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Sacroiliac strain

PostPosted: Thu Feb 22, 2007 2:04 pm
by karen
HI again,
Posted a message 2 days ago and got a prompt reply from Steven-thanks for that. Am still going ahead with the exercises but much more gently than before. Am finding that difficult, just because every other kind of exercise I've ever done you're supposed to push hard to gain results. The stretches I'm doing now here don't 'feel like I'm doing anything'. Anyway, another question, I got in to see the local physiotherapist yesterday (after a 5 mth waiting list), and she told me the pain I have in my left buttock isn't due to sciatica but because I have a strained sacroiliac joint.
What I need to know is does this affect my exercise routine here ? Are there certain exercises I shouldn't be doing etc etc ? I'm not doing any other kind of physical exercise at the moment.

Thanks
Karen

PostPosted: Thu Feb 22, 2007 10:13 pm
by Dean
Hi Karen,

The RYB exercises shouldn't have a negative effect on your sacroiliac joint. However, if the pain increases and you suspect one of the exercises, simply stop doing that exercise and see if the pain subsides.

What did your phsiotherapist recommend for treating the sacroiliac problem?

Dean

PostPosted: Fri Feb 23, 2007 1:01 pm
by karen
Hi Dean,
Rest mainly, I've been doing other forms of exercise, ie an aerobics exercise video 3 times/week to keep up my fitness regime and she thinks this is stopping the strain from healing. Also, a back brace to keep my SI jt stable. I've also found that doing the forward bend exercise you recommend definitely aggravates that particular area so I've quit that one for now. Do you have experience with this injury, are there other treatments/exercises you recommend ?

PostPosted: Fri Feb 23, 2007 9:47 pm
by Dean
I only rarely hear from people with sacroiliac problems, so I haven't had a chance to do much research on the subject and don't know much about it. The few people that I've had contact with have all been under chiropractic care, which makes me wonder if that could be a contributing factor.

It would be interesting to know if you had the problem before or after you went to a chiropractor?

Since the sacroiliac joint is essentially a stationary joint and really isn't supposed to move (except during pregnancy), I don't think exercise would help and may actually be counterproductive. I would tend to think that your physio is correct to simply suggest rest.

That would have been my first guess,
Dean

PostPosted: Sat Feb 24, 2007 9:54 am
by karen
Hi again Dean,
Thanks for the info. My PT suggested that the strain was probably induced initially by pregnancy but she also said the pain I have now (my last pregnancy finished 4 yrs ago) is because the joint is hypermotile. She wouldn't come right out and say it but she indicated that since all my chiropractic manipulations have been to adjust a 'stuck' SI joint there's a good chance that the adjustments have made my joint this way. Great, eh ? Hopefully, enough rest will allow it to heal, I'm not sure what I can do to make it less motile though.
Thanks again for the reply, this website is very helpful
Karen

PostPosted: Tue Feb 27, 2007 10:19 am
by randolph
Hi Karen

I'm wondering what your PT meant by labelling the joint "hypermobile"?

It's my understanding that bone movement is caused by the muscles, tendons and ligaments attached to them. So if a joint is labelled "hypermobile" it would seem to imply some soft tissue strain/malfunction ... which would certainly heal within a few months (less for muscles, more for tendons). Is that correct? If so, any injury from your pregnancy is probably no issue ... and the injury from the DC's manipulations ... how long ago were they? If it hasn't been very long, your PT is probably right on to suggest that too much exercising would prevent healing of the injured soft tissues.

To answer your question (how to make the joint less mobile), isn't that just going to happen once the injured muscles/tendons/ligaments heal?

I was also initially uncomfortable with how little stretch I was feeling with the RYB exercises (my word for it was "wimpy" ... sorry Dean) but I can verify they are very effective.

Randolph

PostPosted: Tue Feb 27, 2007 1:58 pm
by karen
HI there again,
Thanks so much for your interest, Randolph, I feel like since I found this forum I've finally found people who understand what I'm going through. My back pain started in Sept last year and I went to my DC as I'd done so many times in the past. I tried about 10 adjustments, then went to see another DC who gave me roughly the same amount. Still no better, I went to see my GP who sent me for scans/ xrays etc and was told I had 3 bulging discs. THis was around Christmas time. Started the McKenzie exercises but also started my usual exercise routine again in Jan (treadmill/aerobics 2-3 times/wk). My pain changed from just low back pain to L leg pain also in Jan, I presumed this was due to my disc prob (sciatica) and continued my cobra exercises as well as the aerobic stuff. I'm not sure but the PT seemed to suggest that the number of chiro adjustments as well as my continued exercise program has caused a strain in my SI joint and I need to REST (I find this difficult, am usually an active person).
Whatever caused my problem, I've decided not to ever see another chiropractor again-too many gray areas-and to continue with the RYB exercises, simply because I feel good after I've done them. Its about 11 days now and the pain in my leg is no better yet but hopefully if I can continue to rest the soft tissues will heal.
THanks again for your interest, will keep you updated.
Karen

PostPosted: Thu Mar 01, 2007 5:54 am
by Seann
Hey Karen-
A couple of things I'd like to mention here.

First, I would only take at face value any diagnosis you are handed regarding LBP from any physician. According to the many I've seen over the years I suffer from 9 or so different problems; everyhting from ankylosing spondylitis to degenerative disc disease. You know your body better than any MD. If what you are feeling doesn't jive with what they are telling you don't be afraid to question the diagnosis. Get a second opinion. Do some homework and see if you can't isolate better what is actually happening to you. The better you can relay sign/symptoms to the Doc the better the chance of he/she acually getting close to a proper diagnosis.
Keep in mind doctors are human too and apt to make errors like anyone else.

Second, don't be afraid to modify the excercises listed in the book to suit your particular needs. In my case, I've guarded my lower back so long now that he muscles are horribly weak and doing all the prescribed stretches was just too much for me. Do what's comfortable and work your way up. I've had good results this way. Also,do the excercises properly. I found that after a week on the program I was starting to rush things and deviate from the prescribed methods of the stretches. Go back to the book often and check yourself, making sure yuo are doing things properly.

That's about it, I think I've rambled on long enough. I hope this helps in some way, shape or form.

SI joint strains and/or hypermobility

PostPosted: Sun Mar 04, 2007 8:25 am
by Bill P
Karen,

You have come to the right web site.

To answer, assuming your diagnosis is correct pertaining to your SI joint strain and/or hypermobility, in order to correct a SI joint of your nature, do the following: first, forget what you physiotherapist said. SI joint strains or hypermobile SI joints need some exercie.

It will not be easy to give you the exact exercises you need without being able to do a full postural assessment, but this will definitely help you. Purchase a blood pressure cuff (not a digital type; buy one witha needle and gauge), fold it in half, and while lying on the floor, place the folded cuff directly beneath your back - opposite your belly button. Place your feet with knees bent, feet flat on the floor, so your heels are about 1 ft from your backside (knees pointing to the sky). This is position#1. Now, pump the cuff up to 40 millimeters of mercury on the gauge.

The object of this exercise is to maintain as close to 40 mm on the gauge (between 35-45 mm) as possible, while breathing normally. If you can breath normally and maintain a constant 40 mm, then move your feet out away from your backside until your feet are 2ft from your backside, and try to maintain between 35-40 mm again while breathing normally. Most likely, you will not be able to maintain the constant pressure in position 1. This then becomes your starting point until you can maintain the desire pressure for 3-4 minutes.

Stop when you feel you are getting frustrated or are no longer making progress. This exercise is a mind-muscle reconnection. Sometimes as we age, especially with certain muscles, the mind looses its ability to control muscle function or activate it properly.

It is best to do this exercise 2 to 4 times each day, but if time limits you, once per day is fine. Tell me when you can do this for 3-4 minutes while keeping the needle between 35-45 mm.

Your SI joint is locked in place by a number of muscles; one of the major ones is your tranversus abdominis. This exercise is designed to activate and strengthen a weak tranversus abdominis muscle. If you cannot maintain a constant pressure while breathing normally on the floor, your SI joint has basically lost part of it's locking mechanism. If the transversus abdominus is not working properly, then it will not be long (months or years) before you have another back episode.

Unlike conventional exercises that primarily target the body's phasic muscles, corrective exercises feel as if you are not accomplishing anything, but don't let this fool you; they are very effective.

Dean has done everyone a great service with his wonderful book.

Bill

PostPosted: Sun Mar 04, 2007 12:52 pm
by randolph
Pretty cool, Bill.

I hope, Karen, you'll tell us how you get on with the exercise Bill recommends. Sounds like just the thing you had hoped to find out.

Randolph

PostPosted: Sun Mar 04, 2007 1:44 pm
by karen
Excellent-thanks so much for your advice, will buy the cuff tomorrow-local pharmacy ? Also, just a note, have found that gentle exercise is definitely speeding up my recovery. I've been swimming, just half an hour, 3 times last week and have found that the day after my pain is hugely improved. So I've also started a gentle 20 min walk in the afternoons too in the hope that this will also help. My leg hurts a little when I'm doing the exercise but seems to be better the next day. TRial and error, right ? Am up to day 15 with Dean's exercises and as I said before, I feel really good after each set.
Thanks again-Karen

Re: SI joint strains and/or hypermobility

PostPosted: Mon Mar 12, 2007 5:53 pm
by karen
Bill P wrote:Karen,

You have come to the right web site.

To answer, assuming your diagnosis is correct pertaining to your SI joint strain and/or hypermobility, in order to correct a SI joint of your nature, do the following: first, forget what you physiotherapist said. SI joint strains or hypermobile SI joints need some exercie.

It will not be easy to give you the exact exercises you need without being able to do a full postural assessment, but this will definitely help you. Purchase a blood pressure cuff (not a digital type; buy one witha needle and gauge), fold it in half, and while lying on the floor, place the folded cuff directly beneath your back - opposite your belly button. Place your feet with knees bent, feet flat on the floor, so your heels are about 1 ft from your backside (knees pointing to the sky). This is position#1. Now, pump the cuff up to 40 millimeters of mercury on the gauge.

The object of this exercise is to maintain as close to 40 mm on the gauge (between 35-45 mm) as possible, while breathing normally. If you can breath normally and maintain a constant 40 mm, then move your feet out away from your backside until your feet are 2ft from your backside, and try to maintain between 35-40 mm again while breathing normally. Most likely, you will not be able to maintain the constant pressure in position 1. This then becomes your starting point until you can maintain the desire pressure for 3-4 minutes.

Stop when you feel you are getting frustrated or are no longer making progress. This exercise is a mind-muscle reconnection. Sometimes as we age, especially with certain muscles, the mind looses its ability to control muscle function or activate it properly.

It is best to do this exercise 2 to 4 times each day, but if time limits you, once per day is fine. Tell me when you can do this for 3-4 minutes while keeping the needle between 35-45 mm.

Your SI joint is locked in place by a number of muscles; one of the major ones is your tranversus abdominis. This exercise is designed to activate and strengthen a weak tranversus abdominis muscle. If you cannot maintain a constant pressure while breathing normally on the floor, your SI joint has basically lost part of it's locking mechanism. If the transversus abdominus is not working properly, then it will not be long (months or years) before you have another back episode.

Unlike conventional exercises that primarily target the body's phasic muscles, corrective exercises feel as if you are not accomplishing anything, but don't let this fool you; they are very effective.

Dean has done everyone a great service with his wonderful book.

Bill


HI Bill,
Just received my BP cuff today, original sort with a needle and guage. Have tried the exercise but just a few quick questions. I've pumped it up to 40mmHg under my back with knees up and butt on the floor. Feels comfortable and am able to keep the guage at 35-40mmHg while breathing normally. Obviously,I'm supposed to have the valve closed to stop the air rushing out of the cuff ? If so, then it seems like an easy exercise that I can do, but doesn't feel like I'm doing anything. Is that how its supposed to be ? Sorry if I sound unsure but just wanted to check that I'm doing it correctly.
THanks again for your advice,
Karen

SI joint strains and/or hypermobility

PostPosted: Wed Mar 14, 2007 4:58 pm
by Bill P
Karen,
You have done the exercise correctly. It was easy because your transversus abdominus (tva) is working. I had to guess as to what level to start you. (in person, this would have only taken a minute or so to find the point to start training your tva.
Again, this is a guess, but a step up in intensity for your tva: make sure your are wearing loose fitting clothing (but no shoes) while doing this exercise, as it will be more difficult with tight slacks. Lay on the floor in the exact same position I had you in initially with the blood pressure cuff under your lower back. Try and do this on a firm surfacelike a wood floor or carpet that has a short pile. Again, pump the b.p. cuff to 40mm. Watching the gauge, slowly raise and lower one leg at a time (raise until thigh is perpendicular to the ground) to original start position, then slowly raise and lower the other leg. Keep alternating legs while breathing normally, and still maintaining between 35-45 mm on the cuff. Once you can do 20-30 reps on each leg (40-60 total), you have gotten as much benefit as you can from this exercise.
When you have mastered this position, move your feet away from your behind 8-12 inches; this will help to make the exercise much harder because the weight of the leg makes for a much longer lever arm for your tva to control. Follow the same procedure with each leg. If you have trouble understanding any of this, let me know. (this is very simple if it is demonstrated first).
The b.p. cuff is just a visual means to let you know if your tva and lower abdominals are stabilizing your spine. The spine should not be flexing from the movement of your legs (that will show up on the gauge as an increase or decrease in pressure). If the abdominal musculature cannot stabilize the back while lying on the florr, then walking upright with shoes or boots on will be slowly wearing out your lower back.
I should have mentioned that anyone with a history of back pain would be wise to see if they can maintain a constant 35-45 mm while doing the above exercises. This is a great way to tell whether your tva muscle and lower abdominals are working. Most people with back pain will find this rather challenging.

Keep me posted.
Bill

PostPosted: Sun Mar 18, 2007 10:11 am
by karen
Hi Bill,
Thanks for the reply. I've taken your advice and tried the exercise again with leg movement and have found it much more difficult. That is, I seem unable to move my leg even slightly without the pressure guage swinging wildly. I guess it just takes practice. I suppose the idea is to try and keep your abdomen and back as still as possible. Much harder than it sounds.
Anyway, as you seem to know what you are talking about, hope you don't mind if I ask you a few questions about SI strain. All that I seem to have read about it seems to indicate that a hypermobile joint only happens rarely, that is, during pregnancy or as a sporting injury. Chiropractic injury ? I'm still not sure how it happened to me, I didn't have the pain during my pregnancies and I'm not that sporty really, a treadmill workout was about my limit. I've had the same pain since early Jan, nearly 3 mths now. Have been doing the RYB exercises for 1 mth, combined with 3 weeks of light swimming and am not seeing any signs of the pain subsiding. Am I expecting results too soon, how long should it take to heal ?
Thanks for your advice,
Karen

PostPosted: Mon Mar 19, 2007 4:50 pm
by Bill P
karen wrote:Hi Bill,
Thanks for the reply. I've taken your advice and tried the exercise again with leg movement and have found it much more difficult. That is, I seem unable to move my leg even slightly without the pressure guage swinging wildly. I guess it just takes practice. I suppose the idea is to try and keep your abdomen and back as still as possible. Much harder than it sounds.
Anyway, as you seem to know what you are talking about, hope you don't mind if I ask you a few questions about SI strain. All that I seem to have read about it seems to indicate that a hypermobile joint only happens rarely, that is, during pregnancy or as a sporting injury. Chiropractic injury ? I'm still not sure how it happened to me, I didn't have the pain during my pregnancies and I'm not that sporty really, a treadmill workout was about my limit. I've had the same pain since early Jan, nearly 3 mths now. Have been doing the RYB exercises for 1 mth, combined with 3 weeks of light swimming and am not seeing any signs of the pain subsiding. Am I expecting results too soon, how long should it take to heal ?
Thanks for your advice,
Karen


Karen,

I don't mind answering your questions; it's perfectly normal to want to know about your injury.

More than likely, because you indicate more difficulty w/the next progression in the transversus abdominus (tva) exercise, the injury to your SI joint was an accumulation of small traumas that lead to your hypermobile SI joint. The pressure fluctuations on the BP gauge indicate that your tva & lower abdominals are not strong enough to maintain a constant relationship between your ribs and pelvis which would be shown by almost no movement of the pressure on the BP gauge. Over the past "x" number of years that they (the tva & lower abs) have had diminished strength, your SI joint has been hanging on by its ligaments; especially when you bend forward like when picking up something from off of the floor. After years of having almost no muscular support, the ligaments became lax, followed shortly thereafter by pain.

Women, because of their child-bearing ability, have more elastin in their bodies than men. (this is one reason why women are more limber than men). This adds to the need for adequate abdominal strength.

When injured, we want to find the reason for the pain so as not to duplicate the faulty movement and have a reoccurence. However, with back pain, unless you have had a medical emergency, tumor, abcess, fracture, or accident of some type, the conditions I described earlier are what I think lead to your SI joint pain. Most often, it is not the incident prior to feeling the pain that lead to the SI joint pain. It is the result of not having the necessary muscular tone to protect the SI joint from repetitive strain. The musculature of the body dissipates load away from the back when it works properly.

Always let pain be your guide as to whether or not to do an exercise or activity. Think of your pain on a scale of 1 to 10, with 1 being barely noticeable and 10 being unbearable and you cannot imagine it ever being worse. If you rate your pain at say a "6" today, then the exercise should never increase your perceived pain from a "6" to a "7", and hopefully, should actually drop your perceived pain to a "5". Strive to diminish (daily-weekly) your perceived number. It is very hard to give a time frame for improvement, but it WILL diminish and then go away. What you have been doing is fine as long as the pain does not increase in intensity.

The exercises in RYB are great. Many people also find improvement with the addition of activities such as walking, cycling, swimming (which you mentioned you are doing already), yoga and Pilates.

Some things to think about: Were your children delivered normally or did you have a C section? The incision made by the doctor will often shut down the abdominal region because of the associated trauma. This is the body's defense mechanism which wants to allow the area to heal. Often the musculature looses its ability to respond to communication from the brain once the wound has healed. Basically, this will lead to reduced or no muscular support from the abdominals.

You are correct with reference to the abdominal exercises with the BP cuff; they take time. Remember to breathe normally; your body will figure out how to stabilize the area on its own. Breathing normally during the floor portion of the exercise will make it easier to carry over to the standing version, and then to daily actiivities.

Keep up the good work and let me know when you have mastered this exercise. If you have trouble, let me know.

Bill