Walking, sacroiliac joint dysfunction and hip pain
I was going to write about insulin this week, but I’ve been noticing something in my practice, and I figured I’d better write about it before it slipped my mind. So my apologies to those of you that are eagerly awaiting the next installment in the endocrinology series.
I should also apologize to all my wonderful SI joint teachers who took the time to really coach me with respect to SI joint dysfunction, (Diane Lee and Linda Joy Lee, Marcy Dayan, Paul Chek, Shayne McDermott, David Ewert, Mark Finch, Tom Myers, and most recently, Richard DonTigny), because it is very probable that you actually did teach me this, and I forgot and have now simply relearned it for myself.
For those of you that are not in the exercise or physiotherapy field and have no idea what and where the sacroiliac joint is, it is the joint between the sacrum, or the triangular bone at the bottom of our spines that the tailbone is a part of, and the pelvis. People that have SI joint pain frequently point to the "pelvic bump" area in the very low back where the dimples are as the achy spot, and that pain is often one-sided.
For non-exercise people, skip to the next paragraph where I’ll explain this more simply, but for those in the field, what I’ve noticed is that most people that get SI joint pain seem to walk using their hip flexors as the prime movers. While walking quickly, the pelvis is frequently in anterior tilt and/or there is a distinct forward lean of the trunk, and very often the person with the dysfunction is "pulling" their legs forward rather than "pushing" them. In my practice at least, using the hip flexors to walk seems to be a far more obvious pattern in SIJ dysfunction than a Trendelenburg sign, although the patterns do frequently go together. I realize that someone in anterior tilt also tends to have poor local stabilizer and poor glute function, but I have found that even when someone has generally improved their pelvic position and been trained to connect to those muscles in other functional patterns such as stand-to-sit-to-stand, unless their faulty motor-recruitment pattern in walking is also corrected, the SIJ pain does not go away due to the constant forces trying to unlock the joint. So I have put gait to the top of the priority list, and have been spending a lot of time recently teaching people how to walk - and it seems to be helping. Because I frequently see this same faulty walk pattern in those that have had or are about to have hip replacement surgery, I think it is possible that overuse of the hip flexors during gait may pull the femur slightly forward in the acetabulum, potentially creating a wear problem leading to the need for hip replacements. Therefore in my opinion, correcting this faulty gait as soon as it is recognized (possibly in late childhood or adolescence) may go a long way toward not only reducing future pain and suffering, but also reducing the need for hip replacement surgeries. If a study has not already been done on this, I think the idea has potential!
Probably the easiest way to explain this concept is to actually try it and feel it in your body. So, stand up, and pretend that your pelvis is a bucket, and you are pouring water out the front. You should feel like you are sticking your butt out behind you, and you have a big arch in your low back. Now try walking while maintaining this pelvis position. Notice how you have no choice but to use the front of your hips to move your legs? Notice how effortful this is? Not good. Hard on your SI joint, hip joints, low back, turns off your local stabilizers and your gluteus maximus, and way over uses the hipflexors and quads. If you have SI joint or hip pain or if this is how you tend to walk, it may be worth your while to try a different way.
First, stretch your hip flexors gently for a minute or two. Then, while hanging onto something, try standing as tall as possible on one leg on a small stable stool or a stair, tucking the tail under slightly (hold the bucket level so no water spills out) without squeezing the buttocks, so that the other leg can hang down completely suspended from the hip socket. You should be able to swing the leg like a pendulum with no muscles gripping the leg bone at all - it pretty much moves by itself with no muscle effort. That is how one’s leg should feel in the swing phase while walking - loose, like it’s hanging, and pretty much moving by itself. So, now get down from the step and try walking. The trick is to walk while standing as tall as possible - this will frequently be enough to bring your pelvis to a neutral position. If you can’t get that "hanging" feeling at the hip joint while you walk, stretch your hip flexors again, stand taller, and tuck your tail under a bit more by using your lower abdominals to gently pull up the pubic bone. If you are walking correctly, you will not only feel like your legs are floating, but you will also feel that any work that is happening is coming from the back side of the body rather than the front side.
Related Tips
Take your space and improve your posture
Exercise - The fabulous stability ball
Breathe - Are you a chest gripper?
Think - Pain is our body’s alarm system
Lee, Diane The Pelvic Girdle Churchill Livingston, 2004.
Lee, Diane and Lee, Linda Joy An Integrated Approach to the Assessment and Treatment of the Lumbopelvic-Hip Region DVD, 2004
Lee, Diane and Lee, Linda Joy Postpartum Health for Moms - An Educational Package for Restoring Form and Function after Pregnancy CD ROM 2006.
Lee, Diane Assessment Articular Function of the Sacroilac Joint VHS
Lee, Diane Exercises for the Unstable Pelvis VHS
Richardson, C, Hodges P, Hides J. Therapeutic Exercise for Lumbopelvic Stabilization: A Motor Control Approach for the Treatment and Prevention of Low Back Pain Churchill Livingston 2004.
DonTigny, Richard Pelvic Dynamics and the subluxation of the sacral axis at S3 The DonTigny Method.
Myers, Thomas Body Cubed, A Therapist’s Anatomy Reader “Poise: Psoas-Piriformis Balance” Massage Magazine, March/April 1998.
Myers, Thomas Body Cubed, A Therapist’s Anatomy Reader “Fans of the Hip Joint” Massage Magazine, Jan/Feb 1998.
Myers, Thomas Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists Churchill Livingston, 2001
Chek, Paul CHEK Level 1 Advanced Back Training Chek Institute.
Johnson, Jim The Multifidus Back Pain Solution: Simple Exercises That Target the Muscles That Count New Harbinger Publications Inc. Oakland CA, 2002.
Lee, Diane Understanding your back pain - an excellent article explaining the concept of tensegrity and its importance in stabilizing the pelvis and spine.
DeRosa, C. Functional Anatomy of the Lumbar Spine and Sacroiliac Joint 4th Interdisciplinary World Congress on Low Back & Pelvic Pain, Montreal, 2001.
Gracovetsky, S. Analysis and Interpretation of Gait in relation to lumbo pelvic function 4th Interdisciplinary World Congress on Low Back & Pelvic Pain, Montreal, 2001.
Dananberg H. Gait style and its relevance in the management of chronic lower back pain 4th Interdisciplinary World Congress on Low Back & Pelvic Pain, Montreal, 2001.
Online at www.kalindra.com A fantastic website devoted to sacroiliac dysfunction.
Copyright 2007 Vreni Gurd
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Cathy Silvera said,
April 18, 2008 @ 4:24 pm
Hi there,
This particular article, though I did not understand some of the terminologies you use, seems to offer me the hope that there may be an answer to an ongoing pain I have now been experiencing for years! I have seen my doctor, chiropractors, and various massage folk and even been checked for cancer of the colon utilizing an awful xray requiring the ingestion of a white solution whose name I do not now recall…was a few years ago…the cancer specialist gave me the good news that he could see no cancer and suggested that the pain was related to the menstrual cycle - swelling of tissue in the region (lower right area - feels like it goes from the front to the back). Recently I went dancing and that really seems to have caused a negative reaction. I walk just about every evening with my two dogs and do probably 2 miles or so and this does help, especially when I pull myself up tall as you talk about here.
I have limited funds at this time - newly single mother just getting myself financially stable (one day hopefully!!). Can you suggest anyone I could go to see if this is my problem and if it can be corrected by learning how to walk better, or by doing exercises? I live in Delta, British Columbia, Canada.
Very much appreciate your newsletters, information and your response some time.
Cheers and wishes for a great weekend. We are told me may have snow!!
Cathy Silvera
P.s. I am in pretty good shape otherwise - just this pain - always hoping there is a final resolution for it - after all I was not born with it! CAS
Vreni said,
April 21, 2008 @ 11:43 pm
Hi Cathy,
I would suggest you see Bill Lyons at Delta Orthopeadic Physiotherapy Clinic, or Diane Lee at Diane Lee and Associates in White Rock. If your problem is bone, joint or muscle related, they can help you. If it is more an internal problem (digestive, menstrual etc.) then perhaps I can help you with your diet etc. I’m guessing by your comment that it is joint and muscle related, but it is not clear.
Good luck!
Alexandra said,
May 26, 2008 @ 12:03 am
I too have the SI joint dysfunction, I live in Oshawa, Ontario, is there someone in the surrounding area that you would suggest I see?
PS. I am 27 weeks pregnant and worried about what I have to face with this dysfunction during delivery.
Vreni said,
May 31, 2008 @ 4:46 pm
Hi Alexandra,
Sorry to take so very long to get back to you.
I would recommend Proactive Health in Oakville. They have the real-time ultrasound, which I think is invaluable in helping patients connect to the muscles that matter when it comes to SI joint stability. These physios can probably help you during, and definitely after your pregnancy, deal with your SI joint dysfunction.
Good luck!
barb dangelo said,
August 18, 2008 @ 9:07 am
can you help me find someone who specialises in sacroiliac pain? i live in telford pa 18969 not far from phila. thanks. barb
Barb Head said,
November 3, 2008 @ 3:35 pm
I have been experiencing hip/joint pain since I did a bit of jogging in Sept. (I am 69 yrs of age, walk regularly, am not overweight, do yogo) I was hoping that it was an injury from which I could recover quickly, but as the weeks pass, it has not resolved. It has been suggested by my Dr. that I may have sacro iliac problems, so have been wondering what I may do to ease the pain. The chair posture excersize you recommended seemed to allieviate the pain while walking, so I will do it regularly to see if it will help. I was wondering if you could recommend a PT in North Vancouver who may also help. I thank you very much
Vreni said,
November 3, 2008 @ 9:47 pm
Hi Barb,
I would suggest you try the Synergy Clinic on Lonsdale in North Van.
#300 – 1124 Lonsdale Ave, North Vancouver, BC V7M 2H1
604-986-2777
They have an ultrasound to check your core function, which is a bonus, and they would be great at assessing you too.
If you need further help, you can always see me in Vancouver proper.
Rosalia Robinson said,
December 20, 2008 @ 3:01 pm
Can you give me the names of doctors in Calgary that specialize insacroiliac pain?
Thanks eh!
Mitzi said,
December 25, 2008 @ 9:00 am
I’ve suffered with this back pain over 25 years & have recently discovered it was my sacroiliac all along. Though there is some arthritis & compression in 3 of my discs, the main problem has been my sacroiliac out of joint for probably most of my life. I thought I was doomed to live with this forever. I would love to learn how to walk correctly as I know I do not. You don’t happen to have a youtube video showing us how to do that do you? I don’t know what hip flexors are. Though your description is probably really good, with me in your audience I’m afraid I can’t transfer a written description of a physical activity into a mental picture. Would you consider a video and if so, would you let me know if you make one? I know it’s a lot to ask but I’m desperate for pain relief.
Sincerely,
Mitzi
Tricia Ward said,
January 3, 2009 @ 7:03 pm
Hello,
I recently have been told that my pelvis is upshifting creating irritation in the SIJoint and getting sciatica both legs. I get horrible pain in the groin area too. Do you know anyone in Milwaukee area who specializes in pelvic instability?
Thanks
Trish Ward
Elizabeth Nice said,
January 20, 2009 @ 12:58 am
I have been treated for SI dysfunction and hip pain resulting from a fall, for the past two years. I have recieved several cortisone injections and have been in physical therapy the entire time. My SI joint is very unstable and results in a substantial leg length discrepency. The focus by my doctor has been mostly on the spine. I haven’t been able to find a doctor in the Detroit Metro area who specializes with SI dysfunction. Do you have any recommendations? Thank you,
Elizabeth
Nikki said,
February 4, 2009 @ 1:20 pm
Thank you so much for this post! I’m pretty sure this has solved my problem! Such a relief to walk without pain.
Very gratefully,
Nikki
Vreni said,
February 4, 2009 @ 10:35 pm
Thank YOU so much - you just made my day! So glad the post was helpful!
Health Business Blog » Blog Archive » Grand Rounds 4:34 at the Health Business Blog said,
April 8, 2009 @ 11:39 pm
[...] The biggest change since I last hosted GR is the plethora of submissions on wellness. The Fitness Fixer shows us how to stretch mindfully so we don’t just cause new problems. Wellness tips advises: “pretend that your pelvis is a bucket,” to avoid hip pain. [...]
Charlene said,
March 8, 2010 @ 12:56 pm
Incredible. blog.wellnesstips.ca deserves an award.
Tanya said,
March 12, 2010 @ 4:28 pm
Can you please recommended some in Winnipeg, Manitoba? I have been suffering for awhile now and like most have been to chiro/massage etc..
Thank you
LJ said,
April 12, 2010 @ 7:31 pm
Wow, just the article to help confirm whats been going on for me as well. Been walking but the hip pain is so bad just about didn’t make it home. Felt really impressed to stand up straight and tall, one foot in front of the other (slight cross over) and swing the arms. the muscles in the back are sore from top to bottom after doing this but I made it home. Then I stretched out the hip. I picture walking like a model just not as pronounced movement. Been going to doctors, massage, physio and have given up on ever finding out whats going on. How does one get a doctor to see things outside of medication to control pain. Was beginning to think I should have my hips replaced. I am only 37. Life is to short to live in pain. Are there other exercises to strengthen the hips or for hip health?
Vreni said,
April 12, 2010 @ 11:24 pm
Hi LJ,
You may wish to look for a CHEK Practitioner (Level 1 or higher) http://www.chekinstitute.com who can assess you and give you appropriate exercises based on the results of the assessment. In the mean time, if the post rang true with you, perhaps stretch your hipflexors and quads, and work on strengthening your glutes. Bridging from the floor can work quite well. Work on pushing through your feet to lift your hips up, without squeezing your butt cheeks together. You should feel your butt working, particularly at the top of the movement. Hope that helps!