Sacroiliac strain

[karen]

Bill,
Thanks so much for your reply, I think that's the most useful information I've received so far during my back pain journey. Will continue with the exercises you suggested as well as RYB and my swimming. What would we all do without this forum ?
Karen
P.S. Both my kids were delivered normally, no C-sections

[Dean]

Bill,

I also want to thank you for your input on this subject. I've been following it with great interest.

I would initially lean towards rest myself ... at least until the pain resolved ... but I see your point of view as well.

It may be very much like common back pain. Instinct tells you to rest or protect the painful area ... when moderate exercise is really what's needed.

Karen, do continue to keep us posted on your results. This thread could potentially help a lot of people.

Dean

[karen]

Hi again Bill,
Very pleased to say that over the last 10 days my pain seems to be fading. Slowly, but its definitely going, I hope ! I'm still getting pain in my buttock but higher up and seems to be more in my groin now. Off painkillers though, which is just amazing and have stopped using the sacral belt.
Don't seem to be getting better at this exercise though. Doing it once a day for about 10 days I suppose and still don't seem to be able to stop that guage from swinging wildly. Is there a technique ? I'm concentrating so hard as I'm doing it but feel like I'm not really getting anywhere. Now that my pain is getting better I want to make sure my tva is good so it never comes back !!!!!
Thanks-Karen

[Bill P]

Karen,
I seem to have jumped you too far ahead with the exercise progressions. Hopefully, this will be a better starting point.
Lie on the floor with your legs stretched straight out, flat on the floor so your head, back, butt, legs and heels are all on the floor. The exercise is otherwise identical to the 1st one that I gave you.
Try if you can to relax as much as possible. It can be rather frustrating when there seems to be no progress, so keep the efforts short (2 to 3 minutes). Stop for a few minutes; then try again.
Let me know if this is too easy. I am sorry for the overshoot in progression. The next progression is standing - it is much less frustrating.
Keep up the good work and remember to do Dean's exercises.

Bill

[karen]

Hi Bill,
Pleased to be able to to tell you that I'm doing better with the exercises. STarted at the lower level, did those with ease for 2 days and then tried the ones I was doing before. Can now do about 30 reps, 15 each side with much less difficulty, on my back lifting my legs. Am going to try again moving my feet further away from my butt to see if I can do those too.
Unfortunately, my pain has returned with a vengeance this week, I was doing better there for about 2 weeks and thought I was on the mend at last. Not sure what has triggered this bout, I'm not doing anything differently, but then I never seem to be able to work out any pattern-what makes things better or worse, its very frustrating ! NOw, the pain is very intense in my L sided low back but as well as referred pain in my L buttock, I have had several days of pain right down my left leg, at the back of my leg, at the back of my knee and the back of my calf. My muscles feel bruised as though I've really strained them even though, as I say, nothing different. Does this mean that I don't truly have just an SI strain, but maybe have had sciatica all along ? I'm so confused. Otherwise, I'm just plugging along, RYB exercises and swimming 3-4 times/week. Have been considering seeing my GP again to maybe get a neurosurgeon referral. Am I jumping the gun ?
ANy advice you can give me would be great
Thanks, your pal Karen

[cygnet]

Karen and Bill -

You made it into Dean's blog! (see the main RYB page)

Leigh

[Bill P]

Karen,


The Japanese have aword which is usually used in conjunction with business, but is very appropriate for people who are rebuilding their backs. It's called the Kaizem principle, and it means making little improvements on a regular basis, or continuous improvements no matter how small they may be.

This is a good way to view back rehabilitation.You seem to have employed this principle as you have done an excellent job with the exercise. It's not very easy when you don't have motivation from hands-on instruction.

Back pain is similar to early spring weather in that it warms up and gives you hope that spring has finally arrived, only to turn cold shortly thereafter. Try not to let this setback get to you; full spring weather is right around the corner.

The return of your pain does sound a lot like sciatica which can switch from your left side to your right side (sometimes daily). Don't fret about whether the pain is coming from sciatica or a hypermobile SI joint - the beauty of the exercises in Dean's book will help with most back conditions.

A few things to keep in mind that pertain to any lasting health improvement. There is a hugh difference within your body between having something done to your body by a health professional (like an adjustment by a chiropractor), and actively participating in your body's health and recovery. I'm not saying that health professionals don't fill an important role. I just want to stress how important it is to your health that you take an active role instead of a passive role. Remember: your body has all the tools it needs to heal itself. (Take note of how often the same people see the same health professional for the same condition. It is hard to be cured of any condition if the body does not participate in the process. We become a steady stream of income to the health professionals.)

None of the above is meant specifically for you Karen - it's just a concept to remember. That said, I do not want the above to turn you against going to your M.D. There are times when it helps to alleviate the anxiety and uncertainty associated with back pain. There are certain times when we should seek the advice of a medical professional. They are 1) the loss of bowel or bladder control, 2) extreme pain in the legs 3) weakness or loss of function of the lower extremeties, or 4) pain that does not get better, and actually progressively increases. I would not think that you are jumping the gun if you feel a need for a visit; that's fine.

This next Transversus Abdominus exercise is a slight step up in progression, as we move from the floor to a more functional standing position. This standing version is one of my favorites. It's done like the one you did on the floor with the blood pressure cuff under your lower back, except that you're standing next to a wall at the corner so that one leg - either your left or your right - is just beyond the corner of the wall enough to allow you to move your leg as if you are walking. Back up to the wall so that your heel is about 1 ft away from the molding, and lean back so your butt, back and head are resting on the wall. Chose your right leg first. Your right leg should be able to swing gently back and forth freely, and not hit the wall because you are positioned at the corner, and your right leg just clears the wall. Place the blood pressure cuff at the curve in your lower back, and pump it up to 40 mm. Keeping a still military posture, very slowly swing your right leg back and forth as if you were walking. Try and do this 15-25 times while maintaining between 35-45 mm on the gauge (and while breathing normally). Then switch sides and move so your left leg is clear to swing without hitting the wall.

Once this becomes easy, try moving the leg faster and with a little longer arch to your swing. Just a few inches makes the exercise harder. When that becomes too easy to do for 20-30 leg swings on each side, put sneakers on, and try it with the added weight of the sneaker. By simulating walking, this exercise will train your Transversus Abdominus to hold your spine in a constant position when you are actually walking. If your Transversus Abdominus cannot keep a constant relationship between your pelvis and ribs, it will show up as a fluctuation on the gauge. When this happens (as it does to most people), the spine is slowly wearing on the discs through excess movement and pressure.

Karen, please don't hestitate to ask me any question you may have, as I may not be explaining the exercise very clearly. Again, it's easy to learn if you see it demonstrated in person. Keep me posted and keep up the good job.

As a footnote, I must give credit to Paul Chek, a rehabilitation lecturer from San Diego California for these exercises.

[Bill P]

Karen,

I forgot to include this in my earlier e-mail to you...

Must say I am sorry to Bill from Seattle, Wa. as I should have made my sign-on name a little different.

Dean, I just read one of your articles 'What Doctors Are For". I cannot agree with you more with regard to your statement "a bad back is a physical fitness problem". Amen. Unless you are hit by a car, a well conditioned core will keep your back from wearing out.

Keep me posted Karen.

Bill P

[karen]

Bill, you are such a help to me, such sound advice, thanks again. Today, and most of this week I've been good again, who knows but I'm holding on to the feeling ! Since I don't seem to fit into any of your 4 categories you mentioned in your post, I'm going to hold off on the MD visit for now and wait and see.
I really have to say that anyone else reading these posts should try Bill's exercises, they make such sense to me in terms of preventing further back problems. After all, thats the ultimate solution we're all looking for, isn't it ?
Karen

[karen]

HI Bill,
Just wanted to let you know I'm doing well with the new exercises you gave me, found them awkward to start with but better now. Is there a progression from this one.
Pain seems to be the same, shifts around from outer leg to inner leg to tight hamstring/calf muscle to numbness bottom of foot and under toes. Who knows, its usually a surprise most days. Coping though, like everyone else. Take each day 1 at a time.
Went back to my GP, who referred me to an orthopaedic surgeon, on his list for now. Will wait and see,
THanks again for your help, Karen

[Bill P]

Karen,

The progression from this standing version you just completed moves back to the floor.

While lying flat on the floor (like the first Transversus Abdominus (TVA) exercises you did), place the B.P. cuff under your lower back directly below your belly button. Again, do this exercise on a firm surface while breathing normally. Bring you thighs up (flexing at the hip) so your knees are pointing straight up to the ceiling (the legs and trunk are at a 90 degree angle to one another). Both legs from the knees to your ankles are relaxed with the bottoms of your feet facing the floor. Pump the B.P.cuff up to 40mm. Try and maintain between 35-45 on the gauge ( this will be very hard) as you lower one leg at a time to the floor. You pivot just from the hip in slow, controlled tempo - 2 to 3 seconds down, touch, and then 2 to 3 seconds up. Pause at the top and do the same with your other leg. Keep alternating right and left legs.

When you have mastered this exercise with a slow tempo of 2 to 3 seconds in each direction (and you can do 20-30 total repititions), increase the tempo slightly; this will become more challenging for your TVA.

Use a very slow tempo at first, making sure to keep your knees bent at all times. This will make the exercise easier than if your legs were straightened. The more you straighten your legs, the harder it si on the abs because the weight of the leg makes a much longer lever arm against which the TVA has to counter-balance.

The most advanced stage of these exercises has the person lying in the same position - legs flat on the floor. The person brings both feet up at the same time (knees locked) making a 90 degree angle at the hip, pausing at the top, then lower to the floor while holding 35mm to 45mm on the BP cuff. Karen, right now, you are already halfway through the progression to this stage. Just a note; there are many professional atheletes that can not do the advanced version.

Hydration plays a big role in back health. Take your weight in pounds, say 110lbs is your weight, dividing by 2 gives you 55. This then become the minimum amount of water (in ounces) that you should drink per day (just water...not other liquids). Add a pinch of sea salt to your water bottle, and try and eat foods that have a lot of potassium daily. Your back pain will not linger much longer thereafter.

Make sure to include Dean's exercises along with the additional water intake above, as exercises will help to re-hydrate your discs as they take advantage of the increased water levels. This is because exercise, and the corresponding movement of the spine during the activity, aides the natural osmatic flow of water into the discs.

Right now, I'm in the process of writing an article on disc bulges and reduced hydration levels.

Karen, it is a pleasure to work with someone that keeps progressing with these exercises. Many people don't go beyond the standing version you just completed.

Bill P.

[dan14]

HI Bill,
Just wanted to let you know I'm doing well with the new exercises you gave me, found them awkward to start with but better now. Is there a progression from this one.
Pain seems to be the same, shifts around from outer leg to inner leg to tight hamstring/calf muscle to numbness bottom of foot and under toes. Who knows, its usually a surprise most days. Coping though, like everyone else. Take each day 1 at a time.
Went back to my GP, who referred me to an orthopaedic surgeon, on his list for now. Will wait and see,
THanks again for your help, Karen

Hi Karen,

I just wondered how you were getting on as reading your syptoms - they are very similar to mine.

Dan

[karen]

Hi Dan,
I'm doing great today, I'm a 'come and go' with my symptoms, still not really sure what sets me off but for the last three days, I'm almost pain free again. I never seem to lose the pain altogether but in the last 3 months I've been having more episodes like today where I will go for maybe 2 weeks with almost no pain and I find I'm not thinking about my back or leg pain at all ! Slow going, but it's so important to have faith in yourself and continue with the exercises daily even when you're feeling terrible and don't think you're getting anywhere. Keeping busy for me is really important and trying not to dwell too much on how my back is doing. Bill P.'s exercises were probably the turning point for me, if you read through all the posts in this SI strain topic you'll find some really useful info. The forum too is important for emotional support because I really believe that my pain is very much tension related and just talking about it here has helped me tremendously.
Hope all this helps, Dan, good luck !
Karen

[wendy k]

Karen,
I seem to have jumped you too far ahead with the exercise progressions. Hopefully, this will be a better starting point.
Lie on the floor with your legs stretched straight out, flat on the floor so your head, back, butt, legs and heels are all on the floor. The exercise is otherwise identical to the 1st one that I gave you.
Try if you can to relax as much as possible. It can be rather frustrating when there seems to be no progress, so keep the efforts short (2 to 3 minutes). Stop for a few minutes; then try again.
Let me know if this is too easy. I am sorry for the overshoot in progression. The next progression is standing - it is much less frustrating.
Keep up the good work and remember to do Dean's exercises.

Bill

Hello Bill,
I've been following your conversation with Karen. I've been diagnosed with si sprain from repetitive over exercising. I was told my ligaments were overstretched, or frayed, or torn, or all of the above. How can you know for sure, would an MRI show soft tissue damage?


I've got chronic burning pain and I'm only able to sit for short periods. I feel movement in the si joint area and can not bend forward. I've been wondering about rest vs. exercise. I'm used to hiking, biking, and teaching yoga. Now I'm limited to occasional short walks. If my ligaments are overstretched or torn, it seems to me that yoga stretching may ecsasberate the situation. I'm very confused as to how much exercise to try and do. I have an office job where I have to sit. By the time I get home, my back hurts so much from sitting, I get afraid that exercising would irritate the situation even more.

My first back injury was years ago. I had muscle spasms which I ignored. I was an aerobics instructor and I believe I weakened my tissues with repetitive exercise (my diagnosis). My back would go out from time to time, taking only a few days to recover. One day I awakened and couldn't walk. It took years to heal. After a few years of trying different healing techniques, I was eventually lead to yoga which helped, and I became a yoga teacher.

In March, my back went out again and is still out. I've had to give up teaching yoga and all exercising. My body warned me with back spasms. I guess my back never fully healed from the first injury. My life is limited to a few hours sitting at the office (which hurts), laying on the couch, and occasional short little walks when the burning sensation isn't too bad.

I was going to proceed by getting the RYB book and following the instructions you gave Karen. I want my life back, I want to exercise again. I want to be out of chronic pain. Please advise.

Thank you so much (and karen if you are following this, thank you)
wendy

[tita]

Hello Bill (and anyone following this thread),

I am new to this forum and have also been suffering SI joint pain.

I have been active in aerobics and workout tapes for the last few years. I have been seeing a chiropractor for the last 2 or 3 years for migraines and general postural problems. The headaches are better, but I slowly started having the pain in my lower right side of my back. This is the same side my chiro adjusts every time I see him. I meekly suggested that those adjustments might be the cause. He insisted no. He did say it was probably the SI joint.

Long story short, now, a year or so later it has gotten worse! I went to my doctor and then a PT. They both said it is probably SI too. I have not had an xray because I am a cancer survivor-want to avoid it.

So now I found this forum and will read through your suggestions, Bill. I cannot sit for long periods of time. That seems to aggravate things the most. I stopped the aerobics and all but walking and the elliptical and wonder if I should stop that too. I also decided to stop seeing my chiro since I still suspect what he has been doing to my right leg may have caused this. I have had no injuries and never had back problems before. These pains only started after seeing the chiro! Hmmmm...

I appreciate all the great information here. Thanks for sharing your knowledge.

Tita