Chronic SI joint pain is no fun, so here are some techniques to try to realign the pelvis and get rid of the pain.
Before we get to the topic at hand, I want to announce that my long awaited nutrition course entitled “Why the Food Guides are Wrong: How to Find Health and Lose Weight”, is now available online. By the end of the roughly two hours it takes to go through the course, your confusion over food and what is healthy to eat will have disappeared because the lens through which you look at food will have changed.
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Now to the topic of SI joint pain. Thursday I was sitting at a coffee shop in a business meeting with a colleague without the “butt lift” that I need (one side of my pelvis is slightly smaller than the other, so I usually sit with a pad under one sit bone to keep my pelvis level), and I felt my SI joint go out of alignment. Instantly I was back to that left-sided low-back pain I had felt on a daily basis many years ago.
That night I was lying in bed thinking how ironic it was that the following day I would have no time in my day to fit in a chiro appointment to realign my pelvis and resolve my pain, because it was jammed with people coming to see me to fix their back problems. Aarg! I don't have time for back pain!
I decided that surely I knew enough about the SI joint to fix myself, even if I couldn’t assess myself properly to determine exactly what had happened. So at three in the morning I was crawling around the floor in the dark with my cat, trying to fix my back.
If the SI joint hurts, chances are mighty good that the pelvis is out of alignment. The pelvis forms a ring, with the two outside bowl-like bones (iliums) hugging the triangular sacrum in between them in the back, and the transversus abdominis muscle completing the top of the ring, the pubic bone the bottom of the ring in the front.
The sacroiliac joints are held together with very strong ligaments, but the joints are supposed to move a bit as we move. If the pelvis ring distorts to any greater degree than is appropriate for the SI joints, pain can result.
For those of you interested in the technical stuff, keep reading, and those of you that just want to get to the exercises, skip to below.
My pain was exactly where it used to be – left SI joint, and I remembered over ten years ago, when I took Diane Lee and LJ Lee's low back, hip and pelvis course (which changed my life by taking me out of chronic pain), Diane Lee told me that my right sacral multifidus (very deep muscle that stabilizes the spine and sacrum) had atrophied greatly and was not firing at all.
With nothing pulling the right side of the sacrum back, the sacrum would then be free to rotate to the left within the iliums, and this in turn would create an inflare of the left ilium (ASIS moving medially), and an outflare (ASIS moving laterally) of the right one, as they are tugged out of place by the ligaments attached to the now faulty positioned sacrum.
Lying on my back, I felt my sacrum, and sure enough I had to go further to hit bone on the right side than the left, indicating to me that probably my sacrum had rotated to the left. And if the sacrum was rotated left, I figured my lumbar spine probably was as well. Please note the image on the left shows a nicely aligned pelvis, and the image on the right shows a right inflare pelvic distortion.
I needed to pull the left ilium back out, and rotate the sacrum and spine back to straight. So I lay down with my left side about 6 to 8 away from a wall, bent the knee of my left leg and pushed it into the wall for 10 to 15 seconds, activating my left external hip rotators to try and correct the left inflare.
After repeating this a few times, and I turned my attention to my sacrum. I got into an elbow plank, body straight, legs straight, toes firmly connected to the ground, and I lifted my right foot reaching it back to activate the right multifidus, but more importantly to activate the left psoas via the left foot stabilizing me, since it attaches to the front of the spine and would be very powerful in rotating it back to neutral.
I did as many 10 second holds as I could manage while maintaining excellent form. I then did the Don Tigny knee brace a few times on each side to ensure my SI joints were in their best position and I finished off by doing some Swiss ball supermans, to make sure I was connectng to my multifidus and other deep local stabilizers properly. I then went back to bed. The next morning my back felt much better!
If you have SI joint pain, these mobilizations may help, but please understand that there are many pelvic distortions so there are no guarantees. If you decide to try these, you are making the choice to try these without being assessed first. They may not be right for you at all if your back pain is more complicated than simply an SI joint problem.
To be safe, see a physical therapist to find out if these exercises are appropriate for you. I think the may work if your distortion is an obliquity of the pelvis – an inflare/outflare distortion. If you do find these mobilizations helpful to realign your pelvis, do them before you do your stabilization exercises.
If your SI joint continually goes out, you are doing your stabilization exercises correctly and you have been doing them for a while, there is probably an underlying problem such as an organ adhesion or an anatomical leg length discrepancy or smaller hemipelvis on one side that is putting constant stress on the SIJ and needs to be sorted out. Call Neurosomatic Educators at 1-866-597-3772 to find an Integrated Neurosomatic Therapist near you to find out if this is why you can't get better.
1) Dontigny knee brace: Lie on your back in a doorway, one foot on the door jamb, knee pointing slightly out to the side, other leg reaching into the other room. Push through your heel into the doorjamb using your buttocks and hamstrings. Push for 6 seconds, rest for 6 seconds, repeat 6 times. Move over to other side of doorway and do the other side. This alone may do wonders for SI joint pain. If this has helped, leave out exercise 2 and 3 and skip to the Swiss ball superman.
2) Inflare correction: Do on the SORE side. If both sides are sore, don't do this at all. Lie with sore side about 6 to 8 inches away from a wall, knee bent, foot on the floor, other leg straight. Push side of knee into the wall, activating the hip muscles on the sore side. Allow your trunk to rotate the other way. Push for 6 seconds, rest for 6 seconds, repeat 6 times or more.
3) Plank: This is a VERY challenging exercise so evaluate your abilities carefully before attempting this! You can modify it by doing a plank from the knees if you need to. Get into an elbow plank (or high plank on the hands if you prefer), making sure the trunk is straight from the shoulders to the toes or knees. The hips are not hiking way up into the air. If you are able to, lift and reach the leg of the side that is NOT sore, without allowing anything to move in the pelvis. You should feel the front of the hip working hard on the sore side. This will work even better if you can turn the tops of the toes under like a yoga up-dog to do this, but very few people have that kind of flexibility. If you can't lift the leg, push the SORE side toes or knee into the floor for 6 to 10 seconds, feeling the front of the hip working. Hold the position for 6 to 10 seconds, rest for 6 to 10 seconds, and repeat if possible. Do NOT do the opposite side. If both sides are sore, just do a plank without lifting your legs.
4) Swiss Ball Superman: Balance your belly on a small Swiss ball such that you have even weight between your hands and feet, and your spine remains neutral. Anchor those toe pads down and feel the connection to your pelvic floor. Lift the "not sore" leg and reach it back without allowing your trunk to rotate or side-bend on the ball, and without allowing the ball to move. If you are successful, lift the opposite arm off the floor and reach it forward without allowing any movement in the trunk or ball. Hold for 6-10 seconds and repeat. If your trunk or ball is moving, you are not stabilizing correctly, so try smaller movements, and check to make sure you are holding in your pelvic floor. Sometimes it helps to do the "easy" side a few times, to teach the brain how to connect for the "hard" side. If both sides are sore, do both sides equally.
I suggest finishing off with the Don Tigny knee brace again. If these exercises work, do them a few times a day. If you have longstanding SI joint pain and the bones simply won't move, see a soft-tissue therapist before trying again.
There, you see? Sometimes pain serves a purpose. Forced me to think hard, and I think I learned something useful because of it. Movement practitioners out there, feel free to comment and let me know if you think I am completely out to lunch on this, or if you have found anything else that works well that you would like to share. And those with SI joint pain, feel free to let me know if these ideas work for you … or if they don't.
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Foot flexibility important to reducing hip and SI joint pain
Walking, sacroiliac dysfunction and hip pain
Posture, leg-length discrepancies, musculoskeletal pain and organ function
Pain and stabilizer vs mover muscles
Travell, Janet and Simons, David Myofascial Pain and Dysfunction: The Trigger Point Manual; Vol. 2., The Lower Extremities Williams and Wilkins, PA. USA, 1983.
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.
St. John, Paul and Clark, Randall, and Jones, Tracy Integrative Approaches to Low Back Pain Neurosomatic Educators
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, JimThe 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.
Copyright 2010 Vreni Gurd
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