Ongoing pain - SI Joint?

[kelownagirl]

I am getting SO fed up. I was having some pain in my hip and IT band on and off all summer so finally went to the PT to get checked out. She said I had hip bursitis and piriformis and IT Band problems but that with some PT I should be able to get back running and riding hills in a week or 2. I can't remember which "injury" she said came first, but it had referred the pain and problems to the other areas. I went to my family doctor as well and he agreed on the bursitis and he said it would likely be 4-8 weeks before I saw relief.

I went to physio 1-2X a week for most of Sept and Oct. I also started going for massage in Nov. The PT mostly did TENS and ultrasound and massage etc and I may have noticed some minor improvement. She said my hips were "out" and she did some manipulations to put them back in. I noticed relief right away. However, it was usually back the next day and she'd have to put my hips back in line the next time I went in. I did all the stretching and strengthening exercises the PT and MT suggested and bought a foam roller. The IT stuff seems to have cleared up somewhat, the bursitis and piriformis pain seems to come and go, but I am still waking up with a lot of pain in my low back in the mornings. Both the PT and MT say this is my SI joint and that it gets "stuck". This is what the PT puts back in place I think.

ANYWAY, I can't afford to keep going for physio when it isn't really helping or solving the problem and the massage is nice, but it's not curing me either. So I've decided to kind of just "live" with it and get back into running again veeeery slowly. I just don't know what else to do. What can I do to make it go away? I have heard just about every hip diagnosis now - MT has also talked about strengthening my glute medius and also the psoas (sp?). I dunno.... help??

Sorry so long...

[KnottedYet]

Did the PT teach you how to put your own SI back in?

It can be incredibly easy to do with the right tricks (if it's actually the SI. Are they sure it isn't your lumbar spine?). I taught Mimi this one, so if you have trouble and my explanations aren't doing it for you, give her a PM and I'm sure she could help.

Your SI may squeak in and out, but it's the muscles freaking out around it that cause the trouble. To solve it you need to both calm down the muscles and let the SI go back where it wants to be. (trust me, it wants to go back!)

Easy Fix:
This is called the "Soft Shotgun", cuz like a shotgun it hits many targets. (there's also a 'hard' shotgun, and I don't use that) Doesn't matter which SI is out, or what direction it wandered off into. This exercise calms down the muscles in the neighborhood and lets the SI's squidgy their way back where they belong. (if the problem is in your lumbar spine, this will likely make you feel worse) I usually tell folks to do this morning and night, in bed, for a couple weeks. And whenever their SI feels funky. As often or as little as you want.

*Lie on your back, knees bent, feet flat on the bed.
*Stick a pillow between your knees.
*BARELY, gently, imperceptibly squeeze the pillow for 10 seconds.
*Let off for 10 seconds
*Do until you are bored silly. (generally you become bored when the SI's have returned and your bod is no longer excited by the gradually shifting SI's) Maybe 10 or 20 or 30 times.

It's like rocking a baby, in that it calms the muscles. Using the in and out muscles of the legs kind of flaps the bones of your pelvis like elephant ears and lets the SI work its way back into place (which it would normally do with every step you take, every move you make, every bond you break etc etc with apologies to Sting)

You might also want to try sleeping with a pillow or towel roll between your knees if you sleep on your side.

If this doesn't work, let me know. I have a few other tricks up my sleeve... :D

[kelownagirl]

I am off to try that - thanks Knot!!!

I have been trying to sleep with a pillow between my knees but I'm a bit of a thrasher at night and I usually lose it. I DO find my back pain is less when I've sleep well and kept the pillow in place. It's the WORST when I sleep on my stomach they way I love to... :o :(

PS - Nobody once has mentioned lumbar spine as of yet. SI mentioned many times. But who knows. I will try your exercises and see if that helps. My MT also mentioned something similar to "oil" the joint in the morning. Lie on my back, knees up, and gentle bring my right hip towards my head a little, then my left hip. Not sure if that makes sense written down. Anyway, it's supposed to wiggle my si joint around a bit to get the fluid moving a bit and then when I get it's not supposed to hurt as much.

[KnottedYet]

Your MT sounds good.

Yup, the marching motion is another of the useful tricks.

The fact that your back feels WORSE if you sleep on your tummy really tells me a lot. Let me know how your bod feels after a decent try of the soft shotgun.

(I have a couple other ideas, but I'll wait to see how this one works first.)

[kelownagirl]

Hey, ya know what? I was lying in bed reading to my son so I did the gentle squeezes while I was there and I think my back feels better! I wasn't even really trying all that much. I will do it some more when I head to bed in a bit. Maybe that will help!

I'm curious to know more about what you think about lying on my tummy.

PS My MT is great. She was an instructor at the MT "school" as well.

[KnottedYet]

The secret is not to try much at all; very gentle, like rocking a baby. 10 seconds or so on, 10 seconds or so off.

Lying on your tummy making it worse makes me think it's unlikely you have a posterior lumbar disc problem.

Let me know how it goes. Got some other tricks for you to try if this one doesn't clear things up!:D

[RoadRaven]

Kelowna, I know nothing medically that is helpful to you...
Just wanted to say I am sorry this continues to be an ongoing issue for you
Pain is such a difficult thing to live with

Thinking of you, Rave

[kelownagirl]

1:45 pm and STILL no pain. I am SO happy!!! :D :D

[KnottedYet]

Hooray!! :D

[kelownagirl]

I told my BIL about this exercise but his SI joint is "frozen" so I'm not sure it'll help him. If it doesn't, any suggestions to what he can try??

[KnottedYet]

I'd say try it for a couple weeks anyway. If it doesn't help, he should see a DO or a PT who is an OCS. (orthopedic clinical specialist ? something like that. they have taken extra training and passed some intense exams and are good at dealing with stuck joints.)

[kelownagirl]

He has been to a chiro. Said it took about 5 times before they could move it. Not sure when he went the last time though.

[KnottedYet]

A D.O. or a PT OCS will teach him how to move it himself, if it needs to be moved. In older men it usually doesn't move and isn't meant to. If he has a problem with it moving and getting painfully stuck in the wrong spot, the DO or PT will teach him how to correct it and fix it himself. (I think I've only treated maybe 2 men who had actual SI problems.)

And always, always, always; the first thought is to rule out a lumbar spine problem.

[kelownagirl]

So now that I seem to have found a way to get the SIJ back in place and relatively free of pain, how can I prevent it from slipping out in the first place? I assume that it involves some strengthening exercises? My MT thought I needed to strengthen the gluteus medius and both MT and PT said I should do the clamshell to strengthen as well. Is there any other exercises I should do to help? Is there anything I should avoid when I'm running or riding?

[KnottedYet]

It's meant to move. (in women for the most part)

The booger is when it moves but doesn't return to neutral.

Yes, having good strong muscles from doing clamshells will certainly keep you from shocking the pelvis with various impacts and twists and such. Do those clamshells!

your lower ab has a very large part to play in keeping your pelvis and low back stable AND helping the SIJ return to neutral. All the time and forever and ever you should be holding your lower belly flat. The area from pubic bone to belly button. The stuff under your pants zipper. This is the best way to strengthen the most neglected abdominal muscle we own. Just use it!

If you can't hold your lower belly flat and breathe at the same time, then you are probably trying too hard and using the larger abs.

This muslce (transversus abdominus) is the secret to good posture, core stability, bladder and bowel continence, skinny waist/flat tummy, and universal peace and brotherhood.

[OakLeaf]

This muslce (transversus abdominus) is the secret to good posture, core stability, bladder and bowel continence, skinny waist/flat tummy, and universal peace and brotherhood.

Partial thread hijack. Only because the transversus is my favorite muscle too :) Two points.

Best method I've found to teach unconditioned people where their transversus is: Put two fingers just inside the hipbone. Then cough. Ohhhh, THAT muscle!

Key to bladder continence: Relax the bladder! In my personal experience which I suspect parallels that of a lot of fit women, it's not about strength of the pelvic floor, the transversus or anything. It's that no matter HOW strong we make those muscles, a spastic bladder will always be stronger. So stop straining when we pee. Didn't realize you were straining? Neither did I. It takes a lot of conscious awareness to just relax the bladder. And when you're squatting to pee - as a lot of women do when we're "al fresco" or using public facilities - we're predisposed to strain the bladder. Relax the bladder. Visualize a cool breeze blowing across your kidneys. Voila, instant continence!

[KnottedYet]

What I'm finding just fascinating with my incontinent patients is how very little abdominal control and postural awareness they have.

I get a huge kick out of taking someone who leaks every time she picks up her bag of flour at home, teaching her abs/core and posture and proper lifting technique, and having her work out like crazy lifting and stuff in the gym. The look on her face when she realizes she just lifted the equivalent of 25# of flour 50 times *without leaking* is just wonderful!

(for these folks trans abd and the pelvic floor muscles just need to be woken up, and often it's as simple as the posture and core stuff we take for granted! It's awesome!)

[Wahine]

The cue I like to use to get people recruiting their transversus abdomenus correctly is to pretend you're putting on a really tight pair of jeans and you don't want to get anything caught in the zipper. :eek: OK, now hold that for 10 sec, rest 1 second or 2 then repeat. Do this for at least 1 min, at least 2 times per day. More often if you can.:)

I also like to get people doing psoas recruitment exercises. There's some good research out there to support the idea of the psoas acting as a stabilizer for the pelvis and low back. It works really well for some people with chronic SIJ issues. This muscle is a little harder to get to work. The easiest way is to lie on your back, have DH gently pull on your leg, by the ankle and then you try to suck your thigh bone back up into your pelvis. The first time you try, do it as hard as you can and have DH rotate your leg, there will be a lot of resistance. Then do it again but at 25% effort, this should stop you using your quads and hams too much. At that effort level DH should be able to rotate the leg with minimal resistance from you. If there's resistance, you're using the wrong muscles to perform the action. It's hard to explain. It's more of a demonstration type of exercise and even with demonstration a lot of patients struggle with this. So if you don't get it, don't get hung up on it. If you do get it do the exercise on both sides, use the same 10 sec hold, 1 min, twice per day. I might try to post something on yuotube about this. After Christmas, maybe.

[KnottedYet]

I use the zipping-up-tight-jeans cue, too.

I love using our polaroid to take "before" and "after" pics of folks' posture. It's a great learning tool, especially when someone feels that good posture is all wrong; then they get to see the evidence for themselves!

(they really like the flat tummy!)

[kelownagirl]

I do that exercise (holding in my abs) every time pass a mirror. :rolleyes:

I have been working pretty hard at the abs with crunches and I always tighten that TA (long word) in before I do each crunch. Is that correct?

So do you hold your abs in all the time once you're good at it?

I don't leak when I pick stuff up, only when I sneak and don't have a chance to "clench" :rolleyes: ...

My back has not hurt since Knot taught me the trick. Even yesterday when I woke up with back pain from lying on my tummy, I was able to get rid of most of it with the exercise. I am SO happy....

[KnottedYet]

TA doen't do anything to help you crunch (it doesn't move anything) but it does help stabilize you while you crunch. Instead of just flattening it before each crunch, keep it flattened all the time.

Ok, flattening as you go past a mirror is good, now keep it firm and flat ALL THE TIME. :D

Glad the trick is working! Share it with anyone you know who could use it!