SI Joint Pain...Frustrated.

[daisylubob]

So, these are probably stupid questions, but I am impatient when it comes to healing up.

How long before the little disc goes back into its place? Will the pain go away gradually, or overnight magically disapper? And how will I make sure it stays there once it is back in place? What are the chances of it coming back out, especially if the biking position (flexion) may have exacerbated it?

I really hope this works.....

[KnottedYet]

Sally is the best person to answer these questions, because she's seen you and observed the behaviour of your disc.

But, in general:

The disc goes back into place immediately with the corrective motion, or at least partly into place with one set and the rest of the way with the next set or two. The tests Sally did when she had you bend every which way told her how well your disc was going back into place and she based her choice for your first corrective motion (cobra and cobra with overpressure) on what seemed to put your disc back where it belongs.

However, the little booger doesn't stay there... That's why you are doing the corrective motion a gazillion times a day. You are essentially herding cats; chase it where it belongs, it starts sneaking out, chase it back in, etc. and so on.

Your body has been trying to glue the wayward disc where it belongs all this time. But the disc wasn't staying there, so it kept tearing up the glue before the glue had a chance to set. Imagine it is glue that takes a week to dry. If the disc shifted even once during that week, the glue didn't have a chance.

Your corrective motion lets you keep the disc in place long enough for the "glue" to "dry."

If you keep it mostly in, the edges of the bulge will "dry" first. Pain over all begins to decrease. As the glue gets a chance to build up, the disc becomes more and more managable. Eventually the disc is stable enough (the bulge has gotten small enough) that you can get the whole thing into place and it stays for awhile. When it's all the way in, you have no symptoms. You keep it in place for a full week, using the corrective motion prophylactically and your posture. You need to stay symptom free for a full week. Usually by that point the disc repair is complete (the glue has dried undisturbed for a week) and you do a maintainence exercise for a few months to make sure the body gives you the most beautiful repair possible.

Pain is pretty unpredictable. Sometimes irritated neighborhoods stay irritated for awhile. Sometimes relief is immediate, but pain comes back as soon as the disc shifts. More important is your overall sense of "better, worse, or the same," and Sally's evaluation of the quality of your segmental motion as "better, worse, or the same."

Once you have repaired the disc, talk to Sally about ways to keep it from happening again. In all likelihood the biking DID NOT cause the disc to wander out in the first place. Usually the cause is poor posture, and then something else is the final straw. If you are concerned about your biking posture at that point, ask her to check your bike positioning for you.

Really, it will get better! All you are doing is using your body's own corrective motions and processes, and doing them more often than usual so that the process your body was already working on can proceed faster and more efficiently.

Be diligent. If you feel unsure, call Sally and tell her how your back is reacting. The first week is a little rough because the disc bulge doesn't really want to go back into place and it sure doesn't want to stay there. The more time it spends in place, the more fresh collagen builds up without getting torn, the smaller the bulge gets, the easier it becomes to manage.

[daisylubob]

That all makes perfect sense. I have been DILIGENTLY doing the modified cobra positions since 3/18. Back feels better, still bothers some when I sit at work, so I am trying to avoid that for long time periods. After work, I am going for a trial bike ride to see how I feel! Fingers are crossed!!!!

[KnottedYet]

Just remember that there is no way the disc could be completely glued down yet. This test ride is just to let you know if you can be biking (or how much you can be biking) during the repair process.

(We never tell someone they can't do an activity, you have to try it and see.)

I'm glad it seems to be helping! Keep on herding that critter back where it belongs! After this first week is over, it will start to stay in place better and better, so hang in there!

Symptoms tell you the disc is wandering off, so when you feel them immediately get off the bike and chase the disc back into place. This is one of those situations where "no pain, no gain" is a COMPLETE AND TOTAL LIE!!!!

[daisylubob]

The test ride did not go well, I gave up after only 20 mins on the bike. And I have some soreness this morning. I guess that tells me I need to stay off the bikes for a lllloooonnngggg time. This is not going to be easy, I don't handle injury/ lack of exercise very well......My husband suggested trying a different bike (upright, old-lady type) and I about bit his head off. I know he was just trying to help, but it did not sit well. I mean, c'mon, how am I supposed to go out and ride 40, 50, 60 miles on this...

http://www.giant-bicycles.com/en-us/...le/4207/36648/

[KnottedYet]

Not a long time!

A couple weeks, a few weeks!

Get the back fixed (remember, I said there was no way the disc would be stable yet?). Once Sally is certain your disc is fixed, and if you try the bike again and it hurts, then you will know you need to address bike fit and positioning issues.

Clearly something is pretty off with your bike fit or bike posture right now, because the bike is what really hurts the most. However, you can't address that until the disc is healed, because right now it's just confusing the issue.

When you can sit at work without pain, try the bike again.

It hasn't even been a week yet.

Keep chasing that disc back into place.

(if you had gashed your hand open with a kitchen cleaver, would you expect it to be healed up and functioning perfectly after 5 days?)

[Kathi]

Patience is the key and raising your handlebars, although the common solution was not the answer for me.

I had a locked SI joint and went through 4 mos of pt etc. but still in major pain (for me) after PT ended. 3 visits to a wonderful pt settled everything down. Before I met this PT I thought I was doomed to a lifetime of pain, today, less than a year later I'm back to full activity, right now, for me it's downhill and xc skiing, snowshoeing and hiking.

My wonderful bike fitter found my saddle was too wide for me and pushing me forward so he put me on a different saddle. He also changed the pedals on my mtn bike so my knees wouldn't cave in. If you haven't had a professional bike fit please do so, it can make a huge difference in how you feel. A good bike fitter can help you, working along with your PT to work out issues dealing with your pain.

[daisylubob]

Not a long time!

It hasn't even been a week yet.

Keep chasing that disc back into place.

(if you had gashed your hand open with a kitchen cleaver, would you expect it to be healed up and functioning perfectly after 5 days?)

Yeah, yeah. I am very impatient when it comes to healing. But, I will persevere and get this figured out!! Maybe I will end up mtb racing on one of these.....
http://www.giant-bicycles.com/en-US/...le/4207/36648/

Thanks for all of your advice, and support!!!

[Chile Pepper]

Wow. I have learned so much from reading this thread. Knot, you are amazing. Thanks for all your input!

[daisylubob]

I saw Sally this morning, she is 99.9% sure that it is a bulging disc at L4-5 or L5-S1 due to the symptoms that I get. And when I do the cobra movement, it improves. Next appt is 4/5, I am to stay off the bike til then, and continue the stretches. She said an MRI would not be a bad idea, just to confirm or rule out disc issues.
As for bike fit, I have had 2 done by the Specialized BG fit system. At this point, it may be helpful to be more upright on my bikes. And I have put mtb racing out of my mind til I am 'fixed'.

[KnottedYet]

As for bike fit, I have had 2 done by the Specialized BG fit system.

Ah-ha.
After your disc is healed up, lets have a little discussion about bike fit philosophies.

[lisathew8lifter]

you will definitely not like the answer that i'm going to give you but the ONLY way to ever fix this is to take the time to heal and to strengthen your core.

on august 21 i went to a sports med doctor in the twin cities that also treats olympic athletes. i was desperate and in massive pain. i mountain bike, i run, i lift weights and i did classes at the fitness center. i couldn't lay down, i couldn't sit, it hurt to do everything. EVERYTHING. i got a new bike, i went back several times to adjust it. i took 4 motrin before every ride...nothing cut it.

when i went to see amy, she could tell immediately what needed to be done just by looking at me stand, sit and walk. i was skeptical...really...you're going to help me after seeing me two minutes? she said women are prone to pelvic instability and she knew it was SI joint. i had never heard of an SI joint much less thought mine hurt. we started with xrays and went from there.

the xrays didn't tell the full story so we went for an mri. stress fracture in right tibia (running) and disc degeneration. the mri was the worst since i had to lay for 1.5 hours...that is soo not right.

she said the degeneration could be causing pain or maybe not, but i proceeded to have two shots of cortisone in each SI joint. i have never been so happy as the relief i immediately felt after each shot. again, i was desperate..not going to live on advil, not going to quit exercising. when the doctor told me i needed to quit, i cried. it was august...summer still...bike season, i had vacation plans and they involved biking. BUT...i wanted to heal and i knew that i needed to treat the condition or i'd be talking about this forever.

soo...my point is that it takes time. this is NOT a quick fix. not even close. if you want to enjoy yourself and become better at the sport, whatever your goal may be, you need to resign yourself to the fact that you need about 6 months of very low impact (or no impact) activity WHILE you do PT. i am lucky, i had the means and the time to do PT but it was a long road. i was fortunate to get in the hands of the best PT in this area...specializing in this type of injury. it was a long time coming, many years of abuse and over use and using the wrong muscles. i had no core strength, was breathing through my back, using my back for everything i did. i started with limited ranges of motion and no strength and now i have stregnth. this is going to be a life time of PT (on my own now) and continuing to build on what i already do an know.

yes august 21 until february 27...that is SIX months. i walked outside and on the treadmill and did my PT. six months. no biking, no running, nothing. if i lived to tell about it, so can you. i am running, haven't yet started biking (mn - still colder here - but soon) and i am so excited to start because i know that i'm going to be pain free when i do.

bottom line, you know what to do, now do it. if i can, anyone can!

[daisylubob]

UPDATE:
Xrays show disc degeneration and bony changes (arthritic type) in the lumbar spine. MRI is next, and I have an appt w/ a neuro DR who is a cyclist on 5/17. I am not liking the sound of this....scared.

[yellow]

UPDATE:
Xrays show disc degeneration and bony changes (arthritic type) in the lumbar spine. MRI is next, and I have an appt w/ a neuro DR who is a cyclist on 5/17. I am not liking the sound of this....scared.

Don't be...EVERYONE has some amount of disc degeneration and, yes, even arthritis. Some people are asymptomatic their whole lives. Others, not so lucky. The xrays probably show narrowing between the vertebrae, which usually indicates degeneration. Only the MRI will tell the extent/level of degeneration. Deep breath, and wait for the MRI results. Talking to a neurosurgeon is not a bad thing, but you also might want to consult a physiatrist (non-surgical).

After years of pain and trying to fix it on my own, I ended up having lumbar fusion. Life is way better now, and I'm still early in recovery. I'm not saying this is the answer for you...I tried just about everything out there you can try and would be happy to go on and on about it all via PM if you'd like.

Above all, you need to have patience. Take your time. Open your mind to solutions that might not be something you ever thought of.

I hope you find relief soon.

[KnottedYet]

UPDATE:
Xrays show disc degeneration and bony changes (arthritic type) in the lumbar spine. MRI is next, and I have an appt w/ a neuro DR who is a cyclist on 5/17. I am not liking the sound of this....scared.

Don't be scared. Your xray sounds perfectly normal. Remember, the "standard" is a 20 year old male. If your spine doesn't look like a 20 year old male, you are degenerated.

Don't pay any attention.

If your problem required surgery, it would be giving you unremitting agony. As it is, you only have pain on the bike after 20 minutes and if you sit at work too long. If your symptoms are absent some of the time, then you just need to let the body heal so they can be absent all of the time.

(And you need to have someone with a PT background check your bike fit and biking posture.)