand where the symptoms might be coming from. I’m a self-employed farrier, so I spend a lot of time in awkward, highly flexed positions while working on horses. At the same time, the SI symptoms started around the period when I stopped training altogether. I had just begun my self-employment and, unfortunately, had to put down 3 of our animals during that time. All of that threw me off my routine, both physically and mentally. Looking back, I’m wondering whether the sudden loss of regular training may have played a role in the onset of symptoms.

For context: I have several years of experience with Barbell Medicine programs (mainly powerbuilding) and some bodybuilding-focused training. Now that I’m trying to get back into a routine, I’m being very cautious. I’m honestly a bit afraid to return to squats and deadlifts because of the SI symptoms — even though I really miss training that way.

Right now I am back at training for about 2 Weeks and am doing Upper Body work almost unchanged, but only using machines for Legs. What I noticed is that my Back is WAY better while/during training and a bit afterwards, which gives me some hope (right now I have problems to even walk my dog for more than 30 Minutes without going into a squat position here and there to get rid of the pain) funnily enough my work as a farrier is almost unbothered by pain.

My questions are:

  1. How would you approach returning to training when SI joint pain is still present but improving?

  2. Is it advisable to reintroduce squats and deadlifts in a graded way, or should I avoid them until symptoms fully resolve?

  3. Could the onset of SI symptoms realistically be related to both the physical demands of my job and the sudden stop in training?

  4. Any specific recommendations for load management or movement variations that tend to work well during SI flare-ups?

I’d really appreciate any guidance on how to move forward safely and confidently.
Thanks in advance!

PS: I have PB I (never version),II,III, BB II and Strongman from BBM at my hands

and soryy for the long text

2

Hi Josh,

Sorry to hear about this issue – but it is at least encouraging to hear that things are improving!

I think if you take a very “long-term” view on training, the kinds of minor decisions like “do I squat 5 lbs more or 5 lbs less”, or “do I reintroduce squatting and deadlifting today or next week” start to matter a lot less.

  1. So, to your first question, I would not overthink things: simply try squatting and deadlifting the empty bar, or use some sort of very aggressive load cap for your first session, and see how you tolerate it.
  2. You do not need to be completely symptom free before returning to activity.
  3. Your guess is as good as mine, unfortunately.
  4. Our recommendations for these strategies are laid out in our articles on the topic (1. here and 2. here), including specific strategies for load management. There are no special movement variations that you must include (or must avoid, for that matter) – it’s often a matter of personal preferences and individual tolerance, so this leads to a fair amount of experimentation and trial-and-error at low loads, before ramping things up. More variation tends to be less, at this stage, though.

If you are feeling a lack of confidence in the path forward here, working with one of our rehab clinicians would be our strongest recommendation to get you back to where you want to be.

3

Hi,

had my share of SI pain, I feel you. Just my story, food for thought.

What helped:

  • “Waking up my glutes”, hammering it with stuff.
  • Made extra sure I don’t tilt my pelvis either front or back. (Pelvic tilts are a bitch, especially posterior.)
  • PT showed me a way I can crack my groin and my SI, both helped immensely. First one is pushing knees together, second is pulling them apart, against some resistance. I needed some practice for the first, I never felt a good crack in my groin ever, but since I managed the first one, it feels great.
  • Low bar heavy hinge glute focused squats always put everything back into place.
  • DL from blocks (bar just below kneecap), always figure 8 straps double overhand - no rotational forces, so the whole thing is in balance on that plane as well. Eventually managed to ditch the blocks.
  • Before sleep I just lay in my bed on my back, and decide to violently squeeze my asscheeks together. I’m talking about “Satan is trying to climb into your ass” level force. It always seems to “reset” everything at the back side of my pelvis.