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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.

Suddenly the conflicting nutrition messages that are everywhere won't be a problem anymore and you won't be pulled from one diet to another depending on what diet guru you happen to be listening to at the time. Everything will seem so obvious that you will wonder how you could have possibly been confused before. I echo Paul Chek’s suggestion that food is the drug we take three times a day. Eat poorly and your health will be taken from you. Eat right and your health will be restored.

The feedback I have received from people that have attended the course in the past have included sentiments like "life changing", and "I didn’t really expect to learn anything, but found out I didn't know anything at all", and “I don’t think I’ll bother taking the other nutrition course I signed up for – I now know all I need to know”. People have come up to me months after taking the course and thanked me for the presentation and changing their lives.

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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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In order to maintain our ability to participate in the physical activities we enjoy throughout life and to keep leg, hip and back pain away, we need to be able to get up off the floor at least three different ways.

From a physical ability perspective, the toilet was a dastardly invention. We are designed to poop by squatting right down to the ground, so before the toilet, from the time we learned to squat poop as a child until the time we died, we had the flexibility and strength to do so.

We pooped often enough to keep ourselves adequately limber to squat low, and strong enough to easily get up from that position.

Now a-days many of us stop getting down onto the floor altogether once the kids are past the toddler age. The chair is about as close to the floor as we get.

Then some years later we find ourselves on the floor for some reason or another, like looking for something that rolled under the sofa, and we realize that getting up off the floor is suddenly quite hard work.

In those intervening months or years of no floor time, our leg muscles have tightened up to the point that we can’t bend our knees, ankles or toes as far as we used to, and we have lost the strength to easily get up from the floor.

So we rely on our arms to either pull ourselves up onto the furniture, or we push our hands down on our thighs to get our trunk up. And then the grandkids come along, and we want to be able to crawl around the floor with them like we did with our kids, but somehow the effort is too much.

We attribute it to ageing and accept this as an inevitable part of life, and we try and keep up with the grandkids while staying on our feet. But for some, even that is challenging, as the knees, hip or back hurts.

The question is whether the knee, hip, or back pain is the reason for the lack of ability or whether the lack of ability is the reason for the knee, hip or back pain.

More frequently than is acknowledged, the lack of ability in terms of flexibility and strength is the underlying cause of the pain. If the pain came on gradually as opposed to a sudden trauma such as a car accident or fall, it is quite possible and even likely that the pain is due to being too tight and/or too weak.

Interestingly enough, if one is flexible enough to squat right to the ground and stay there comfortably, it is easier to recruit the correct muscles in the right order when getting up, which would reduce the chances of getting low back, hip and knee pain.

One of the biggest mistakes well-meaning adult children do is move their parents out of a home that has stairs into a home that does not, thinking that a stair-free environment will be easier on them.

But having stairs keeps one able to do stairs, and once there are no stairs to climb on a regular basis, the ability to climb stairs is lost. Soon stepping up or down a curb becomes a problem, and getting into or out of cars is impossible without help. And so the life closes down even further.

This gradual loss of function is not an inevitable part of ageing and can be avoided all together. The saying “If you don’t use it you’ll lose it” is true, but so is its opposite, “If you use it you will regain it.” The miracle of our bodies is that with consistent, appropriate daily practice targeted to one’s current ability, function can be regained.

I believe everyone should be able to get up from lying on their back on the floor in at least three ways. They are listed here from easiest to hardest:

1. Bend technique: Rolling onto the belly, pushing up onto all 4s, lifting the knees off the floor and using the hands on the floor to push the hips back until the heels are down, and rag-dolling up to standing.
2. Squat technique: Doing a full sit up, pushing oneself forward onto the feet
   into a low squat, and standing up by pushing the feet into the floor, and keeping the chest higher than the hips at all times.
3. Lunge technique: Getting onto the knees, lifting one foot forward, pushing through the whole front foot and back toes to stand up. One should be able to do this on both legs.

In my experience, many people are impaired in their ability to do the squat and lunge technique due to a lack of flexibility in the hips, knees, ankles and toes.

Many don’t have the strength in the abdominals to do even one full sit up from the floor in order to get into the squat position, and many don’t have the strength in the buttocks and legs to push up to standing from the floor without using the arms. I’ve seen this in people in their early 20s, so this is not only a problem for those in middle age and beyond.

For some people there are good reasons why certain techniques should not be practised (if you have an acute disk problem, the bend pattern and the very bottom of the squat may be problematic for example), so see your doctor for clearance.

Then hire a trainer who can help you stretch your tight muscles and strengthen you to the point you can do these movements effortlessly. And watch how your life expands!

If you want to share this article, scroll to the very bottom and click the “share” icon to post on Facebook, Twitter etc. If you want to subscribe or search for other posts by title or by topic, go to www.wellnesstips.ca.

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