Ongoing pain - SI Joint?

[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. 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!)