SI Joint Pain and Pelvic Repositioning

In my last video I explained what it meant to reposition a left pelvis. In this video I talk about how repositioning a left pelvis can help people who are experiencing SI joint pain.


I suffered from right and left sided SI joint pain from my sophomore year in college to my mid-30s.

Even when I became a trainer, and was obsessively researching the SI joint, nothing in the literature helped. It was always “stretch this” or “strengthen that”. Poor core stability, tight hamstrings, etc…

Nothing helped.

Then I discovered Postural Restoration and everything changed. They were the only organization that taught that the human body is completely asymmetrical and due to these asymmetries, the left pelvis ends up rotating forward compared to the right side, and that this was the source of my SI joint pain.



  1. Shelley Gentner says

    Neal, I have been reading your blog entries re SI joint dysfunction. I have dealt with a wonky pelvis and SI joint problems/chronic back pain since my 30s…I am now 62. All this stemmed from dance and running overuse injuries. Fast forward all these years to look for a long term solution. I have just happened upon a PR therapist in my state. She is 2 hrs away and I cannot see her until August but I am hopeful she can help get me to a more comfortable place. Your comments about the depression, anxiety and frustration it causes as the years go by really hit home. So much time lost without great quality of life. Thank you for your info. Shelley in NC

    • admin says

      Thanks for the kind words, Shelly.

      You mentioned a PR therapist in your comment. I assume you meant a PRI therapist? If so, I think you’ll be in good hands.

      In the bad old days, I used to get angry and depressed about the pain and dysfunction, which is quite normal and expected.

      Repositioning of my pelvis took care of my SI joint issues, and gave me some breathing room and made me understand that my situation wasn’t unsolvable. I got physical and mental relief, and importantly, hope.

      It turned out that my odyssey was not over because (unbeknownst to me until I went further into PRI) I had torso and neck patterns as well, but at least the worst pain was gone.

      Since that time, I learned that keeping a sense of “curiousness” about my body, and what it does and why it does it, has helped immensely. Thankfully, my later issues weren’t anywhere as severe as the SI joint pain, so keeping that curious attitude wasn’t so difficult.

      A benefit of maintaining curiosity is that it will ease some of the mental anxiety that feeds muscular tension and patterning. I borrowed the technique from Buddhist psychology. It’s very applicable.

  2. Shelley Gentner says

    Neal, thank you for your reply. Yes, on the days that I can step outside the pain and say hummmm, wonder what is going on, let me see if I can learn more about this, my anxiety decreases. I will hold the “curiousness” idea closer to my heart.

    I am eager to get started with PRI therapy and the waiting is difficult. I am starting on my own by observing my breathing, practicing the inhale/exhale techniques. I have read so much I feel I could have gone to med school at this point so I am aware of the muscle patterns involved.

    I will be working with Susan Henning at Advance Physical Therapy in Chapel Hill. She has great credentials and is also certified to work with scoliosis, so I imagine her understanding of pelvic issues is deep. We have already spoken over the phone about my condition.

    Any other pieces of wisdom you can share while I take this journey are greatly appreciated. I am a former dancer and runner. I have not done those activities in many years, sadly. -sbg

  3. Shelley Gentner says

    Neal did you get my reply from this AM? Shelley in Greenville NC (but originally from Scranton PA and went to U of MD for a while…small world).

    • admin says

      Hi Shelley. I’m UMD class of 1999. Small world, indeed.

      As for further wisdom….not sure if I can offer anything else besides breathing practice.

      A typical position for PRI pelvic and rib re-positioning techniques is the 90/90 where your knees and hips are both bent at 90 degrees.

      Generally the feet will go on the wall and then some modifications will be made depending on what the therapist is trying to accomplish.

      You could put yourself in this position and practice your breathing like that. Particularly, you would want to inhale through your nose and exhale through your mouth, with a focus on exhaling twice as long as you inhale.

      In PRI, it’s all about the exhale in order to get all your air “out” while your ribs internally rotate (they should move down towards your waist and down towards the floor).

      You can then bring awareness to your lower back on the left side, feeling it on the floor, and then breathe in again while maintaining contact with the floor. Essentially, you are attempting to inhale gently without letting your lower back arch. This will force the ribs to expand. Rib expansion for inhalation, rather than going into lower back extension for inhalation, is a huge PRI concept. Most of us lose the ability to expand our ribs and we start using accessory muscles to breathe.
      So…gently inhale, exhale twice as long as you inhale to get all your air “out”, pause 5 seconds, and then inhale again. That’s the breathing sequence you’ll likely use when you see Susan.

  4. Shelley Gentner says

    Neal, great and thanks again. I have watched a few videos on the 90 90 and am working with my breath. Tried to use a balloon. Too hard right now so I am using a straw. Interesting about this breathing stuff. My dear friend and brilliant Alexander Technique guru Karen in Albuquerque (was out there in April) commented to me about my breathing, rib movement, and working on the exhale, gently staying there a few seconds as my ribs soften before inhaling normally. My tendency as a dancer is to inhale big, hold and fix the ribs there, not exhale fully. My poor diaphragm and psoas. So when I read the PRI stuff it all kinda clicked. I figured they both couldn’t be wrong!

    May I let you know how it goes with Susan? It will be a miracle if she can help me reverse this pattern after all these years, but miracles do happen . sbg

    • admin says

      Yes, please let me know!

      PRI definitely isn’t the only discipline that identifies dysfunctional breathing habits as part of the problem, it’s just that they seem to be the only people who recognize it as part of a larger neuro-muscular pattern that needs to be broken out of.

      Breath work is important, but it will only be maximally effective if your pelvis and ribcage are positioned correctly to allow the diaphragm to actually engage and let the psoas shut off. The 90/90 enables that to happen (but it’s very easy to do wrong)

      Good luck!

  5. Marijan says

    My name is Marijan and I am from Croatia, Europe.
    There is no PRI terapist in Europe as I know so I read everything I can find on net.
    As I learn by now, I have left aic pattern. ( I have typical higher left shoulder, winging right shoulder blade, pain in left upper trap and left side of neck and around left clavicle, pain in right gluteus medius, higher left pelvic ) I can’t test myself so I am not sure what exercise to do and in witch order.
    Can you writte a blog or just make short answer how does look typical recovery through phases. I mean, at the beginning do you work only PRI exercise and how long, or do you beside PRI work regular exercise like sqauts, push ups and so on. With some basic PRI I manage to reduce my chronic pain to minimun level but it is still present and if I start to run or work some exercise I get it back. And my upper body still looks like square that is incline on left and it becomes rhomb.

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