Sacroiliac strain

Discussions relating to Lower Back Pain.

SIJD

Postby bagsua » Sun Aug 19, 2007 1:27 pm

I too would like to hear if expatients cure was from a chiro or not.
I've been suffering from buttock pain, sciatica for 2.5 years now and have been through the gammet of "cures" , none which have worked. I've done everything except for surgery. MRI's Xrays, SI injection, PT, chiro, acu, estem, anything you can think of, no results.
I will begin trying the BP thing as that sounds new , maybe it will work.
bagsua
 

Postby Dean » Mon Aug 20, 2007 3:51 am

expatient is a chiropractor (or some variation) attempting to lure people to a European clinic.

He has a bad habit of spamming forums posing as an ex patient and promoting manipulation as the instant cure for SIJD.

He has a very badly done video on YouTube that only an idiot would not be able to see through as a fake. It is entirely staged. I have had to delete his posts in the past for attempting to lure people to that video. I should have deleted his latest post, but decided to let it pass this time because I think you're smart enough to see through his garbage.

Why he came back here again, I have no idea. Apparently, he thought sufficient time had passed that perhaps I'd forgotten him.

expatient... I never forget.

Here is his attempt to spam the Chirotalk discussion board, which includes my comments on his fake video:

Fraudulent Video Discussion

If you'd like to follow this discussion, the Chirotalk forum is the appropriate place to do so. I don't allow dishonest people like expatient to post on this board.
Dean
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John

Postby Bill P » Wed Aug 22, 2007 4:59 pm

John,

Before I give you an exercise, let me ask a few questions about your scoliosis.

Do you know whether or not your leg length discrepancy is a Structural or Functional discrepancy? Let me explain; a structural discrepancy means that there is a physical difference between your right and left sides. The femur or tibia on one side is shorter than the corresponding bone in length. This can be congenital - meaning you were born with it, or acquired - meaning an event happend after birth to cause the asymmetry.

A functional discrepancy is one where the legs are of equal length, but the pelvis is higher on one side making it appear as if you have a longer leg on the side with the raised hip. The bones of the leg, femur, tibia are of the same overall length from left to right. The symmetry is altered by the height of the pelvis (one side is higher). Many times this can be caused by a muscle imbalance that produces a sideways sway to the pelvis which raises the hip. Some of the muscle imbalances that will produce this are a tightness in the Tensor fasciae Latae and Iliotibial band on one side of the pelvis, or a weakness in one Gluteus medius which causes the pelvis to raise on the weak side.

To determine if your pelvis is level, stand in front of a full length mirror in shorts or briefs. You want to be completely relaxed. Take note of the tops of your shoulders left to right. Are they on the same horizontal plane? (i.e. level?). Next, place your thumbs on the top front edge of your pelvis. Note if there is a difference from left to right; is one side higher than the other? Often with scoliosis, the same shoulder and hip will be lower on the dominant hand side. Therefore, a right-handed person will have a lower right shoulder than the left, and the right hip will be lower than the left hip.
John, let me know what you find after you've checked your shoulders and pelvis.

Another point that needs to be made is, if you do have a functional leg length discrepancy (both legs are of the same length when measured by a competent person), you do not want a heel lift to be inserted in your shoe. This can give you a permanent leg length discrepancy if it is left there long enough. What happens over time is that the muscles around the hip shorten because of the lift. If they stay in a shortened state, over time, the shortened muscle will lose sarcomeres (the contractile mechanism within the muscle). Research has shown that once a muscle loses sarcomeres, it cannot regain it's original length, and therefore it becomes a permanently shortened muscle.

What was the exercise the Doctor gave you that re-aggravated your back pain? Follow Annie's suggestion and download Dean's book, as this should be your initial step from an exercise standpoint. My B.P.cuff exercises are secondary to the exercises in Dean's book. Concentrate the majority of your efforts on his recommendations.

It is nearly impossible to say how long the recovery will take. There are many factors involved. Here are just a few: 1) your age 2) your commitment to your exercise program 3) the effectiveness of the exercise in the program 4) your overall body weight 5) whether your job places additional demands on your scoliosis and lower back. The demands placed on your lower back from the work environment may go unnoticed if they are subtle and/or repetitive. For example, "checkers" in grocery stores often work and rotate in the same direction; so do airline employees that check your bags. The better you are at identifying injurious movement patterns throughout the day and reducing them, the more likely you will be able to eliminate situations that contribute to your condition. That said, I would consider your progression from a perceived pain level of a 6.0 down to a 4.5-5.0 in a 6 wk period to be pretty good.

If I were you, I think I would continue seeing the 1st physical therapist you went to. This is a complex condition that warrants the hands-on care of a professional. But don't despair. You will make progress; maybe just not always in a straight up-hill fashion. Try not to get down if you have a set-back.

I hope this has been of some help. Keep us posted.

Bill P.
Bill P
 

Re: John

Postby john_r » Thu Aug 23, 2007 1:15 am

Bill P

Thank you for the time you spent replying to my post.
Do you know whether or not your leg length discrepancy is a Structural or Functional discrepancy?
It is mostly Functional discrepancy with a possible structural difference of 2mm. The first heal lift I was given was about 12mm. I have stopped using the heal lift and my knees feel much better.

My hip flexers are very tight with the right side quite a bit tighter than the left. This is causing the pelvis to twist and giving the appearance off the legs being different lengths
To determine if your pelvis is level, stand in front of a full length mirror in shorts or briefs. You want to be completely relaxed. Take note of the tops of your shoulders left to right. Are they on the same horizontal plane? (i.e. level?). Next, place your thumbs on the top front edge of your pelvis. Note if there is a difference from left to right; is one side higher than the other? Often with scoliosis, the same shoulder and hip will be lower on the dominant hand side. Therefore, a right-handed person will have a lower right shoulder than the left, and the right hip will be lower than the left hip.
John, let me know what you find after you've checked your shoulders and pelvis.
I just had a PT session today so everything is fairly level, however before the PT session the Right pelvis was high, and I am not sure about the shoulders. I have also noticed that the pelvis and the rib cage are rotated in relation to each other. I will check the shoulder level in a few days when the si slips out of alignment again.


Another point that needs to be made is, if you do have a functional leg length discrepancy (both legs are of the same length when measured by a competent person), you do not want a heel lift to be inserted in your shoe. This can give you a permanent leg length discrepancy if it is left there long enough. What happens over time is that the muscles around the hip shorten because of the lift. If they stay in a shortened state, over time, the shortened muscle will lose sarcomeres (the contractile mechanism within the muscle). Research has shown that once a muscle loses sarcomeres, it cannot regain it's original length, and therefore it becomes a permanently shortened muscle.
I used the heal lift for 3 weeks. My body never got used to it being there. I hope that there will not be permanent damage.
What was the exercise the Doctor gave you that re-aggravated your back pain?
single knee to chest with other knee bent. I could do the right knee but the left caused pain in the SI area. He also gave me partial situps to do - though the PT said this really does not help.

It is nearly impossible to say how long the recovery will take. There are many factors involved. Here are just a few: 1) your age
45
2) your commitment to your exercise program
I have done every exercise the PT has given me for the recommended number of sets. If I could not complete a set I rest and try again later until I match the number of reps set forth.
3) the effectiveness of the exercise in the program
I don't have enough information to evaluate this yet
4) your overall body weight
I am 5'10" and weight 162 fully clothed. I consider my ideal weight to be 145. One of my goals this summer was to start riding my bike more.Increasing the distance to about 250 miles a week. But the therapist killed that dream.Last year before I knew that cycling was hurting be I was doing about 150 miles per week. So now the inactivity is killling me. I want to do some exercise that will burn off my extra energy
5) whether your job places additional demands on your scoliosis and lower back. The demands placed on your lower back from the work environment may go unnoticed if they are subtle and/or repetitive. For example, "checkers" in grocery stores often work and rotate in the same direction; so do airline employees that check your bags. The better you are at identifying injurious movement patterns throughout the day and reducing them, the more likely you will be able to eliminate situations that contribute to your condition.
I work in a IT department and I have reduced activities that are on the “no twist, no lift more than this list”.
That said, I would consider your progression from a perceived pain level of a 6.0 down to a 4.5-5.0 in a 6 wk period to be pretty good.
I guess the first two days after my first PT sesson with the pain less than 2 set my expectations too high.
If I were you, I think I would continue seeing the 1st physical therapist you went to.
This is the path that I am traveling now.
I hope this has been of some help. Keep us posted.
It does help. I must remind myself that I am in the early stages of O. L. D. and my body does not heal like it used to
[/quote]

Thank you again for your input. I know that it is hard to figure out what is going on without seeing for yourself. I think that the PT is having a hard time trying to sort out the problem and develop a solution. I had no idea that the back and hip connections were so complex.

John
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Re: John

Postby john_r » Fri Aug 24, 2007 9:06 am

Bill



Take note of the tops of your shoulders left to right. Are they on the same horizontal plane? (i.e. level?).


My SI has shifted again there by giving me a chance to check the level of my shoulder and pelvis. You are correct when you said that the shoulder and the pelvis may be low on the same side. Mine are low on my left side even though I am right handed.

The PT gave me more exercises the other day. I am struggling with this exercise - keeping the back in a neutral curve and straight while standing on one foot and being gently pulled forward by a theraband. I am holding a broomstick in contact with head, shoulders and tail bone. Throughout the motion I must maintain contact on all three points. I am then to straighten up using the gluts. The PT noted that I want to lock my knee and use my hip flexors to stabilize the motion. When I unlock my knee I just wobble all over the place - though I am slowly gaining more control.

Thanks again for your insights.

John
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SIJD

Postby bagsua » Mon Aug 27, 2007 11:45 am

Bill, how long is too long for the muscles to stay shortened. I work a 5mm heal lift for about 3 months. I have been doing some exercises lately such as lunges and the BP cuff thing, and seeing minimal results. But i still definately see a longer pant leg on one side, which is also the side that has a weak glute.
Hope I didn't make permanent damage with the heel lift.
bagsua
 

John

Postby Bill P » Wed Aug 29, 2007 7:08 pm

John,

Here's the exercise I promised you.

It's called "Hanna's Three-Part Side Flexion" named after it's creator, the late Dr. Thomas Hanna. Check with your physical therapist first to rule out any reason he/she may have for not wanting you to perform this exercise.

I'll describe the starting position of the exercise. Lie on the floor so that the convex side of your spine is facing up. (Assuming you have a "convex left" scoliosis, you would lie on your right side. With a convex left scoliosis the right Quadratus Lumborum is tight, which pulls the spine into a convex left. So, by lying on your right side and performing this exercise you will be stretching the right side and strengthening the left. (Another way of saying this is you will be stretching the side that is tight, while at the same time strengthening the weaker side) . While lying on the floor make a 90 degree angle at the knee and hip by flexing your hip and knee. You will look like you're in a seated position while lying on the floor (legs are together). Then, place your hands behind your head, your elbows will be forward. (Naturally, if your spine is convex right, just reverse the positions in the above example)

As the name implies this is a three part exercise.To perform the 1st Part of "Hanna's Three-Part Side Flexion", place your knees together on the floor, start by raising your top foot up and away from the floor in an upward arc (remember...both knees stay together and on the floor throughout the exercise). Use a slow tempo of 2 seconds to raise your foot, pause at the top for 5 seconds, then lower for a count of 2 seconds. Rest with feet together on the floor for 5 seconds before beginning the next repetition. Repeat this sequence - 2 seconds to raise, 5 second hold at top, 2 seconds to lower, pause for 5 seconds at the bottom - for a total of 5 repetitions.

The tempo or speed of this exercise is important. All movements are done in a slow, deliberate manner. Unlike regular exercises where you execute the movement to failure, rehabilitative exercises should be stopped when your form breaks down, or you experience tiredness or discomfort.

The 2nd part is done with the upper body only (your lower body - knees and feet - stay on the floor in the original start position). Again, hands behind your head, and elbows pointing forward. Start the exercise by side flexing your torso off of the floor ( the ribs of your upper body will be moving towards your iliac crest). Do not pull on your head with your hands. Use the same tempo as part 1 in the leg raise (2)(5) (2) (5) for a total of 5 repetitions. As you side flex the upper body away from the floor, keep the lower body quiet, just side bend your torso off of the floor. Again, do not rotate or twist your spine; this is a very small movement.

Part 3 combines the action of parts 1 and 2 together. So, you raise the top foot upward in an arc while the knees stay together (medially rotating the leg), while at the same time, raising your shoulder off the floor as in Part 2. The tempo stays the same as in parts 1 & 2. Repeat for 5 repetitions as long as your form does not break down.

If you have trouble completing all 5 repetitions with good form, stop. This exercise can be done every day if you have time.

This exercise is somewhat difficult to describe, so if you have any questions about the position in which you must be for part 1, 2 or 3, please feel free to write back and ask.

This exercise is meant for someone with functional scoliosis. It will not help if you have structural scoliosis.

Hope this helps. I'm leaving on vacation, but will reply once I return.

Bill P
Bill P
 

Bagsua

Postby Bill P » Sun Sep 09, 2007 1:06 pm

Bagsua,
I'm sorry this reply took so long. I do not know the length of time it takes for a muscle to become permanently shortened. If in fact, it was in the research I read, I have forgotten the time frame specifics.

In my reply to John on August 22nd, I stated you do not want a heel lift in your shoe if your legs are of equal length. If you were correctly diagnosed with a leg length discrepancy, and have one leg that's truly 5mm shorter than the other, then do not remove the heel lift unless instructed to do so by your doctor. Your case is quite different from John's.

There are two types of leg length discrepancies; one where the bones of the leg measure the same length, and a second type in which there is a measurable difference between the two. In the 1st example other factors make it only appear as though one leg is shorter than the other. That's a "functional" discrepancy, also called an apparent leg length discrepancy. The 2nd example is a "structural" discrepancy, or an actual leg length discrepancy, where there is a physical difference between the length of the bones from one side as compared to the other.

Many factors can fool an experienced examiner here are a few; 1) The pelvis can deviate anteriorally/posteriorally from the left to the right side 2) The effects of an old injury can also alter the alignment of your lower back and pelvis 3) A gluteus medius weakness on one side of your pelvis will also alter the alignment of your pelvis. In this case, the leg with the weaker gluteus medius will appear to be longer. Additionally, if the examination and measurements for your leg length were taken while in a lying position, the pull of the stronger muscles on one side of your body can alter your alignment enough to make it appear as if you actually have legs of different lengths. This can throw an examiner off if he/she is not aware of the existing strength imbalance. 4) From a frontal view, an elevated hip may indicate a possible tight Quadratus Lumborum on the elevated side. 5) Less likely, but still possible, is a weak Quadratus Lumborum and Psoas muscle on the lower hip.

As you can see, it takes an experienced professional to determine whether you have an apparent or actual leg length discrepancy. Before jumping to the conclusion a heel lift is not needed, you need to assess why it was placed in your shoe in the first place. Has the heel lift helped your condition? Hopefully it was placed there by a skilled medical professional.

Bagsua, have you been working with a PT? Who determined you have a weak glute, and was it the gluteous maximus? If, in fact, it was the gluteous maximus that was weak, try working the weak side only by doing lunges; at least until the bilateral deficit is eliminated.

I am assuming you came to this web site because you experienced lower back pain. If so, it would be wise to follow Dean's recommendations in his on-line book. It may prove to be the best $20 you ever spent.

Again, sorry for the delay. I hope this post is of some help and finds you well.

Bill P
Bill P
 

Re: John

Postby Guest » Mon Sep 10, 2007 10:52 pm

Bill P wrote:This exercise is meant for someone with functional scoliosis. It will not help if you have structural scoliosis.

Hope this helps. I'm leaving on vacation, but will reply once I return.

Bill P


Bill

Thanks for the exercise unfortunately I am not back to square one. I re injured my back. The PT has put my treatment on hold until I see my doctor and get a MRI. My sciatica symptoms are worse than they have ever been, so something has changed and not for the better. On the plus side the SI joint appears to be functioning correctly and my pelvis has been level for two weeks now.

Thanks again for the exercise may be someday I will get a chance to try it.

John
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Postby Meg » Sun Oct 21, 2007 1:09 pm

This is a message for Bill P
Hi Bill, I have followed this string with enormous interest. Last June, I restrained my left SI joint. I have multiple restrain incidents, all the while diagnosed as DDD until this incident. I have worked with some excellent PTs, all to no avail.

When this first happened, I flew to Guatamala for a trip. My doctor diagnosed DDD and told me the walking would be good for me. Over the years, I have remained in pretty good shape always working on staying strong to prevent a new episode. Needless to say, the walking and stabilization exercises weren't good. Neither were they when I flew to England. I have tried everything and recently tried your Paul Check series. I have no problem with #1. However, with #2 straight leg on back, the straight leg lifting seems to pull on the left SI joint which is still pretty hot (inflammed.) Do you have an even smaller progression?
Thanks for your input and advice in advance. Meg
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SI Injury

Postby Dori62 » Fri Nov 16, 2007 3:37 pm

Hello, I, like others, have been reading this string. I am so glad I found this forum as I have gotten several answers to questions I have been looking for. I injured my SI a month ago. Just a dumb move while lifting a planter pot. In the last couple of weeks the pain has subsided a few times for a day or two at a time. My problem is, when I sneeze, I am set back for at least a week. Does anyone else have a problem like mine? I thought about trying some cold meds or Claritin, but don't know if it will keep me from sneezing. I just want to get healed. I am going to try the B.P. Exercise and also plan on getting Dean's book. You guys are the best!

Dori62
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Meg

Postby Bill P » Sat Dec 01, 2007 5:28 am

Meg wrote:This is a message for Bill P
Hi Bill, I have followed this string with enormous interest. Last June, I restrained my left SI joint. I have multiple restrain incidents, all the while diagnosed as DDD until this incident. I have worked with some excellent PTs, all to no avail.

When this first happened, I flew to Guatamala for a trip. My doctor diagnosed DDD and told me the walking would be good for me. Over the years, I have remained in pretty good shape always working on staying strong to prevent a new episode. Needless to say, the walking and stabilization exercises weren't good. Neither were they when I flew to England. I have tried everything and recently tried your Paul Check series. I have no problem with #1. However, with #2 straight leg on back, the straight leg lifting seems to pull on the left SI joint which is still pretty hot (inflammed.) Do you have an even smaller progression?
Thanks for your input and advice in advance. Meg


Meg,

I am very sorry to have taken so long to reply to your e-mail. My computer crashed, and then my login to this site was inactivated, so I couldn't reply to you until now.

Try this smaller progression rep from the 1st Transversus abdominus exercise. Lie on the floor with your feet about 1/2 way between your butt as in version #1, and the extended straight-out version in #2. There should be about 18-24 inches from your behind to your heels. The remainder of the exercise stays the same - 40mm of mercury on the gauge as well as the leg movement. This will make the exercise somewhat easier than the straight leg version, but slightly more difficult than the fully flexed one in version #1. Perform this modified version without shoes on. The added weight of a shoe/sneaker adds to the difficulty of the exercise.

Here are some things to keep in mind:1. Doing the exercises in Dean's book are paramount in your quest to eliminate further back pain episodes. 2. This may seem obvious, but I'll point it out nonetheless. If you exceed the capacity of your stabilizer muscles' ability to maintain the correct biomechanical relationship between joints, injury will eventually result. Injuries (especially of the lower back type) often occur in one of these two ways. The stabilizer muscles gross stabilization threshold is exceeded, or the duration threshold is exceeded. In other words, either you exceed the threshold for the load, or you exceed the threshold for the amount of time.

As your stabilizer muscles become de-conditioned due to misuse, poor posture, overuse, or lack of proper exercise, the stabilization threshold diminishes. Eventually, picking up that 10lb bag of groceries becomes a wear and tear process on the vital components of the lower back. I am referring to those typically injured: i.e. SI joints.

Exceeding the stabilizer muscles' ability to maintain proper alignment over a period of time is another way we might injure our backs - this is the duration stabilization threshold. Often this happens when we do more of something we have done in the past. Hitting an extra bucket of golf balls at the range would be an example of an instance in which the duration threshold could be exceeded.

Again, sorry my reply is so late. Good Luck and please keep us posted.

Bill P
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Re: SIJD

Postby Dori62 » Mon Dec 03, 2007 1:01 pm

bagsua wrote:I too would like to hear if expatients cure was from a chiro or not.
I've been suffering from buttock pain, sciatica for 2.5 years now and have been through the gammet of "cures" , none which have worked. I've done everything except for surgery. MRI's Xrays, SI injection, PT, chiro, acu, estem, anything you can think of, no results.
I will begin trying the BP thing as that sounds new , maybe it will work.


Bagsua,

You really should download Dean's ebook to try his exercises. I started doing them right after posting here and my back is sooooooo much better. I'm still being very careful at this point, but the exercises worked for me! (-:
Dori62
 
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Sacro-iliac function

Postby Margie » Tue Apr 15, 2008 8:05 am

I've enjoyed reading this thread as there is some good information and the responses adress individual concerns. My problem is similar to some of those adressed but a little different as well. I'm currently battling with what I believe to be an SI joint disfunction that started just under a year ago. X-rays showed no abnormalities in my spine or pelvis. Symptoms I've experienced include:

Pain in the piriformis and general buttock area on my right side at more or less level 6, (now diminished)
Pain around the SI joint on the right side at more or less level 7 (now diminished)
Constant pain at about level 3 on the outer trochanter on the right side when it is under pressure (lying on that side),
Knotted muscles in the hamstring which was relieved by dry needling
More recently pain around the SI joint on the left side, usually after doing something remotely strenuous, this pain has started to move into the left buttock as well
A feeling of being twisted and unbalanced around the pelvic area

I was playing soccer regularly, cycling, hiking and generally quite sporty and active before the injury, I'm 24 years old, never been pregnant and the only back injury I've had was an accident with a swing when I was 6. I also work in a desk job and believe sitting to be a contributer (I'll be looking into buying a swiss ball soon, thanks for the tip)

Diagnosis was done by an orthopeadic (spelling?) doctor who believed the cause of the problem to be repetetive strain combined with ligament laxity. At the time he said he couldn't be sure if a tight piriformis was contributing to the si problem or the other way round. However piriformis symptoms have diminished significantly so I think the SI joint is probably the cause.

I've experienced no numbness and still have good mobility, I can pretty much move normally except movement causes pain after. Treatments included:
Physiotherapy: massage, needlepoint, ultrasound and core stabilising exercises which kept up quite well
I also now wear orthotics inserts for walking

Pain has reduced alot especially since I started wearing the orthotics, for a while I only felt slight pain on the outer trochanter when lying on that side. However my ultimate goal is to be able to return to intense activity and I have hit a wall here. Every time I try something slightly strenuous, I end up in pain again. I am also concerned that the pain has started shifting to the other side of my body and seems to be starting to get worse again.

I'd like to get some additional insight into my problem. Are my goals unrealistic? Should I be trying to manage pain rather then return to my former level of activity? Are there any other actions I should consider? Am I just being impatient. I would really appreciate help or suggestions especially on things I can do without having to pay for expensive treatments.
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Re: SIJD

Postby Dori62 » Wed Apr 16, 2008 3:30 pm

Dori62 wrote:
bagsua wrote:I too would like to hear if expatients cure was from a chiro or not.
I've been suffering from buttock pain, sciatica for 2.5 years now and have been through the gammet of "cures" , none which have worked. I've done everything except for surgery. MRI's Xrays, SI injection, PT, chiro, acu, estem, anything you can think of, no results.
I will begin trying the BP thing as that sounds new , maybe it will work.


Bagsua,

You really should download Dean's ebook to try his exercises. I started doing them right after posting here and my back is sooooooo much better. I'm still being very careful at this point, but the exercises worked for me! (-:



Bagsua,

I downloaded Dean's ebook back in December. Within two months of doing the excercises, my back felt almost normal again. It is April now and I have very little pain. To any and all who check out this forum, the excercises work!

Thanks Dean and all of you who post here! :D
Dori62
 
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