Sacroiliac strain

Discussions relating to Lower Back Pain.

Wendy

Postby Bill P » Sun Jun 24, 2007 8:55 am

Wendy,

Yes, in fact an MRI will show soft tissue damage, but with an overstretched S.I. joint, it's not likely to be picked up because you were probably lying on a table during the test. Laying on the table stabilizes the S.I. joint, so unless your hypermobile S.I.joint was extremely stretched, it's probably too hard to see.

An excellent set of tests for determining if your sacroiliac joint is causing your low back pain are 1) the Patrick test and 2) the Gaenslen test. The examiner has you move your legs into different positions, and if pain is re-produced, it indicates that excess SI joing mobility is probably the culprit. The Spring test can also determine whether or not your SI joint is the source of pain. It is a passive test that has you lying in the prone position(face down) with a towel placed under your anterior superior ilias spine. The examiner applies downward pressure over your sacrum, and if the pain reappears, or becomes worse, it is a positive sign that the pain is coming from your SI joint.

Since Sacroiliac joint strain in women is commonly found with excess lordosis ( a pronounced forward curve of the lower back), it may help to stretch your hip flexors if you have a lot of curvature in your lower back. To test yourself,lay on the floor and see if you can slide your entire hand under your lower back at the belt line level. If you can, and there's a lot of extra room between your hand and your back, you have too much forward curve. If that is the case, stretching the hip flexors should help.

Dean's low intensity exercises in RYB are a great place to start. Also, if you have a blood pressure cuff, you might like to try the first B.P. exercises I gave to Karen (see my reply to Karen dtd March 4,07) If you have trouble with that exercise, let me know. (Dean's exercises should be your main focus, and the b.p.cuff is just an adjunct).

Another thing you might want to try is purchasing a Swiss Ball or a physio ball. Use it to sit on at work, and it will help to take some of the pressure off of your sacrum. Initially, alternate with the office chair and the Swiss ball - eventually sitting a larger part of the day on the Swiss ball than in the chair. They come in sizes ranging from 45cm thru 75 cm; in 10cm increments. Try and determine which size feels best for your back, and still allows you to work at your desk.

Things you want to try and avoid if you can are motions or exercises that involve forward-bending from the waist with the knees locked (e.g. bending from the waist to pick something up off of the floor). Sitting in a chair is tough on the sacrum also, as you alreay know.

Exercise is fine, just be very judicious in the amount of exercise and the duration of the exercise. (naturally, the intensity of the exercise must be low). Assess how each activity makes you feel during and after. If you are in doubt about an exercise's effectiveness, leave it out; especially if you think it might be detrimental.

There is a belt you can buy to help stabilize your SI joint. It is called an "SI.Loc", and while it is worn underneath your clothing, it is thin so it will not show. It goes over your hips and can be purchased on line. Type in OPTP on your search engine, and look for Orthopedic Physical Therapy Products (their phone number is 1-888-819-0121). Call them and ask about the SI.Loc tm. The SI.Loc is not very expensive - I think it costs about $25-30 US dollars.

Wendy, it would be wise to take some supplements as well, vitamins C, D and a trace mineral like manganese. These are excellent for bone, cartiladge and connective tissue repair. Also, for connective tissue repair and muscle strengthening and repair is the amino acid S-adenosyl-metheonine-SAMe.

Take 1,000 mg per day of vitamin C, and slowly increase this amount every two weeks, adding an additional 1,000mg, until you are taking 3-4,000mg/day. With the amino acid, take 200mg twice daily. For pain and inflammation, flax seed oil shows great promise as an anti-inflammatory. There are some others as well that have worked for other people if you care to know. Check out the post on vitamin D on Dean's site. That was a new one for me, but give it a try.

Tita, most of this reply can be of use in your case, with the exception of the answers to Wendy's specific questions.

Let us know how you are doing. I will reply to you just as soon as I can, but it may take longer than usual, because my time is becoming more limited. But I will reply to Tita shortly.

Let us know how you are doing.

Bill P.
Bill P
 

Tita

Postby Bill P » Sat Jun 30, 2007 2:19 pm

Tita,

Your back history sound very much like Wendy's case history (her post is just above your own).

I would like to ask a few questions, as I think some more information might help me to give you a better answer. Did you have an opertaion in connection with the cancer? When you initially went to the chiropractor, what were the general postural problems? Is the pain localized in one spot or does it travel? I think it would be wise to check the lordosis (curve) of your lower back. The explanation as to how to perform the check of your lordosis is in my reply to Wendy. I suspect that you may have an increased lordosis of the lower back (forward curve).

As I suggested to Wendy, you can try sitting on a Swiss/Physio Ball as this position will help take some of the pressure off of your sacrum. Do not forget to implement the exercises from Dean's book. Also, if you care to do so, you can try the blood pressure cuff exercise that I gave to Karen dated March 4, 2007.

If you don't think that the walking you are doing is hurting your back, then by all means, keep it up. The same goes for the Elliptical Trainer if you think it helps your back, it probably does. While we are on the subject of elliptical trainers, there is a post on the subject dated Feb.9,2007 which I found very interesting as I had not considered this piece of equipment for back rehab, and Don P.Mitchell indicated that he found it was very effective. Therefore, I would continue to use your elliptical trainer unless you find it is impairing your progress.

The advise I gave to Wendy should work just as well for you. Rebuilding your back is analogous to building a house. You need the right tools to build it well; the excersises in Dean's book are the hammers, my blood pressure cuff exercise is the framing square, and your walking and elliptical trainer are some other tools. The hammer in this scenario is the most important tool, because it helps to fasten everything together.

If you have any other questions, let me know, and keep us all posted on your progress.

Bill P
Bill P
 

Postby tita » Mon Jul 02, 2007 3:28 pm

Hi Bill,

Thank you for the post.

I think my situation is similiar to Wendy in some ways. I had also been doing repetitive aerobic exercises. My pain started before starting these exercises but after going to the chiro for about a year. I initially went for migraines but he did general adjustments each time I visited. One particular adjustment was pulling out the right leg with a gentle jerk. Why? He said my hip was off. I never asked specifically what was wrong but just trusted that he knew what he was doing to set things right. Now I know better to ask.

To answer your other questions, the pain is pretty much in one spot, on my right side. Only once or twice has it moved up my back and down my right leg. I do have Dean's book and was reading about the curve of my spine. I tend to tilt back, especially now as it feels more comfortable with the pain. But it is hard to tell what my normal tendency is.

As for my cancer, I had breast cancer on the right side and have had several surgeries in the last 3 years. I also went through radiation last summer.

I have been doing the basic stretches of Dean's book for the past 6 or 7 days and started your blood pressure excercises too. Both helped a lot but I have had lapses. The bp excercises feel good...very strengthening. I have had very little trouble doing them and am doing the advanced ones. I do have a lot of mobility. The worst thing seems to be sitting. I can walk and do the elliptical okay without suffering for it later.

I just started to enjoy running and some other exercising. Now I can't do most of it. I guess doing things like leg lunges and other lower body building is not a good idea for now, right? It took a while to figure out that some exercises are a strain because I usually don't feel pain while I am doing them. If there is pain, it comes many hours later.

I will continue on the path to healing...thank you so much for your time.
Tita
tita
 
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Karen update?

Postby Mollie » Wed Jul 04, 2007 2:44 pm

Hi!

I have been suffering from low back pain for 6 months now. I have had it on an off in the past, but the past 6 months it has been pretty constant. I went the Chiro a few months back for 4 sessions - didn't seem to help at all. Finally went to the Dr. (an Orthopedic Surgeon $600!!!! - should have read Deans book first!) After givnig me X-rays (???), he told me I had disc degeneration. Sent me to PT, who gave me an at home routine (no insurance, PT very expensive), which I have been doing. Then I found Deans book. I have been doing the exercises for a few weeks now, and the pain is slowing improving. Just this weekend, after noticing that the pain is really centered around my left side, I did some more research, and discovered it's my Sacroiliac Joint where all my pain is coming from. As I read Karen's post I realized this is exactly how I feel - can't bend forward, pain in my leg on the one side, etc. I have also had 2 pregnancies, and it seems that is is a more common condition for women due to the pressure that is caused during pregnancy. I would like to get pregnant again sometime soon, so I need to get this all figured out before that can happen. I'm only 27 - my life can't be over yet, right?

I was just wanting to get an update on Karen's condition - have the BP exercises been helping more? Can you bend forward now? Is the pain gone? How long has it taken? What have you found to be the most helpful? Also, anyone else out there who has been helped from this thread, please post your results, and encouragement. I will be sure to do so as I go!

Thanks!

Mollie
Mollie
 

Tita

Postby Bill P » Wed Jul 04, 2007 5:41 pm

Tita,
The things I would avoid are the chiropractor and the body building exercises; especially the lunges. I would rather see you wait until you have improved your core strength with Dean's exercises and are very proficient at a blood pressure cuff exercise I will explain later.

While we are on the subject of avoidance, stay away from exercises or activities that bring about pain - even if the pain does not present itself during the activity. The closer to the onset or beginning of the activity that the pain presents itself, the more harmful is the exercise or activity. For example, if you are a runner, and you experience pain in your knee shortly after setting out on a 3 mile jog, that would be far worse than if the pain started shortly after you stopped. Therefore, pain you experienced many hours after stopping the exercise is not as injurious as if it happened shortly after completion.Nevertheless, avoid those exercises/activities until your core is stronger and even then, only if there is no post-exercise pain.

If you care to read a good Internet article on back pain and posture, let me know, and I will direct you to the site. These two articles by Ian King (one of the best strength coaches in the world) explain how to assess your posture, and some corrective actions you can take. Although he does not delve into exercises in the two articles, his basis theory behind the postural assessment matches exactly Dean's assessment methods.

Keep us posted.

Bill P
Bill P
 

Postby tita » Mon Jul 09, 2007 9:04 am

Bill,

Yes, I am interested in the Ian King article. I am continuing the excercises and feel much improved overall. Yesterday I went out with friends and we sat for a long time in the car and at lunch. The pain was less than usual and did not last as long.

You mentioned another bp cuff excercise I could try. Could you explain that please?

I am seeing my doctor this week and I will ask if she can do a more complete assessment.

Thanks again,
Tita
tita
 
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Tita

Postby Bill P » Thu Jul 12, 2007 5:47 pm

Tita,

Glad to here you are making progress in your recovery.

As requested, here is some reading you might be interested in.

The article by Ian King is located at "Testoterone Nation". Click on "current site", then on the home page, click on "archives", then on the page that appears, click on "2003", scroll down to "10-2-03" Ian King's article titled "Out of Kilter". Part II of this article is titled "Out of Kilter II" posted on 10-30-03. There is also "Out of Kilter III", but it pertains to knee pain. He explains how to do a visual assessment on yourself.

Although this is a hard-core on-line body building magazine, he explains very well how to assess your current postural alignment. Naturally, it is better to have a professional perform the assessment, but this will suffice if you follow his outline. You can disregard the rest of the magazine. We'll just take what's useful and disregard the rest. This compliments the postural assessment method in Dean's book. He does not cover exercises in the article, but sometimes it helps to hear another person explain what to look for from a postural standpoint.

Tita, before attempting the next exercise in the progression, you should be proficient at the standing version of the blood pressure cuff exercise I gave to Karen dated April 13th (likewise for the blood pressure cuff exercises dated May 11th) before you attempt the more advanced version that I will give you. If you are not proficient at these 2 blood pressure cuff exercises, you will end up recruiting the rectus abdominus instead of the transversus abdominus. While this will work to keep the needle within 5 mm of mercury on the gauge, the transversus abdominus muscle will not be recruited, and therefore, will not benefit. The rectus abdominus wants to do most of the work if given the chance; especially if the transversus abdominus is not properly conditioned.

Basically the difference between the transversus abdominus and rectus abdominus is the rectus abdominus is a flexor and stabilizer of the spine, while the transversus abdominus is primarily a stabilizer of the lower back(especially when the body is under light loads). Examples of when you are just recruiting the transversus abdominus would be when carrying light objects, walking, bending, jogging, etc.

Although there is a better way to tell if your rectus abdominus is being recruited as a gross stabilizer of the spine, the easiest way to tell is if your breathing stops (holding your breath). This indicates that the ability of the transversus abdominus to stabilize the back on its' own has been exceeded. The reason any of this matters to us is because when the transversus abdominus is not conditioned properly, those every day activities become a wear and tear process on the back.

To summarize, be absolutely certain that you can perform the 2 aforementioned exercises before moving onto the more advanced version. Make sure to breath normally through the exercises and perform 20-25 reps .


If you feel you are ready now, let me know, and I will provide you with the next exercise.

Good Luck

Bill P
Bill P
 

Postby tita » Wed Jul 18, 2007 3:21 pm

Hi Bill,

I have been working on all the exercises the last several days, including the bp cuff from the dates you indicated. I feel pretty good about my progress with them and think I am ready for the other ones. I have checked my breathing and it is fine.

I read through the Ian King link and assessed myself. I tend to have a backward tilt and also some minor posture issues, but nothing severe.

My back feels very good after doing the stretches and strengthening, although it is certainly a committment of time and effort. So far, its paying off.

Thanks again and I appreciate your help,
Tita
tita
 
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Tita

Postby Bill P » Wed Jul 25, 2007 6:01 pm

Tita,

I am providing a hamstring stretch to help correct your rearward tilted pelvis. There are two reasons why you may want to use this stretch. Most important of which is the correction of a postural fault that may contribute to back pain. Also, the last progression of this blood pressure cuff exercise will be challenging enough without having tight hamstrings.

Tight hamstrings will not affect the version I am giving you today, but may hinder your ability to perform the more advanced form of this exercise.

Lying Hamstring Stretch
-Roll a small towel up (the thickness and width of the widest part of your hand. Lie supine, and place the towel under your lower back.
-While leaving one leg extended straight out and flat on the floor, bring the other leg up with the knee bent; pivoting at the hip.
-Support the raised leg with the hand that's on the same side as the raised leg by placing the hand between the hip and knee to help keep the leg vertical.
-Slowly extend the lower leg upward (with the toes pointed towards the shin) until you feel tightness in the back part of your thigh.
-Now hold a comfortable stretch for 20 seconds, then switch sides. Alternate stretching each side 3 times.

This version of the blood pressure cuff exercise is performed on the floor, and is almost identical to the last version that I gave to Karen dated May 11, 2007, except both legs move together. I'll explain it to you here so there's no confusion. While lying flat on the floor, place the blood pressure cuff under your lower back, directly below your belly button. Again, do this exercise on a firm surface while breathing normally. Bring your thighs up (flexing at the hip) so your knees are pointing straight up to the ceiling and your thighs and trunk are at a 90 degree angle from each other. Both legs from the knees to the ankles are relaxed with the bottoms of your feet facing the floor. Pump the BP cuff up to 40mm, lower your legs till your feet just touch the floor, and then raise them again back to the starting position. Throughout the movement, try and maintain between 35 and 45mm on the gauge. This will be harder than the single leg version because you have lost some support from the leg that was on the floor, along with the added weight of the other leg.

When performing this exercise, remember to pivot from the hip, lowering your feet to the ground so the movement takes 2 to 3 seconds to lower, pause on the floor, then raise, taking 2 to 3 seconds to return to the starting spot.

When you have mastered this exercise with a slow tempo (2 to 3 seconds in each direction) and you can do 20-30 repetitions, increase the tempo slightly. This will challenge your transversus abdominus because of the increase in tempo.

Tita, if you would like to read an excellent book on diets, which is the best one out there, I'll add it to the next reply. I didn't bring it up earlier, because my wife says that I overwhelm people with too much info. Try not and get frustrated with this next exercise. Your body will need time to develop the motor patterns and strength necessary to perform the exercise. If you do get frustrated, it's probably better to stop and do the exercise later in the day.

Good luck. Keep us posted.

Bill P
Bill P
 

Rehabilitation time for damaged SI joint

Postby john_r » Wed Aug 15, 2007 10:29 am

Hi I just found this forum and really appreciate all of the information. I damaged my SI joint over a year ago. I took my time going to the doctor because the pain was getting less, however about a 14 months after I damaged the joint I started having numbness in my foot. The Dr found that I had a moderatly severe degenrated disk at the L5 level, and I have a transitional vertabre. From the xrays I notice that I also have slight scoliosis. He gave me some exercises to try which I did, however these exercises only seemed to aggravate the pain and numbness. I am now going to a PT. The PT diagnosed the SI joint problem, I am guessing that it is hyper-mobile because it keeps slipping out of position. The first treatment was great I had no pain for two whole days. For my next treatment I saw another PT who looked at me and said I know what the problem is "you have one leg shorter than the other" he gave me a heel lift which I have quit using after 4 weeks because it was causing more pain. I am working with the first PT because I felt that he did a better job of assessing the problem, I've been doing the BP cuff exercise for 4 weeks now but I can only do at the most 10 reps on each side. My SI slips out of position within a few hours to a day, and when it does I notice that my ability to exercise the TA is reduced to 1 or 2 reps. I just made that connection this last week. My PT has also given me an exercise where I kneel on one knee and pull a elastic band from right shoulder to left hip and then left shoulder to right hip. I am getting frustrated with the lack of progress. I am being very careful to avoid the movements the PT has told me to avoid. I have quit riding my bike, I have reduced the amount of walking I do. I am starting to feel depressed I think in part due to the lack of aerobic exercise. What is a reasonable recovery period. I've been in PT for almost 6 weeks now, and I don't feel that much better except right after a visit. My pain level was about 6 when I went in it is now maybe 4.5 to 5.
Thank you for you input
john_r
 
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Postby annie » Wed Aug 15, 2007 5:01 pm

Hi John,

One thing you wrote bothers me. You wrote, "The PT diagnosed the SI joint problem, I am guessing that it is hyper-mobile because it keeps slipping out of position."

How do you know this is true? Physical therapists are not MDs and don't have anywhere near the medical training that doctors have. Has a doctor confirmed that you have a damaged SI joint? You may be completely wasting your time working on a problem you don't even have. Just felt I had to say something.

My next question is have you read Dean's book, "Rebuild Your Back" yet? If not, you should really get it. I discovered this forum about three months ago and I started out doing the BP cuff exercise first but it didn't seem to help. I then got the Rebuild Your Back book since everyone recommended it and that's when I started making progress. Right now I'm only doing Dean's exercises as they seem to help me the most. I'm going to go back to doing the BP cuff exercise here eventually. I think it's a great exercise for the abs, but it wasn't helping me.
annie
 

Postby Guest » Wed Aug 15, 2007 9:19 pm

Hi Annie

Thanks for the input. No my Dr. did not diagnosis the SI. He did not even notice the scoliosis on the x-ray until I asked him about it. I don't believe that my Dr. would be able to confirm or disprove the PT diagnosis. I believe that the PT is correct for the following reasons.
1. The SI joint is very tender
2. After correction both legs appear to be equal in length pelvis is level and the scoliosis is corrected.
3. After treatment the pain is greatly reduced.

I know that these may be considered subjective reasons but I believe that the diagnosis is correct. Having said this I believe that I am ready for a second opinion.


I will check into "Rebuild your Back" it sounds like it if very good and I am glad that it has helped you.

Thanks again for your input.

John
Guest
 

Postby tita » Thu Aug 16, 2007 11:41 am

Hi Bill and any interested readers,

I want to share my progress for anyone who might be interested in how the exercises in Dean's book and the blood pressure cuff are working.

Its been a while since I last posted and I have been doing most of Dean's exercises and bp cuff everyday. I am a teacher who is taking this summer fairly easy...a summer of healing, so I am able to dedicate myself to this back issue.

It took a while to get into the routine of the exercises and I could not do all of them to start with. I can now do all of them, some not to full degree. The bp cuff ones were not that hard for me to do, but I do have to everyday or else I regress.

The hardest thing is not doing most of the activities I love...aerobics,
any kind of toning that requires leg work.

I got to the point where I had no pain at all and was even able to sit without pain at the theater. Then something happened, I am not sure what. I did try to do some mild exercise with leg toning. One day I did not have a chance to do any of the back stuff. That night I want to the movies again. My back started to ache a little. The next day I was in pain again. I felt like I had completely regressed. How discouraging! But I refused to give in to self-pity and went back to my rigid routine. It took about a week to feel better again, which is far less time than at the beginning.

I thought I could do some of my old activities, but I guess not. I am acutely aware of the types of movements that irritate my SI joint. When doing gentle movements with exercise DVDs, I notice that any side to side movements cause slight irritation. If I keep doing it, I feel the pain later.

Bottom line is, the back exercises have been extremely helpful, but also require commitment, time and stopping any harmful activities.

I am going to continue doing them everyday. I have read on the forums here that people say full healing will come. I look forward to that day.
tita
 
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Postby expatient » Fri Aug 17, 2007 6:30 am

This is how I see it:

SIJ dysfunction is very common disorder. SIJ pain is just one symptom of many it can cause. And usually the pain is on the healthy side. You don't believe? When you get an upslip of ilium it moves up compared to sacrum and usually rotates too. That lifts hip bone too and the rest of the leg has to follow. When standing and walking you have to get that leg touching the ground so you have to twist your pelvis so that the leg at upslipped side can reach the ground. That way your sacrum is leading to the upslipped side. But your upper body has to lean to the other side to keep the body in balance.

So as far as 80% of your body mass can be carryed by the other side SIJ with every step you take. So eventually muscles and ligamenst get tired and cause cramps and pain, sometimes even inflammation. And also on that side the nerves are more compressed bacause the scoliotic curve of lumbar causes more pressure on that side. It is not always like this but most cases are. Many other subluxations of pelvis can happen too and they can cause different posture and functional changes.

And medical sudies tell back pains are in 70-80% of the cases on the longer leg side. They just think that length difference is anatomical. Even if you look from X-rays there can be length difference because pelwis is twisted and iliums are not equally positioned so other femur is closer on z-axis than other, but on 2-dimensional picture you don't see the z-axis. You see only 2D prjection of 3D world and that can shorten other leg easilly 1-2cm depending of the picture angle.

Some say SIJD is mostly women's disorder. They are right, but many men have it too. About 80% of people have it causing them many different Muscular Skeletal Disorders. For women it is easier to happen because their pelvis is buld to give up easier. So smaller trauma can cause them upsplips, subluxations etc. And after giving birth those problems arevery common...

Most common SIJD case is upslip: Other ilium has moved out of it's natural range and got stuck because of a trauma, fall, slip, or other accident. usually it is also rotated forward (anteriorly). When stuck it has no schock elimination and all those forces from down to up go to spine and causes countinuous stress there: wear and tear of spine and discs.
When pelvis is not functioning symmetrically it stresses the spine. There you get scoliosis, extended lordosis, wear and tear in discs and vertebra. Also altered pelvic ring posture causes piriformis tightening, ischias, leg weaknes, muscle imbalance, back muscles tightening, bad body posture, neck problems, shoulder problems,.. And to legs not only hip problems but also knee, ankle, achilles and many others too because it changes the way you walk.

But because the pain usually comes after yers of walking with SIJD that is difficult to diagnose. The trauma that caused it is so far in history. And it is not only a disorder for adults but also for children too. To children it causes ie. idiopathic scoliosis. See those pictures they use describing scoliosis: 9 out of 10 have pelvic bones malaligned. They say scoliosis causes that. But if your pelvis is not levelled the spine can not be straight. Can it? It was corrected from me at the age 35 by pushing it back by one old doctor. I had had mild scoliosis, short left leg and unleveled pelvis for all my life. Not any more!

And when they diagnose that rotation scoliosis, it means your other ilium is more forward than other (upslip and anteriorly rotated). It causes that twisting force to lumbar spine. And up in shoulder level you willingly fight against it trying to compensate that twist...
And when you have both SIJS upsipped you will get very exteded lordosis and you walk like Donald Duck ...

This was a short message about SIJD and I am just an exSIJD patient who has interviewed hundreds of other similar patients and few experts who really knew how to help by correcting the problem.
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Postby tita » Fri Aug 17, 2007 10:05 am

Your explanation is interesting although a little technical for me. When you say a doctor healed you, was that person a chiro? How were you diagnosed? What you say is a bit discouraging unless someone gets the treatment like you received. I guess I am just wondering where to go from here.

Thanks for your info,
Tita
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