Sacroiliac strain

[Bill P]

Margie,

After reading your post, I believe your primary problem is a muscular imbalance at the hip, which in turn, has caused you to develop sciatic or piriformis pain. Your condition is likely the result of poor posture and faulty movement patterns in the hip area.

The muscular imbalance at your hip stems from the various activities that you indicte you participate in on a regular basis - soccer, hiking and cycling - all of which places a heavy demand on the psoas muscle, especially soccer.

Within the body, there are muscles that are classified as slow twitch, and muscles that are classified as fast twitch. Slow twitch muscles tend to shorten and tighten with use/overuse, while fast twitch muscles tend to lengthen and weaken with use/overuse. Of all of the muscles in the body, the psoas muscle is the most likely to shorten and tighten the more it is used because it is of the slow twitch type.

This is called a "facilitated muscle" or an "altered neurological flow"between the muscle and the central nervous system.

Because of the psoas' attachment points on the vetebra of the lower bake and the lesser trochanter of the femur, the psoas in a shortened state plays havoc with our spines. One way to tell if you have tight psoas muscles is to back up to a wall so that your head, shoulders, behind and heels touch the wall (called the "wall standing test" for lordosis). Take your hand and slide it between the wall and your lower back at the beltline level. With a proper arch in your lower back, your hand should just slide between the wall and your lower back. If it slides in with extra space between your hand and back, then you most likely have tight psoas muscles. If you look vertically aligned from the side, your shoulder, hip and ankle are aligned vertically above each other, you probably have a kyphosis-lordosis posture.

Let me know what you find after you perform the "wall standing test" and I'll give you some stretches and exercises to do.

Don't despair, your condition is fairly common; especially among more athletic types. It just takes persistence using the correct stretches and exercises.

Your goals are realistic - one year is a long time to rehab your lower back. Hold off on activities that cause a lot of hip flexion, until you have strengthened the weak side of your hip. Try to avoid any activity or movement that causes you pain.

Bill P

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.

[Margie]

Thanks you for such a well considered response, it is reassuring as the volumes of information about pelvic disfunction can be both confusing and distressing.

I performed the wall standing test with about a 2cm gap between my hand and lower back.

Margie,

After reading your post, I believe your primary problem is a muscular imbalance at the hip, which in turn, has caused you to develop sciatic or piriformis pain. Your condition is likely the result of poor posture and faulty movement patterns in the hip area.

The muscular imbalance at your hip stems from the various activities that you indicte you participate in on a regular basis - soccer, hiking and cycling - all of which places a heavy demand on the psoas muscle, especially soccer.

Within the body, there are muscles that are classified as slow twitch, and muscles that are classified as fast twitch. Slow twitch muscles tend to shorten and tighten with use/overuse, while fast twitch muscles tend to lengthen and weaken with use/overuse. Of all of the muscles in the body, the psoas muscle is the most likely to shorten and tighten the more it is used because it is of the slow twitch type.

This is called a "facilitated muscle" or an "altered neurological flow"between the muscle and the central nervous system.

Because of the psoas' attachment points on the vetebra of the lower bake and the lesser trochanter of the femur, the psoas in a shortened state plays havoc with our spines. One way to tell if you have tight psoas muscles is to back up to a wall so that your head, shoulders, behind and heels touch the wall (called the "wall standing test" for lordosis). Take your hand and slide it between the wall and your lower back at the beltline level. With a proper arch in your lower back, your hand should just slide between the wall and your lower back. If it slides in with extra space between your hand and back, then you most likely have tight psoas muscles. If you look vertically aligned from the side, your shoulder, hip and ankle are aligned vertically above each other, you probably have a kyphosis-lordosis posture.

Let me know what you find after you perform the "wall standing test" and I'll give you some stretches and exercises to do.

Don't despair, your condition is fairly common; especially among more athletic types. It just takes persistence using the correct stretches and exercises.

Your goals are realistic - one year is a long time to rehab your lower back. Hold off on activities that cause a lot of hip flexion, until you have strengthened the weak side of your hip. Try to avoid any activity or movement that causes you pain.

Bill P

[Mazz]

Posted: Fri Apr 25, 2008 12:06 am Post subject: New Poster Reply with quote Edit/Delete this post Delete this post

--------------------------------------------------------------------------------

Hi Bill-

I am new to the forum but not back pain. In 1986 had LBP and calf pain from a torque injury playing college football. 21 dr's, PT's, chiro's, MRI's, neuro's, EMG's, CT scans, epidurals can not relieve my calf pain. Finally operated on and remove a cyst against my sciatic nerve anterior at L-5 S-1.....15 months post surgery calf pain is gone. Stays gone for 14 years. I am a former power athlete and fighter......In shape I am 5'10" 202 pounds......

3.5 years ago I was out of shape......to 235 pounds and lifting and throwing logs....then the dreaded pop. For some reason i dreaded the return of calf pain and it was back with a vengance. Also had pain at the SI joint. Went to Dr. and MRI came back normal. No scar tissue, no disc problems, great spacing, etc. Diagnosed as sprain/strain and go to PT.

Therapist puts me on the reformer (pilates) and all this does it hurt me more.....I get discharged 8 weeks later and pain is at a 8. Chiro does nothing. I have a massage and I get a reprieve for a day at a time. Then I notice that I am so tight everywhere....quads especially, low ab pain(psoas), testicle pain (when bad), QL pain, IT band pain....(all can barely be touched without me jumping). I read up on things and the best thing i read is that I have lower crossed syndrome. I have virtually NO TVA strength, overly strong quads, weak hammies. I now have a gut and it appears excessive lordosis.

Last year I hooked on with a CHEK practitioner and NMT. My pain has been reduced to about a 2-3 most days....and a flare up once a month. After reading up on SI joints I realized my pseudo-sciatica is coming from that and my pelvis being tilted dramatically forward. My CHEK man checked it out and there is a binding and leg shortness. I really feel now I am on my way. I am now 250 pounds and HAVE to get rid of my gut. It seems to be pulling everything forward. My TVA is much stronger as my multifidus is as well. I am going to buy the BP cuff since my CHEK man gave me that excercise as well. I feel if i can get down to 210 pounds i will be free of pain. I have eaten for comfort and find myself in this place now. I am doing 60 minutes on elliptical and do circuit type weights. Should i lay off all weight training and just do pushups and planks and other swiss ball activities?


Sorry for being so wordy, but the last 4 months have been my first repreive from pain and it has exhausted me.

Thank you in advance. I downloaded the excerciese from DonTigny. I did them 1 night and felt UNLOCKED if that makes sense. I still get a calf pain every few days when i overdo it.

Is extra weight that big a contributor for someone like me? I believe i know the answer.

[Mazz]

I also did the back to the wall test and I have roughly 2.5-3" of space. I assume this means I am tilted forward pretty good. Am I correct in assuming that TVA strenghtening, weight loss and corrective excercise should help cure me? I have many good days now, but seem to overdo it.

I am a former fighter and weight loss comes quickly for me. (hard as hell but i can do it). Once I incorporate these excercises my pelvis should be more towards neutral and the strain should be lessened. Is this a correct assumption?

Thank you. Tired of this up and down existence.

[Bill P]

Margie,

Double check yor "Wall Standing" test and make absolutely sure that you have a gap between the back of your hand (not just the fingers) and your lower back. If you confirm your initial finding, and you do indeed have a 1-2 cm gap, then perform the stretch that follows. Do not attempt any of the stretches or additional tests if you feel discomfort. To answer your earlier question, pain management is "priority one" at this stage.

This stretch is called a "Lunge Stretch"/"Hip Flexor Stretch".
1.Stand in a lunge position with the front shin vertical and an 80-90 degree bend in the front leg at the knee. Bring the belly button in, and tip the pelvis backward as you shift your weight forward over your knee.
2.Keep the pelvis square to the front as you stretch the hip flexor (the psoas muscle) in the trailing leg. The front foot should be flat on the floor. If needed, hold onto a stable object to steady yourself with the arm on the same side as the front leg.
3. When you feel a comforatble stretch in the hip flexor, hold for 20-25 seconds relax and repeat on the other leg; alternating left and right 3 times. If time allows, stretch twice per day.
4. If you feel after several days or a week that you need a little more stretch, bring the arm (on the side of the trailing leg) overhead, and side bend very slightly to increase the effect of the stretch.

Here is a "Side-Step" test you can try. Let me know what you find. This may take some practice, so please attempt it in small stages only, and progress only if it does not produce any pain at all!
1. Stand with your arms straight out to your sides, palms facing the floor. They will be used to help balance yourself on your right leg.
2. Shift all of your weight to your right leg, and slightly bend it at the knee. Extend your left leg out as far to the left as you can, and lightly touch only your big toe to the floor. Make sure to maintain all of your weight on your right leg.
3. Repeat this test on the opposite side (i.e. your left leg in the example)

Have someone measure the distance from the big toe of your planted leg (the right) to the big toe of your extended leg (the left). I need to know great this distance is for both sides. (remember, you must be able to maintain your balance). If knowone is avalible mark the spot with tape under your large toe (planted foot) and the furthest point you touch with the other toe. Only use a measurement when you can return to start without losing your balance.

Little noticed, and often overlooked postural positions you may be maintaining for long periods of time can have a significant impact on your back pain. They can exaccerbate or initiate back pain. For example, someone in a seated work environment who sits with their leg crossed, with a slight weight shift to one side of the body, may impact a light force that contributes to the onset of back pain. Sitting is detrimental for your back alone, but combined with poor posture in the seated position it can significantly add to the problem. Therefore, it is important to be aware of positions you habitually migrate to; whether they be standing or sitting. Because of the amount of time spent at work, it is particularly important to develop an awareness of your posture. You may also want to stay way from wearing high-heeled shoes for a while as they alter the mechanics of the hip, knee, and lower back.

I will give you a hamstring exercise in two weeks, but try the "Lunge Stretch"/"Hip Flexor Stretch" first. Also, please Let me know how you make out on the "side step" test (the measurements for each side). Again, do not rush taking the "Side-Step" test.

Because I will be away for the next two weeks, I will not be able to respond to your next post until after I return.

I hope these descriptions make sense.

Good Luck,

Bill P

Thanks you for such a well considered response, it is reassuring as the volumes of information about pelvic disfunction can be both confusing and distressing.

I performed the wall standing test with about a 2cm gap between my hand and lower back.

Margie,

After reading your post, I believe your primary problem is a muscular imbalance at the hip, which in turn, has caused you to develop sciatic or piriformis pain. Your condition is likely the result of poor posture and faulty movement patterns in the hip area.

The muscular imbalance at your hip stems from the various activities that you indicte you participate in on a regular basis - soccer, hiking and cycling - all of which places a heavy demand on the psoas muscle, especially soccer.

Within the body, there are muscles that are classified as slow twitch, and muscles that are classified as fast twitch. Slow twitch muscles tend to shorten and tighten with use/overuse, while fast twitch muscles tend to lengthen and weaken with use/overuse. Of all of the muscles in the body, the psoas muscle is the most likely to shorten and tighten the more it is used because it is of the slow twitch type.

This is called a "facilitated muscle" or an "altered neurological flow"between the muscle and the central nervous system.

Because of the psoas' attachment points on the vetebra of the lower bake and the lesser trochanter of the femur, the psoas in a shortened state plays havoc with our spines. One way to tell if you have tight psoas muscles is to back up to a wall so that your head, shoulders, behind and heels touch the wall (called the "wall standing test" for lordosis). Take your hand and slide it between the wall and your lower back at the beltline level. With a proper arch in your lower back, your hand should just slide between the wall and your lower back. If it slides in with extra space between your hand and back, then you most likely have tight psoas muscles. If you look vertically aligned from the side, your shoulder, hip and ankle are aligned vertically above each other, you probably have a kyphosis-lordosis posture.

Let me know what you find after you perform the "wall standing test" and I'll give you some stretches and exercises to do.

Don't despair, your condition is fairly common; especially among more athletic types. It just takes persistence using the correct stretches and exercises.

Your goals are realistic - one year is a long time to rehab your lower back. Hold off on activities that cause a lot of hip flexion, until you have strengthened the weak side of your hip. Try to avoid any activity or movement that causes you pain.

I hope these discriptions make sense.

[Bill P]

Mazz,

To answer your question, the extra weight is a co-conspirator to your back pain. Working along with it, was your initial lack of transversus abdominus strength. Indeed, the extra weight is hurting your chances for a faster recovery.

It does sound as if you have lower cross syndrome, with 2 1/2-3 inches of space between the wall and your lower back. Also, it sounds as if the posterior chain (some of the muscles you described as being tight) are overworked because they are trying to keep you from going further into lumbar lordosis.

With regard to your comments on your stomach and weight training, I would stick with whatever exercises your C.H.E.K. practioner recommends for the weight loss; it was an excellent choice to have chosen the C.H.E.K. practioner. What were his/her findings?

Good Luck, and by all means, definitely continue your visits to him/her.

Keep us posted.


Bill P

Posted: Fri Apr 25, 2008 12:06 am Post subject: New Poster Reply with quote Edit/Delete this post Delete this post

--------------------------------------------------------------------------------

Hi Bill-

I am new to the forum but not back pain. In 1986 had LBP and calf pain from a torque injury playing college football. 21 dr's, PT's, chiro's, MRI's, neuro's, EMG's, CT scans, epidurals can not relieve my calf pain. Finally operated on and remove a cyst against my sciatic nerve anterior at L-5 S-1.....15 months post surgery calf pain is gone. Stays gone for 14 years. I am a former power athlete and fighter......In shape I am 5'10" 202 pounds......

3.5 years ago I was out of shape......to 235 pounds and lifting and throwing logs....then the dreaded pop. For some reason i dreaded the return of calf pain and it was back with a vengance. Also had pain at the SI joint. Went to Dr. and MRI came back normal. No scar tissue, no disc problems, great spacing, etc. Diagnosed as sprain/strain and go to PT.

Therapist puts me on the reformer (pilates) and all this does it hurt me more.....I get discharged 8 weeks later and pain is at a 8. Chiro does nothing. I have a massage and I get a reprieve for a day at a time. Then I notice that I am so tight everywhere....quads especially, low ab pain(psoas), testicle pain (when bad), QL pain, IT band pain....(all can barely be touched without me jumping). I read up on things and the best thing i read is that I have lower crossed syndrome. I have virtually NO TVA strength, overly strong quads, weak hammies. I now have a gut and it appears excessive lordosis.

Last year I hooked on with a CHEK practitioner and NMT. My pain has been reduced to about a 2-3 most days....and a flare up once a month. After reading up on SI joints I realized my pseudo-sciatica is coming from that and my pelvis being tilted dramatically forward. My CHEK man checked it out and there is a binding and leg shortness. I really feel now I am on my way. I am now 250 pounds and HAVE to get rid of my gut. It seems to be pulling everything forward. My TVA is much stronger as my multifidus is as well. I am going to buy the BP cuff since my CHEK man gave me that excercise as well. I feel if i can get down to 210 pounds i will be free of pain. I have eaten for comfort and find myself in this place now. I am doing 60 minutes on elliptical and do circuit type weights. Should i lay off all weight training and just do pushups and planks and other swiss ball activities?


Sorry for being so wordy, but the last 4 months have been my first repreive from pain and it has exhausted me.

Thank you in advance. I downloaded the excerciese from DonTigny. I did them 1 night and felt UNLOCKED if that makes sense. I still get a calf pain every few days when i overdo it.

Is extra weight that big a contributor for someone like me? I believe i know the answer.

[Mazz]

Bill-

His findings are lower crossed syndrome and now SIJD. He believes my excessive lordosis is stretching the nerve and irritating it. I just find it hard to excercise while i have the calf burn. I may need to get in the pool. Because the more cardio i do the more it hurts....(most days)...I lift weights but am putting an abrupt halt to that ASAP after taking picture of myself from the side. (disturbing how much forward I am). I just need to get through this pain and get the pelvic girdle stable and lose weight. I guess I was not as honest with myself. If you have an e-mail I can send you photos and maybe you have a recommendation.

Thanks

[Bill P]

Mazz,

I'd be glad to correspond directly w/you; but would rather that you provide your e-mail address to me in a reply post. (you didn't indicate that you purchased Dean's book, but I believe you should, as his book has some very good information).

Bill P

Mazz,

To answer your question, the extra weight is a co-conspirator to your back pain. Working along with it, was your initial lack of transversus abdominus strength. Indeed, the extra weight is hurting your chances for a faster recovery.

It does sound as if you have lower cross syndrome, with 2 1/2-3 inches of space between the wall and your lower back. Also, it sounds as if the posterior chain (some of the muscles you described as being tight) are overworked because they are trying to keep you from going further into lumbar lordosis.

With regard to your comments on your stomach and weight training, I would stick with whatever exercises your C.H.E.K. practioner recommends for the weight loss; it was an excellent choice to have chosen the C.H.E.K. practioner. What were his/her findings?

Good Luck, and by all means, definitely continue your visits to him/her.

Keep us posted.


Bill P

Posted: Fri Apr 25, 2008 12:06 am Post subject: New Poster Reply with quote Edit/Delete this post Delete this post

--------------------------------------------------------------------------------

Hi Bill-

I am new to the forum but not back pain. In 1986 had LBP and calf pain from a torque injury playing college football. 21 dr's, PT's, chiro's, MRI's, neuro's, EMG's, CT scans, epidurals can not relieve my calf pain. Finally operated on and remove a cyst against my sciatic nerve anterior at L-5 S-1.....15 months post surgery calf pain is gone. Stays gone for 14 years. I am a former power athlete and fighter......In shape I am 5'10" 202 pounds......

3.5 years ago I was out of shape......to 235 pounds and lifting and throwing logs....then the dreaded pop. For some reason i dreaded the return of calf pain and it was back with a vengance. Also had pain at the SI joint. Went to Dr. and MRI came back normal. No scar tissue, no disc problems, great spacing, etc. Diagnosed as sprain/strain and go to PT.

Therapist puts me on the reformer (pilates) and all this does it hurt me more.....I get discharged 8 weeks later and pain is at a 8. Chiro does nothing. I have a massage and I get a reprieve for a day at a time. Then I notice that I am so tight everywhere....quads especially, low ab pain(psoas), testicle pain (when bad), QL pain, IT band pain....(all can barely be touched without me jumping). I read up on things and the best thing i read is that I have lower crossed syndrome. I have virtually NO TVA strength, overly strong quads, weak hammies. I now have a gut and it appears excessive lordosis.

Last year I hooked on with a CHEK practitioner and NMT. My pain has been reduced to about a 2-3 most days....and a flare up once a month. After reading up on SI joints I realized my pseudo-sciatica is coming from that and my pelvis being tilted dramatically forward. My CHEK man checked it out and there is a binding and leg shortness. I really feel now I am on my way. I am now 250 pounds and HAVE to get rid of my gut. It seems to be pulling everything forward. My TVA is much stronger as my multifidus is as well. I am going to buy the BP cuff since my CHEK man gave me that excercise as well. I feel if i can get down to 210 pounds i will be free of pain. I have eaten for comfort and find myself in this place now. I am doing 60 minutes on elliptical and do circuit type weights. Should i lay off all weight training and just do pushups and planks and other swiss ball activities?


Sorry for being so wordy, but the last 4 months have been my first repreive from pain and it has exhausted me.

Thank you in advance. I downloaded the excerciese from DonTigny. I did them 1 night and felt UNLOCKED if that makes sense. I still get a calf pain every few days when i overdo it.

Is extra weight that big a contributor for someone like me? I believe i know the answer.

[Mazz]

Bill-

I did buy deans book. I have not been diligent in my excercises since i started doing better. My TVA are weak and it seems i reinjure myself a day or 2 after weightlifting. I am going to not do that until I tighten up my pelvis girdle and TVA.

Can you advise any cardio that would not irritate? I tend to overdo the elliptical (60 minutes) and walking (4 miles) which i tend to fight through the pain. Is swimming adviseable.

I also do not see where I can give e-mail. I tried to leave it and it deleted my whole response to you.

I also spoke to Dontigny himself and this is what he said,
Paul,
You look pretty good from the neck up. You just are not tightening your
abs. For exercise - walk and slowly increase tempo and distance.
I think you should just do corrections and follow my program until you just
can't get any better. I always say get the SIJ corrected first and then
reassess.
To test for tears in the capsule or cysts, an ortho can do an arthrogram.
That is injecting dye into the joint and x-raying it.
First correct the SIJ and get it stable. This should take care of most of
your problems. After your SIJ is stable and then reassess.
Richard


Any advice from you would be great. I need to buy the blood pressure cuff also.

[Mazz]

Mazz,

I'd be glad to correspond directly w/you; but would rather that you provide your e-mail address to me in a reply post. (you didn't indicate that you purchased Dean's book, but I believe you should, as his book has some very good information).

Bill P

Mazz,

To answer your question, the extra weight is a co-conspirator to your back pain. Working along with it, was your initial lack of transversus abdominus strength. Indeed, the extra weight is hurting your chances for a faster recovery.

It does sound as if you have lower cross syndrome, with 2 1/2-3 inches of space between the wall and your lower back. Also, it sounds as if the posterior chain (some of the muscles you described as being tight) are overworked because they are trying to keep you from going further into lumbar lordosis.

With regard to your comments on your stomach and weight training, I would stick with whatever exercises your C.H.E.K. practioner recommends for the weight loss; it was an excellent choice to have chosen the C.H.E.K. practioner. What were his/her findings?

Good Luck, and by all means, definitely continue your visits to him/her.

Keep us posted.


Bill P

Posted: Fri Apr 25, 2008 12:06 am Post subject: New Poster Reply with quote Edit/Delete this post Delete this post

--------------------------------------------------------------------------------

Hi Bill-

I am new to the forum but not back pain. In 1986 had LBP and calf pain from a torque injury playing college football. 21 dr's, PT's, chiro's, MRI's, neuro's, EMG's, CT scans, epidurals can not relieve my calf pain. Finally operated on and remove a cyst against my sciatic nerve anterior at L-5 S-1.....15 months post surgery calf pain is gone. Stays gone for 14 years. I am a former power athlete and fighter......In shape I am 5'10" 202 pounds......

3.5 years ago I was out of shape......to 235 pounds and lifting and throwing logs....then the dreaded pop. For some reason i dreaded the return of calf pain and it was back with a vengance. Also had pain at the SI joint. Went to Dr. and MRI came back normal. No scar tissue, no disc problems, great spacing, etc. Diagnosed as sprain/strain and go to PT.

Therapist puts me on the reformer (pilates) and all this does it hurt me more.....I get discharged 8 weeks later and pain is at a 8. Chiro does nothing. I have a massage and I get a reprieve for a day at a time. Then I notice that I am so tight everywhere....quads especially, low ab pain(psoas), testicle pain (when bad), QL pain, IT band pain....(all can barely be touched without me jumping). I read up on things and the best thing i read is that I have lower crossed syndrome. I have virtually NO TVA strength, overly strong quads, weak hammies. I now have a gut and it appears excessive lordosis.

Last year I hooked on with a CHEK practitioner and NMT. My pain has been reduced to about a 2-3 most days....and a flare up once a month. After reading up on SI joints I realized my pseudo-sciatica is coming from that and my pelvis being tilted dramatically forward. My CHEK man checked it out and there is a binding and leg shortness. I really feel now I am on my way. I am now 250 pounds and HAVE to get rid of my gut. It seems to be pulling everything forward. My TVA is much stronger as my multifidus is as well. I am going to buy the BP cuff since my CHEK man gave me that excercise as well. I feel if i can get down to 210 pounds i will be free of pain. I have eaten for comfort and find myself in this place now. I am doing 60 minutes on elliptical and do circuit type weights. Should i lay off all weight training and just do pushups and planks and other swiss ball activities?


Sorry for being so wordy, but the last 4 months have been my first repreive from pain and it has exhausted me.

Thank you in advance. I downloaded the excerciese from DonTigny. I did them 1 night and felt UNLOCKED if that makes sense. I still get a calf pain every few days when i overdo it.

Is extra weight that big a contributor for someone like me? I believe i know the answer.

P m a z z d o g @ a o l . c o m

[Bill P]

Margie,

Here are some exercises to help balance out the musculature in your hip. You will need to purchase a Swiss ball (also called a "Physio ball"). Make sure to obtain one that is of good quality as they can be quite harmful if they explode while you're using it (it is not very common, but does happen).

Before performing these two exercises, it is important to stretch the psoas muscle using the lunge stretch I iniatially provided to you. I will explain why if you need to know, but the explanation is a little involved. Also, if either of these exercises cause any pain, do not continue with that particular exercise at this time.

Exercise #1: Supine Hip Extension-Feet on Swiss Ball
Lie on the floor with your feet on a Swiss Ball. Your heels should be a few inches apart to help stabilize the ball's lateral movement. Also, your heels should extend just beyond the top to help keep the ball from being pushed away from you. It will also help, at least initially, to perform these exercises on carpeting.
Place your arms straight out to the side along the floor or carpet; palms rotated toward the floor. If viewed from above, your body would look like a "T".
Lift your body off of the floor by extending upward from the hips until the knees, hips and shoulders are all in a straight line. At the top position, when you're knees, hips and shoulders are lined up, hold for the prescribed count. Then lower, touching your backside to the floor.

Perform this exercise at a slow, very controlled tempo; 2 seconds up, 1 second pause at the top position, 2 seconds to lower, and a 1 second pause at the floor before proceeding to the next repitition. Do only as many repititions as you can with perfect form. Stop when your form breaks down, or when you feel you still have 2 repititions left.

Exercise #2: Swiss Ball Hyper Extensions
Lie prone over Swiss ball with your feet shoulder width apart so that the ball comes to rest at the upper part of your thigh, but not so high up the leg that it restricts movement at the hip.
The first progression of this exercise starts with your arms at your sides, so you look as though you are "at attention"; your body is in a straight line from the shoulders to the ankles.
It is important to have your feet firmly anchored or held down by a partner/spotter so you don't fall face first over the ball as you perform the exercise.
Drop down over the Swiss ball, pivoting only at the hip (do not curl your shoulders or drop your head forward) until your hamstrings become tight, or you are as low as you can naturally bend. Be mindful of your lower back - keep a slight curve in the lumbar region.

It is important to maintain good form and to perform these exercises in a slow, controlled manner. Perform this exercise taking 2 seconds to lower yourself, a 1 second pause at the bottom, and taking 3 seconds to raise yourself back to the starting position. Be sure to remember to pause for 1 second before you return to the start position as you do not want to change directions too quickly as this could hurt your lower back.

If you feel discomfort or pain, wait to implement this exercise in the future.

Once you can do 3 sets of 10 reps with good form, the next progression is to bring your arms up and across your chest. This will increase the difficulty of the exercise.

Try this piriformis muscle length test: Sit up straight in a chair with your feet flat on the floor. Take your right leg and place it so that the ankle is just lying across the top of your left knee. Relax and let the right knee lower toward a horizontal position. If your two knees in the relaxed position are on the same plane, both the planted knee (the left one) and the bent knee (the right one) will be the same distance from the floor (i.e. "level"). If you find this to be true in your case, you have good length in your piriformis and gluteus minimus muscles. Compare both sides and let me know what you find. You may have a difference from left to right. If this test brings an onset of the pain you have been experiencing, then the likelihood is that you have piriformis syndrome as opposed to sciatica. In short, by stretching the piriformis muscle in this test, you're actually stressing it slightly in order to determine whether it is the culprit causing your pain.

Margie, how did you make out with the "Single Leg Side Step" test I gave you? What did the orthopedic doctor find that caused him/her to give you orthodics? Do you have flat feet? This can exacerbate, or possibly initiate piriformis syndrome. What is the wear pattern on your recreational shoes? Is it on the inside or outside edge?

Other considerations - make sure to sit with your feet flat on the floor. Also when standing, make sure to stand with your weight evenly distributed on both feet, because when the weight is placed predominantly on one leg, it places additional stress on the gluteus medius.

There is one other exercise I will give you, but first you need to perform these two for one month, three times per week, taking a day off between.

I would highly recommend that you include the exercises in Dean's book. They are the core of a good corrective back program. Let me know if you have questions, and keep us posted on your progress.

Bill P

[Alison Cross]

Hello all - stumbled across this site while trying to find out what the heck is wrong with my hip and have paid for and downloaded the RYB book today.

I've been to the doctor and had an x-ray taken - nothing seems to be wrong bone-wise (which is good!). He signed me up for 6 sessions of physiotherapy and I've been attending religiously, but to be honest, my pain didn't improve. So, I went to an osteopath who said that he reckoned it was my SI joint.

I went twice - got a jolly good cracking up and down my back - but nothing improved.

From what I've read on the internet, I reckon that it is my joint. I'll give you a potted history.

Had my appendix out in mid eighties - nast big scar still there. Had my son by caesar section in 2000 - so abdomen has been well cut up! Developed sciatica whilst pregnant and attended a sports physio after son born - this helped enormously (left hip - down leg, heel pain etc).

Everything pretty much ok until last August. Dancing with son, swung hips out to right side, heard a bit of a crack on right side....no pain....but ever since then, hip pain and back pain been gradually getting worse.

When I lie on my back with my knees up to my chest and rock over my right hip, I can hear a click (not all the time). No noise on left side.

Got a bit of a flat back thing going on (no bottom!) but being doing the cobra to improve that (the physio helped me with this bit).

I spend a lot of time sitting at the computer - and sitting really makes my hip ache. I sometimes feel like I've got a groin strain in my right side too, not all the time though. Walking and cycling are fine - lying in bed and sitting are hellish though. Bed situation improved by putting pillow between my knees.

Just feeling very despondent that this doesn't seem to be getting better. I can't sleep with a pillow between my knees for ever or my hubby will leave me!

Can you wonderful people a) confirm that this joint is the problem and b) that the damned thing can be put right?!

Best regards - fabulous site btw!

Heck - forgot to say that when I stand and try to curl forward a vertebrae at a time, I get to my lower back and everything just seems to bend forward as a single unit and my pelvis hurts (stretches?) on the right side.

Also, when I lie on the floor and try to let my spine drop onto the floor, vertebrae at a time, by the time I get to my lower back, it just flubs onto the floor like it's all welded together.

I feel like an old lady and I'm 44.

AX

[Bill P]

Hello all - stumbled across this site while trying to find out what the heck is wrong with my hip and have paid for and downloaded the RYB book today.

I've been to the doctor and had an x-ray taken - nothing seems to be wrong bone-wise (which is good!). He signed me up for 6 sessions of physiotherapy and I've been attending religiously, but to be honest, my pain didn't improve. So, I went to an osteopath who said that he reckoned it was my SI joint.

I went twice - got a jolly good cracking up and down my back - but nothing improved.

From what I've read on the internet, I reckon that it is my joint. I'll give you a potted history.

Had my appendix out in mid eighties - nast big scar still there. Had my son by caesar section in 2000 - so abdomen has been well cut up! Developed sciatica whilst pregnant and attended a sports physio after son born - this helped enormously (left hip - down leg, heel pain etc).

Everything pretty much ok until last August. Dancing with son, swung hips out to right side, heard a bit of a crack on right side....no pain....but ever since then, hip pain and back pain been gradually getting worse.

When I lie on my back with my knees up to my chest and rock over my right hip, I can hear a click (not all the time). No noise on left side.

Got a bit of a flat back thing going on (no bottom!) but being doing the cobra to improve that (the physio helped me with this bit).

I spend a lot of time sitting at the computer - and sitting really makes my hip ache. I sometimes feel like I've got a groin strain in my right side too, not all the time though. Walking and cycling are fine - lying in bed and sitting are hellish though. Bed situation improved by putting pillow between my knees.

Just feeling very despondent that this doesn't seem to be getting better. I can't sleep with a pillow between my knees for ever or my hubby will leave me!

Can you wonderful people a) confirm that this joint is the problem and b) that the damned thing can be put right?! :wink:

Best regards - fabulous site btw!

Heck - forgot to say that when I stand and try to curl forward a vertebrae at a time, I get to my lower back and everything just seems to bend forward as a single unit and my pelvis hurts (stretches?) on the right side.

Also, when I lie on the floor and try to let my spine drop onto the floor, vertebrae at a time, by the time I get to my lower back, it just flubs onto the floor like it's all welded together.

I feel like an old lady and I'm 44.

AX

Allison,

From reading your history, it sounds as if you have a classic case of a transversus abdominus muscle that is not functioning or at best, is very weak. It is not possible to say whether or not your SI joint is the cause of your back pain. The beauty of Dean's exercises are that they will help most folks that have back problems because of deconditioned musculature in the lower back and abdomen which happens to be a high % of people that have back pain. For example, the "Prone Cobra" is excellent for developing the intrinsic stabilization musculature of the back. Very often, in folks that have back pain, these smaller stabilizer muscles have lost their ability to help stabilize the vertebrae of the back which can eventually result in various back conditions.

Allison, did your doctor check you for anklylosing spondylitis? Ankylosing spondylitis is an inflammatory condition of the spine which predominantly affects men about twice as often as women. I am mentioning this because you wrote (relating to your description of your lower back) "Everything just seems to bend forward as a single unit". Ankylosed means immobility of a joint. Also, did your doctor say you had a flat back or a sway back? They are different, but look very similar when viewed from the side; both have the flat butt appearance. In either case, I would refrain from doing the Prone Cobra exercise at least until you have developed greater strength in the iliopsoas musculature. This course of action will benefit you whether you have a vertically aligned flat back, or you have a sway back. The reasoning behind my recommendation to avoid the prone cobra are taken directly from "Muscles, Testing and Function" by Kendall, McCreary & Provance ": 1) "Careful consideration must be given to examination findings when planning a course of treatment. It is a mistake to assume that extension exercises are indicated. They may be unnecessary or may be contraindicated. The flat back posture is one in which the hip joint is in extension, and the hamstrings are strong, and usually short. 2) If this type of posture exists without low back pain, it is not necessary to change it. If the back is painful, and restroring the normal anterior curve is indicated, the measure of choice should be strengthening the weak hip flexors. The problems with back extension from prone position are that it involves strong hip joint extension, and extensor muscle action to stabilize the pelvis to the thigh in order for the trunk to be raised, and the hip extension stretches the already weak illiopsoas."

Here is a little information on pain. Central Pain syndrome, which I think most back pain falls under, is damage or disfunction to the brain, brain stem or spinal cord. This type of pain is typically characterized by a constant level of pain; whether it be moderate or severe. With back pain, the level of pain is directly related to the severity of disruption to the nerve(s). Central Pains actions should not be confused or compared to that which is normally felt in peripheral pain.

An example of peripheral pain would be if you stubbed your toe; the amount of pain you feel initially is much greater than what is present 2 or 3 minutes later. In short, as time passes, there is a diminishing quality to the perceived level of pain from the trauma. On the other hand, with back pain or central pain, because of the initiation of mitogin-actived protein kinase within the body, pain can remain at a constant level much longer.

With central pain, the body initiates a complex process that places a high-energy phosphate (kinase) bond on the pain neuro transmitters which can make the affected nerves fire out of control signalling pain. You can feel pain locally or referred (feels as if it comes from one place, but actually comes from somewhere else) or radicular pain, which has that shooting sensation radiating from a nerve root towards its' periphery.

The point I'm trying to make here is don't despair - you may actually have made progress, but your pain level is telling you otherwise. I think when a spinal injection has a successful outcome in alleviating pain, the groundwork had already been laid by the events previous (i.e. exercises, stretches, rest, massage). In cases where the spinal injection is ineffective, the cause (etiology) may still be present, hence the pain eventually returns. However, in cases where the pain is so severe as to be physically debilitating, an epidural may serve to provide sufficient relief from the pain to allow the individual to perform the physical exercises that will form the foundation for the best chance of recovery.

The following is the course of action I would take:
1. Ask your doctor whether he found any indications you may have ankylosing spondylitis?
2. Hold off on performing the Prone Cobra.
3. On days you want to take corrective action (hopefully 3 or 4 times per week), first stretch your hamstrings, followed by an exercise for your illiopsoas muscles.
4. Follow the illiopsoas exercise with a transversus abdominus exercise.
5. Then follow the exercises in Dean's book.

Allison, if you want to follow my suggestions, I will be happy to provide the stretches and exercises.

Bill P.

[Bill P]

Hello all - stumbled across this site while trying to find out what the heck is wrong with my hip and have paid for and downloaded the RYB book today.

I've been to the doctor and had an x-ray taken - nothing seems to be wrong bone-wise (which is good!). He signed me up for 6 sessions of physiotherapy and I've been attending religiously, but to be honest, my pain didn't improve. So, I went to an osteopath who said that he reckoned it was my SI joint.

I went twice - got a jolly good cracking up and down my back - but nothing improved.

From what I've read on the internet, I reckon that it is my joint. I'll give you a potted history.

Had my appendix out in mid eighties - nast big scar still there. Had my son by caesar section in 2000 - so abdomen has been well cut up! Developed sciatica whilst pregnant and attended a sports physio after son born - this helped enormously (left hip - down leg, heel pain etc).

Everything pretty much ok until last August. Dancing with son, swung hips out to right side, heard a bit of a crack on right side....no pain....but ever since then, hip pain and back pain been gradually getting worse.

When I lie on my back with my knees up to my chest and rock over my right hip, I can hear a click (not all the time). No noise on left side.

Got a bit of a flat back thing going on (no bottom!) but being doing the cobra to improve that (the physio helped me with this bit).

I spend a lot of time sitting at the computer - and sitting really makes my hip ache. I sometimes feel like I've got a groin strain in my right side too, not all the time though. Walking and cycling are fine - lying in bed and sitting are hellish though. Bed situation improved by putting pillow between my knees.

Just feeling very despondent that this doesn't seem to be getting better. I can't sleep with a pillow between my knees for ever or my hubby will leave me!

Can you wonderful people a) confirm that this joint is the problem and b) that the damned thing can be put right?! :wink:

Best regards - fabulous site btw!

Heck - forgot to say that when I stand and try to curl forward a vertebrae at a time, I get to my lower back and everything just seems to bend forward as a single unit and my pelvis hurts (stretches?) on the right side.

Also, when I lie on the floor and try to let my spine drop onto the floor, vertebrae at a time, by the time I get to my lower back, it just flubs onto the floor like it's all welded together.

I feel like an old lady and I'm 44.

AX

Allison,

From reading your history, it sounds as if you have a classic case of a transversus abdominus muscle that is not functioning or at best, is very weak. It is not possible to say whether or not your SI joint is the cause of your back pain. The beauty of Dean's exercises are that they will help most folks that have back problems because of deconditioned musculature in the lower back and abdomen which happens to be a high % of people that have back pain. For example, the "Prone Cobra" is excellent for developing the intrinsic stabilization musculature of the back. Very often, in folks that have back pain, these smaller stabilizer muscles have lost their ability to help stabilize the vertebrae of the back which can eventually result in various back conditions.

Allison, did your doctor check you for anklylosing spondylitis? Ankylosing spondylitis is an inflammatory condition of the spine which predominantly affects men about twice as often as women. I am mentioning this because you wrote (relating to your description of your lower back) "Everything just seems to bend forward as a single unit". Ankylosed means immobility of a joint. Also, did your doctor say you had a flat back or a sway back? They are different, but look very similar when viewed from the side; both have the flat butt appearance. In either case, I would refrain from doing the Prone Cobra exercise at least until you have developed greater strength in the iliopsoas musculature. This course of action will benefit you whether you have a vertically aligned flat back, or you have a sway back. The reasoning behind my recommendation to avoid the prone cobra are taken directly from "Muscles, Testing and Function" by Kendall, McCreary & Provance ": 1) "Careful consideration must be given to examination findings when planning a course of treatment. It is a mistake to assume that extension exercises are indicated. They may be unnecessary or may be contraindicated. The flat back posture is one in which the hip joint is in extension, and the hamstrings are strong, and usually short. 2) If this type of posture exists without low back pain, it is not necessary to change it. If the back is painful, and restroring the normal anterior curve is indicated, the measure of choice should be strengthening the weak hip flexors. The problems with back extension from prone position are that it involves strong hip joint extension, and extensor muscle action to stabilize the pelvis to the thigh in order for the trunk to be raised, and the hip extension stretches the already weak illiopsoas."

Here is a little information on pain. Central Pain syndrome, which I think most back pain falls under, is damage or disfunction to the brain, brain stem or spinal cord. This type of pain is typically characterized by a constant level of pain; whether it be moderate or severe. With back pain, the level of pain is directly related to the severity of disruption to the nerve(s). Central Pains actions should not be confused or compared to that which is normally felt in peripheral pain.

An example of peripheral pain would be if you stubbed your toe; the amount of pain you feel initially is much greater than what is present 2 or 3 minutes later. In short, as time passes, there is a diminishing quality to the perceived level of pain from the trauma. On the other hand, with back pain or central pain, because of the initiation of mitogin-actived protein kinase within the body, pain can remain at a constant level much longer.

With central pain, the body initiates a complex process that places a high-energy phosphate (kinase) bond on the pain neuro transmitters which can make the affected nerves fire out of control signalling pain. You can feel pain locally or referred (feels as if it comes from one place, but actually comes from somewhere else) or radicular pain, which has that shooting sensation radiating from a nerve root towards its' periphery.

The point I'm trying to make here is don't despair - you may actually have made progress, but your pain level is telling you otherwise. I think when a spinal injection has a successful outcome in alleviating pain, the groundwork had already been laid by the events previous (i.e. exercises, stretches, rest, massage). In cases where the spinal injection is ineffective, the cause (etiology) may still be present, hence the pain eventually returns. However, in cases where the pain is so severe as to be physically debilitating, an epidural may serve to provide sufficient relief from the pain to allow the individual to perform the physical exercises that will form the foundation for the best chance of recovery.

The following is the course of action I would take:
1. Ask your doctor whether he found any indications you may have ankylosing spondylitis?
2. Hold off on performing the Prone Cobra.
3. On days you want to take corrective action (hopefully 3 or 4 times per week), first stretch your hamstrings, followed by an exercise for your illiopsoas muscles.
4. Follow the illiopsoas exercise with a transversus abdominus exercise.
5. Then follow the exercises in Dean's book.

Allison, if you want to follow my suggestions, I will be happy to provide the stretches and exercises.

Bill P.

[Bill P]

Hello all - stumbled across this site while trying to find out what the heck is wrong with my hip and have paid for and downloaded the RYB book today.

I've been to the doctor and had an x-ray taken - nothing seems to be wrong bone-wise (which is good!). He signed me up for 6 sessions of physiotherapy and I've been attending religiously, but to be honest, my pain didn't improve. So, I went to an osteopath who said that he reckoned it was my SI joint.

I went twice - got a jolly good cracking up and down my back - but nothing improved.

From what I've read on the internet, I reckon that it is my joint. I'll give you a potted history.

Had my appendix out in mid eighties - nast big scar still there. Had my son by caesar section in 2000 - so abdomen has been well cut up! Developed sciatica whilst pregnant and attended a sports physio after son born - this helped enormously (left hip - down leg, heel pain etc).

Everything pretty much ok until last August. Dancing with son, swung hips out to right side, heard a bit of a crack on right side....no pain....but ever since then, hip pain and back pain been gradually getting worse.

When I lie on my back with my knees up to my chest and rock over my right hip, I can hear a click (not all the time). No noise on left side.

Got a bit of a flat back thing going on (no bottom!) but being doing the cobra to improve that (the physio helped me with this bit).

I spend a lot of time sitting at the computer - and sitting really makes my hip ache. I sometimes feel like I've got a groin strain in my right side too, not all the time though. Walking and cycling are fine - lying in bed and sitting are hellish though. Bed situation improved by putting pillow between my knees.

Just feeling very despondent that this doesn't seem to be getting better. I can't sleep with a pillow between my knees for ever or my hubby will leave me!

Can you wonderful people a) confirm that this joint is the problem and b) that the damned thing can be put right?! :wink:

Best regards - fabulous site btw!

Heck - forgot to say that when I stand and try to curl forward a vertebrae at a time, I get to my lower back and everything just seems to bend forward as a single unit and my pelvis hurts (stretches?) on the right side.

Also, when I lie on the floor and try to let my spine drop onto the floor, vertebrae at a time, by the time I get to my lower back, it just flubs onto the floor like it's all welded together.

I feel like an old lady and I'm 44.

AX

Allison,

From reading your history, it sounds as if you have a classic case of a transversus abdominus muscle that is not functioning or at best, is very weak. It is not possible to say whether or not your SI joint is the cause of your back pain. The beauty of Dean's exercises are that they will help most folks that have back problems because of deconditioned musculature in the lower back and abdomen which happens to be a high % of people that have back pain. For example, the "Prone Cobra" is excellent for developing the intrinsic stabilization musculature of the back. Very often, in folks that have back pain, these smaller stabilizer muscles have lost their ability to help stabilize the vertebrae of the back which can eventually result in various back conditions.

Allison, did your doctor check you for anklylosing spondylitis? Ankylosing spondylitis is an inflammatory condition of the spine which predominantly affects men about twice as often as women. I am mentioning this because you wrote (relating to your description of your lower back) "Everything just seems to bend forward as a single unit". Ankylosed means immobility of a joint. Also, did your doctor say you had a flat back or a sway back? They are different, but look very similar when viewed from the side; both have the flat butt appearance. In either case, I would refrain from doing the Prone Cobra exercise at least until you have developed greater strength in the iliopsoas musculature. This course of action will benefit you whether you have a vertically aligned flat back, or you have a sway back. The reasoning behind my recommendation to avoid the prone cobra are taken directly from "Muscles, Testing and Function" by Kendall, McCreary & Provance ": 1) "Careful consideration must be given to examination findings when planning a course of treatment. It is a mistake to assume that extension exercises are indicated. They may be unnecessary or may be contraindicated. The flat back posture is one in which the hip joint is in extension, and the hamstrings are strong, and usually short. 2) If this type of posture exists without low back pain, it is not necessary to change it. If the back is painful, and restroring the normal anterior curve is indicated, the measure of choice should be strengthening the weak hip flexors. The problems with back extension from prone position are that it involves strong hip joint extension, and extensor muscle action to stabilize the pelvis to the thigh in order for the trunk to be raised, and the hip extension stretches the already weak illiopsoas."

Here is a little information on pain. Central Pain syndrome, which I think most back pain falls under, is damage or disfunction to the brain, brain stem or spinal cord. This type of pain is typically characterized by a constant level of pain; whether it be moderate or severe. With back pain, the level of pain is directly related to the severity of disruption to the nerve(s). Central Pains actions should not be confused or compared to that which is normally felt in peripheral pain.

An example of peripheral pain would be if you stubbed your toe; the amount of pain you feel initially is much greater than what is present 2 or 3 minutes later. In short, as time passes, there is a diminishing quality to the perceived level of pain from the trauma. On the other hand, with back pain or central pain, because of the initiation of mitogin-actived protein kinase within the body, pain can remain at a constant level much longer.

With central pain, the body initiates a complex process that places a high-energy phosphate (kinase) bond on the pain neuro transmitters which can make the affected nerves fire out of control signalling pain. You can feel pain locally or referred (feels as if it comes from one place, but actually comes from somewhere else) or radicular pain, which has that shooting sensation radiating from a nerve root towards its' periphery.

The point I'm trying to make here is don't despair - you may actually have made progress, but your pain level is telling you otherwise. I think when a spinal injection has a successful outcome in alleviating pain, the groundwork had already been laid by the events previous (i.e. exercises, stretches, rest, massage). In cases where the spinal injection is ineffective, the cause (etiology) may still be present, hence the pain eventually returns. However, in cases where the pain is so severe as to be physically debilitating, an epidural may serve to provide sufficient relief from the pain to allow the individual to perform the physical exercises that will form the foundation for the best chance of recovery.

The following is the course of action I would take:
1. Ask your doctor whether he found any indications you may have ankylosing spondylitis?
2. Hold off on performing the Prone Cobra.
3. On days you want to take corrective action (hopefully 3 or 4 times per week), first stretch your hamstrings, followed by an exercise for your illiopsoas muscles.
4. Follow the illiopsoas exercise with a transversus abdominus exercise.
5. Then follow the exercises in Dean's book.

Allison, if you want to follow my suggestions, I will be happy to provide the stretches and exercises.

Bill P.