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.