I hurt.

[sfa]

Warning--whining and self-pity ahead!

So I did a triathlon way back in August, and in the process of training I fell and knocked my SI joint out of alignment. The injury wasn't immediately apparent--the pain was minimal in the summer and got progressively worse over the fall. I started PT in November and ALL of my former training time was devoted to just getting myself healed. So while I worked on getting this joint healed, the rest of me was getting soft and lazy and my cardio conditioning was going down the tubes.

I "graduated" from PT at the end of January and started back into regular workouts. Slow runs on the treadmill, biking on the stationary bike. I still had some ligament pain, but was assured that the pain would diminish now that the bone that was out of alignment was back in place. I kept up with all of my PT exercises too.

On Saturday I went to the pool for my first swim since the triathlon. The pain hit in my ligaments as soon as I hit the water (I think from the cold) and then when I actually started swimming, the pain became intense--almost as bad as it had ever been, and not just the ligaments, but the joint itself. I made it one length, hoping the pain would work itself out, then made it back the other length of the pool only using my upper body.

I had hoped to do a short triathlon in April, but now that isn't looking likely. I'm signed up to do Iron Girl again in August. I'll be back at the orthopedist next Monday and then probably back to PT. I'm wondering now if swimming will ever be possible again. I'm kicking myself for registering for another triathlon before knowing if I'd be physically able to, but I never imagined that this injury would bother me for so long. And who knew that swimming would be the one activity to exacerbate it? Cycling, fortunately, is the one activity that doesn't hurt at all--if anything, it feels better than just sitting still. But I hate it that I hurt all the time. I hate not being able to do simple things like carry a basket of laundry upstairs. Making my kid's bed hurts. I hate it that I've put on 10 pounds in the past five months and my clothes don't fit. I hate it that I went from healthy and fit and strong to weak and overweight and tired in such a short time. I've never been injured before (except for a pulled growth cap when I was 13, but I bounced back from that in six weeks) and I'm having a hard time dealing with it mentally and physically.

NNTR--I just wanted to whine.

Sarah

[rocknrollgirl]

Well, I am gonna reply anyway!

I am really sorry that you are in pain. I was injured a few years ago and it took months for me to heal. So I really do feel your pain. I got SO cranky from being in pain all the time, and very sympatheic to people that live with chronic pain.

All I can say is hang in there. It took me two rounds of PT and a lot of hard work to recover. Now I am very faithful about doing my "pre-hab" exercies and keeping the snarky knee happy.

I am shocked that the pool caused such an issue.

We are all here for you.....rant away.

[Blueberry]

I'm really hoping Knot will chime in here. She has a couple of tricks in her bag that have really helped my SI joint (exercise type things that really sooth it). Mine has been crankier all winter from the cold - so I can only imagine that cold water might have the same effect. Core strengthening is key to mine not hurting.

You're right - it interferes with everything. Driving a stick shift for me is bad (when it's inflamed), as is laundry, dishes, etc., etc.

[OakLeaf]

((((((sfa)))))) It s*cks to be injured. Hang in there.

[colby]

No good advice here, just sympathy -- or empathy, if you will, having been injured before. It was really hard for me to feel like I had to ask permission from my body (or my PT ;)) to do anything for a good 3-4 months.

My PT always reminded me how long it took me to get to the point I got - several months of using the injured system every day the wrong way, compensating for a lack of alignment or whatever it was that started it - and that I couldn't expect for it to get UNdone quickly just out of sheer will. All that bad muscle memory I built had to be re-built, and it would take a lot of time, even after graduating PT, to keep rebuilding and maintaining it correctly.

August is a long time away. If you can't do it safely, you can't do it, but don't get disappointed in yourself that far in advance just yet. One day at a time. ;)

[NbyNW]

Glad you're checking in with your orthopedist next week. It's not a bad idea to get re-assessed. These things can be tricky, and it's important to make sure you have the support you need to get through it.

After my sacrum fracture I felt like I wasn't making the progress I needed, I went back to the doc, maybe 4-5 months after being released from PT. It was good to get back into PT for a few months to keep my healing on track.

Good luck!

[HillSlugger]

I'm sorry that you are in pain again!

Iron Girl is still 6 months away so still lots of time to get back into swimming and exercising. I'm trying to get my run back for IG, too. Hope to see you there.

[KnottedYet]

Where to begin....

SI joints: It's a girl thing. Seriously. In 10 years I've only had 2 men with SI problems. They were big traumas (a fall for one, and I think a rugby tackle for the other). Because it's a girl thing, it got neglected for a long time. Treatments are starting to pick up and it's being recognized as an issue.

What causes the problem: Heck if I know. If you figure it out, tell me. No, really, it's largely because women have wider pelvises and sharper angles at the thighbone so force gets directed in wonky ways. SI joints are kind of like those expansion joints you see in the floor in big buildings. They aren't hinges, they aren't ball-and-socket. They're more like what you'd get if you tried to glue a broken dinner plate back together with a thick pad of rubber cement; something that can move in all kinds of ways, but not very far.

How does it move: in-flare, out-flare, upslip, downslip, anterior rotation, posterior rotation... and that's just ONE bone of the joint (the ilium). The other bone has it's own motions it can do relative to the ilium. These babies shift slightly all the time, even when you breathe. The problem comes up when they shift and get stuck, and it gets worse when the muscles in the neighborhood panic and try to hold everything still by getting very tense. The body doesn't know what is wrong, it only knows that joint HURTS and so tries to lock it down and not use it.

How do I tell which way mine got stuck: Ask your PT or orthopod. The pelvis is a big ring with only 3 "expansion joints" and movement at one effects the other two. It's very funky.

Does it matter: No. Well, I take that back. It matters if someone is measuring at a bony landmark of your pelvis trying to see if you have a leg length difference. If the pelvic bones are shifted the measurement will be off. It helps to know which way they went so you can decide if a leg length based on them is valid.

to be continued...

[KnottedYet]

continued

How do I fix it: Movement of one bone relative to another caused the problem, and movement of one bone relative to another can fix it. This is where you need someone to go through the steps with you. The pelvis is it's own little universe, and we influence that universe by moving the bones that interact with it; the thigh bone and the lumbar spine. Someone familiar with SI problems will know all the goofy movements you can do to let the SI settle back into its happy place, and they'll go through them systematically with you until you find the one that works. You'll do that movement multiple times a day (like every couple hours or even more often) until the body makes that settled place the ground state again. It wants to be happy, but it's kind of sloppy for a while and slides in and out seemingly at random until the body glues it down better.

How do I make it stay fixed: This is the million dollar question. While you are working to put the critter back where it belongs using your corrective movement, you must also work to keep it there. That means getting the panicked muscles to calm down (cuz they're just making things worse at this point) and waking up the stabilizer muscles who stuck their fingers in their ears singing "la-la-la-I-can't-hear-you" and went on vacation to avoid all the excitement. This is again where a therapist who is familiar with SI problems really is a big help.

It won't stay fixed, now what: Repeat the movement, the calming/waking muscles, and investigate outside help. Outside help can be things like temporary shoe lifts. Everyone (I exaggerate, it's only 90% of everyone) has a bony leg length difference. The bones on one side are shorter than the bones on the other. The body deals with it without you ever knowing if the difference is less than about an 3/4 inch. Or unless you develop an SI issue. Suddenly that difference explodes as the ilium on the short side rotates forward and the ilium on the long side rotates backward. Augh! An icecube becomes an iceBERG! It's the sinking of the Titanic all over again! What was 1/4 inch, say, is now a 1 inch difference between leg lengths. Wild things happen to the hips, the legs, the back (even shoulders sometimes). Imagine walking around all day wearing one high heel shoe and one moccasin. Now imagine that EVERY SINGLE DAY. Temporary lifts can put panicked muscles on a slack and encourage the ilia to rotate back home. But you will want to take them out eventually because really you are making yourself tilted against a compensation (the hypothetical 1/4 inch) your body already made.

[KnottedYet]

How do I give my PT good information: First, make note of what makes it feel better, and what makes it feel worse. That is crucial information! Remember, your body doesn't want to hurt any more than you do. Often people are already heading into corrective movements on their own, before they ever get to the PT. (for example think of all the folks who stretch backwards after they've been sitting hunched over the computer too long. the body knows what it wants) Second, do a little experimenting. Wanna see if you've got a wacky rotation going on? Stand up. Stick your hands in your pockets. Feel the pointy bit of bone just inside your pocket? Stand in front of a mirror. Close your eyes. Put your thumbs (over your pockets) on each of those bones. Open your eyes. Are your thumbs level? Is one higher than the other? Make note of that. See if it's the same in the morning as in the evening, or if it's the same when you hurt bad and when you don't hurt much. Good info for the PT.

That's nice, but what can I do RIGHT NOW: Rock the baby and flap the elephant ears. This is moving the thighbones very very gently where they meet the pelvis (ilia-ish). Lie on your back with your knees bent and feet flat on the bed. Put a pillow between your knees. Barely squeeze the pillow with your knees the tiniest TINY bit. Hold that imaginary squeeze 10 seconds. Let it go for 10 seconds. Do this until you are bored out of your mind. (3 or 4 minutes or more) This is a soft and gentle motion, like rocking a baby. It calms the panicked muscles, it shifts the hips into a little abduction and adduction, it lets the ilia squirm a little like an elephant flapping his ears. After this, do you feel better, worse, or the same? If same, do it again. (if same after 2nd try, it's probably not doing much for you) If worse, toss this one out. If better, this is your new best friend!
Cobra. This is moving the lumbar spine where it meets the pelvis (sacrum) Yoga cobra, where you lie on your tummy, use your arms to push your chest and belly up off the floor and leave the rest of your body flopping on the floor like a snake. Kind of like a very lazy push up. Hold a second, lower gently back down. Do 10 times. If you can, eventually get your arms all the way straight. After this, do you feel better, worse, or the same? Same rules as above. And let your PT know what these did or did not do for you. (this info is also VERY useful and tells the PT a lot about what is going on - even if you felt the same after each)

[NbyNW]

Yet again, someone else's thread has kicked me into action. I've let this whole relocating to Edmonton thing disrupt much of my self-care work and lately I wanna jump off the table when my (new) massage therapist is working near/on my SI joint. (It's not so much out of place as it is stiff/sticky)

sfa -- hope you get some good info and good information with your own healing, and thanks for starting the thread.

Knott -- what a great writeup! Thanks again for being so generous with your knowledge. Lots of reinforcement for me as well as a few new things.

[Bike Chick]

(((sfa))) I think everyone here understands. Being sidelined is just as tough mentally as it is physically. I hope you are soon healed and are participating in Iron Girl stronger than ever. Knot certainly gave you some wonderful advice (ain't she great?).

Knot, thanks so much for your input....Can I put you on retainer???

[OakLeaf]

Thanks Knott - I've passed this thread on to my next door neighbor who's having SI joint trouble.

Take care sfa.

[sfa]

Thank you all for the replies and support!

Thank you especially, Knott, for all that information. From my MRI we discovered that my SI joint isn't fused properly, either a congenital thing (thanks, Mom and Dad!) or from repetitive stress in my misspent youth (funnyish aside: the orthopedist was questioning me to find out if I had done any activity that would involve repetitive back and forth movement around my waist. He says you see this a lot from people who played tennis and volleyball. I was all "no, nope, never done anything like that." It wasn't until I left the office that I remembered that I spent three years in college as a rower. Oops.) so I was primed for this sort of injury to begin with. I'm picturing my pelvis like a jigsaw puzzle that you can glue together to get it to stay permanently, but if the glue comes loose around individual pieces, it can make that piece pop out and weaken all the other ones around it. I don't know if this is accurate, but it's how I like to visualize what's going on.

From searching other threads I had found the "elephant ears" thing and had tried that to no effect. I'll give the cobra a try later today. The PT has me doing a couple of exercises that twist my pelvis as I do them, and that seems to provide immediate relief, but it doesn't last. I'm doing lots of planks (regular and side), pelvic tilts and bridges. Massage really helps, but what I need is for the PT to give my husband some instructions in how to do it right! It's hard for me to explain to DH what helps because I can't *see* what the PT is doing, and my attempts at explanation don't get the desired effect. I want to tell him to just get a meat mallet and whack the joint into place. Somehow I don't think that'll be too helpful, though.

Sarah

[NbyNW]

sfa -- are you familiar with The Trigger Point Therapy Workbook by Clair Davies?

My former massage therapist incorporated trigger point into the work he did on me, and he would show me how I could work on certain muscles on my own.

Since I couldn't bring him with me to Edmonton, this book is the next best thing. Assuming your pain is muscle-related, there are great diagrams showing which muscles refer pain to other parts of the body and he provides techniques for working on them yourself.

[KnottedYet]

The PT has me doing a couple of exercises that twist my pelvis as I do them, and that seems to provide immediate relief, but it doesn't last.

Excellent! You've already got your corrective movement!

I assume you are doing this 10 repetitions, every two hours? (so 8 or more sessions a day)

How long does the relief last? You may need to do it more frequently for a few days: for example, if relief lasts for 35 minutes, you may need to do the movement every 30 minutes, etc.

The more time the bones spend lined up right, the faster the collegen your body is throwing at the SI can get it stuck back down. It's like spiderweb. You don't want to stretch or tear it and you want it to build up.

It may take a while and a lot of work, but if you can chase it down and keep it symptom free for a week (that means in place for a week and doing your corrective movement that entire time) that is about enough time for the collagen to build up. It may take a few weeks to get to that point.

[Pax]

...Knot, thanks so much for your input....Can I put you on retainer???

I think Knott could make her fortune treating the women here! :D


sfa - that cobra thing saved my quality of life. My lower back was feeling so good I sort of stopped doing it, then I hurt my knee and was walking with a limp, it has flared up again so bad it makes me cry. Back to doing the cobra thingy religiously!!

[NbyNW]

Knott, all that talk about collagen has me wondering -- is there anything nutrition-wise that helps that process along?

[KnottedYet]

Knott, all that talk about collagen has me wondering -- is there anything nutrition-wise that helps that process along?

Not really. The body wants to heal the area, that's part of why it hurts. It hurts because it's out of place and it hurts because it is inflamed. Inflammation is your friend: it is increased metabolism and circulation and collagen production and white blood cell excitement, etc.

If you are not eating adequately, the body will borrow from existing healthy tissue to supply the repair. Robbing Peter to pay Paul.

That's why we jump all over athletic folks who decide to cut down their food intake while they are injured, because they are afraid they will gain weight. No, no, no! You need continued performance-level nutrition to fund and fuel the repair! Repair is expensive! Eat good food and lots of it, no dieting during repair.

The best way to help repair is to keep the parts of the joint functioning and lined up where they belong. It's like a slow setting glue. You gotta keep them lined up for at least a week (no symptoms at all. pain = not lined up) before you can begin to assume the glue has "set." If they keep coming apart, all that glue goes to waste and the body has to start all over again.

SFA mentions not being fused. THIS is the fusion process. This IS the repair. Put them where they belong and work on keeping them there until you can keep them perfectly there for an entire week. Any time a sypmtom shows up, you start your week over. (symptom = oops, we lost it, start over)

[sfa]

I assume you are doing this 10 repetitions, every two hours? (so 8 or more sessions a day)

How long does the relief last? You may need to do it more frequently for a few days: for example, if relief lasts for 35 minutes, you may need to do the movement every 30 minutes, etc.



Hmmm, more like just three times a day (once in the morning, right after work, before bed). I'll up the frequency, even if it means looking like a fool lying down on my office floor! One of them involves an exercise ball, so that's not happening at work. The relief lasts about an hour or so, but can be longer depending on my overall activity level.

Thanks so much for your help!

Sarah

[KnottedYet]

Hmmm, more like just three times a day (once in the morning, right after work, before bed). I'll up the frequency, even if it means looking like a fool lying down on my office floor! One of them involves an exercise ball, so that's not happening at work. The relief lasts about an hour or so, but can be longer depending on my overall activity level.

Thanks so much for your help!

Sarah

Oh my goodness!!! You DO have your corrective movement! Fabulous! If you know relief lasts about an hour, then I'd suggest you try to do the movement every hour. Your goal is to never let it slip awry enough to hurt, chase it back into place before it even THINKS about slipping awry.

This is so exciting, you've already got everything you need to fix it! Choose the one exercise that works the best (gives the best relief) and do that one 10 times every hour. Don't wait for the SI to hurt (by which time it's already awry), fix it before it gets the chance to hurt. Doing a movement 10 times will take about 45 seconds out of your hour, well worth it to get the healing process rolling.

After a few days you may find the SI is less sloppy, and you may be able to decrease the movement to every 2 hours. It gets less sloppy as collagen builds up without getting torn asunder every time the SI moves.

You know how to put the SI right, you know how to make your pain go away. Don't put up with any pain! Get rid of it! You have the power!

[Pax]

Knott - I LOVE your enthusiasm for your work!

[tctrek]

Wow! I've had SI problems for several years after falling down oak hardwood steps on my butt and back. It was so painful to sit down that I worked standing up at my desk for 1.5 years. Visit and visit to the PT's and chiropractors and icing it down. After about 4 years I have it mostly under control, but it will flare up if I don't sit up straight or sit in a soft chair.

I've been doing Feldenkrais lessons for a few months now and it is also helping me. Another funny thing that helps me when my back gets tight is to get on my hands and knees and totally relax my stomach muscles.... kind of like those yoga poses where you make your back convex and concave.

But no one has ever explained it like Knot did. That was absolutely awesome.

sfa --- I really hope you find the clues from your body about how to get past this.

[Pax]

...But no one has ever explained it like Knot did. That was absolutely awesome.

I know what you mean, when I ruptured a disk in my back last year I came here and asked Knott to help me understand what my PT was talking about...she made it crystal clear for me and I got sooo much more from my PT sessions after that!

[colby]

Knot: You rock. That is all.

[KnottedYet]

I'm glad all my ranting and raving is useful. I work at a clinic where the major emphasis is on educating the patients. I don't heal anyone, I teach them how to heal themselves. I rarely touch patients. I don't use modalities (ultrasound, electrical stim, traction) other than hot or cold packs every once in a great while. People already have a good idea what is going on. The body is already working like sixty to fix itself. They just need some guidance to make it happen faster and more efficiently.


Another funny thing that helps me when my back gets tight is to get on my hands and knees and totally relax my stomach muscles.... kind of like those yoga poses where you make your back convex and concave.


Yoga is cool beans. Here's an exercise program that's been refined over 3,000 years. How can PT beat that? (ummm, by stealing yoga poses... which we do shamelessly) Here's a system that's been studied over generations. Lots of attention paid to aging bodies, injured bodies, and what happens to them over years and years. Student learning from mentor, and then watching mentor's body change until death. Incredibly valuable stuff. Yogis had disc problems. Yogis had SI problems. They knew this stuff over the lifetime of the patient.

TCTrek, if doing the cow part of cat/cow feels good, consider doing the cobra as well. Both are extension of the lumbar spine at the sacrum. Remember, the only way we can reach the pelvis (ilium and sacrum) is through the bones that meet it (femur and lumbar spine).

[tribogota]

whining is underrated!

[Kathi]

Knot: Thank You so much for this information. Due to your post I now have a better understanding of what is going on with the SI joint and that this issue may not magically go away. My second PT gave me a basic understanding of what the SI joint does but didn't go through the detail that you did.

Last year I suffered with pain in my right hip, knee and foot. Several different Drs., 4 mos of PT and an MRI didn't shed light on the problem. The 1st Pt said my right side was weaker than the left but he couldn't figure out why. When I'm in rehab for an injury I faithfully do my exercises prescibed by my PT but the prescribed exercises to strengthen my right hip made me hurt more so I quit doing them. I resorted to bracing my knee when I exercised because it made my hip feel better. The MRI showed osteoarthritis in my right hip and SI joint, which was attributed to the source of my pain, except my PT said I didn't move like an arthritic person. When I was released from PT I was still experiencing pain and had no resolution as to the cause.

I saw a PT who did bike fits because I couldn't ride. Instead of a bike fit he decided to check me out and found my left SI joint was locked. One exercise prescribed and 3 visits and all the issues went away, including the knee pain which had been diagnosed many years ago as chondromalicia.

I copied your post to my exercise blog so when I do things that make my SI joint angry I have reminder of what is going on. Please continue to share your wealth of knowledge with us. It is very much appreciated.

[wavedancer]

I want to tell him to just get a meat mallet and whack the joint into place. Somehow I don't think that'll be too helpful, though.

My SI joint went out for the first time last fall. My chiropracter tried some adjustment, but it was still giving me grief. It didn't hurt while I was riding, so I went to a cyclocross race the next weekend. I had one crash, and when I got up, the pain was gone. Maybe meat mallet is an alternative ! :D

And thanks, Knott for the in depth info.

[KatzPajamas]

KnottedYet! Thank you so much for your expertise! I injured my SI joint in July 2012. I could barely ride 8 miles after a summer filled with 40-50 milers. I tried anti-inflammatory meds, began working on my core strength and regular visits to a kinesiology chiropractor. I even had a steroid injection in June of 2013 and a perfectly normal MRI. The steroids helped for a few weeks, and I have tried every stretch and exercise that I can find to help the pain. I am often awake off and on at night due to the pain. I read your recommendation of gently squeezing the pillow...so I tried it. The immediate relief has lasted about 6 hours so far! It is miraculous! How could it be so easy and simple?!?!?! The last few days have been difficult due to the pain, and here I am as tho the pain never existed...without the help of medication or chiropractic adjustments!!!! I will definitely be doing this as often as your post suggests! After a year and half off of my bike, I may just be able to get back out there in the spring!
THANKS!!!!