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Walking, sacroiliac joint dysfunction and hip pain
Featured in: Nutrition & Life
Walking incorrectly may "unlock" the SI joint, leading to SI-joint related low-back pain as well as wear and tear in the acetabulum.I was going to write about something else this week, but I've been noticing something in my practice, and I figured I'd better write about it before it slips my mind.
I should also apologize to all my wonderful SI joint teachers who took the time to really coach me with respect to SI joint dysfunction, (Diane Lee and Linda Joy Lee, Marcy Dayan, Paul Chek, Shayne McDermott, David Ewert, Mark Finch, Tom Myers, and most recently, Richard DonTigny), because it is very probable that you actually did teach me this, and I forgot and have now simply relearned it for myself.
For those of you that are not in the medical, physiotherapy or exercise field and have no idea what and where the sacroiliac joint is, it is the joint between the sacrum (the triangular bone at the bottom of our spines that the tailbone is a part of) and the pelvis. People that have SI joint pain frequently point to the "pelvic bump" area in the very low back where the dimples are as the achy spot, and that pain is often one-sided.
For non-medical/exercise people, skip to the next paragraph where I'll explain this more simply, but for those in the field, what I've noticed is that most people that get SI joint pain seem to walk using their hip flexors as the prime movers. While walking quickly, the pelvis is frequently in anterior tilt and/or there is a distinct forward lean of the trunk, and very often the person with the dysfunction is "pulling" their legs forward rather than "pushing" them. In my practice at least, using the hip flexors to walk seems to be a far more obvious pattern in SIJ dysfunction than a Trendelenburg sign , although the patterns do frequently go together. I realize that someone in anterior tilt also tends to have poor local stabilizer and poor glute function, but I have found that even when someone has generally improved their pelvic position and been trained to connect to those muscles in other functional patterns such as stand-to-sit-to-stand, unless their faulty motor-recruitment pattern in walking is also corrected, the SIJ pain does not go away due to the constant forces trying to unlock the joint. So I have put gait to the top of the priority list, and have been spending a lot of time recently teaching people how to walk - and it seems to be helping. Because I frequently see this same faulty walk pattern in those that have had or are about to have hip replacement surgery, I think it is possible that overuse of the hip flexors during gait may pull the femur slightly forward in the acetabulum, potentially creating a wear problem leading to the need for hip replacements. Therefore in my opinion, correcting this faulty gait as soon as it is recognized (possibly in late childhood or adolescence) may go a long way toward not only reducing future pain and suffering, but also reducing the need for hip replacement surgeries. If a study has not already been done on this, I think the idea has potential!
Probably the easiest way to explain how poor pelvic position affects gait is to actually try it and feel it in your body. So, stand up, and pretend that your pelvis is a bucket, and you are pouring water out the front. You should feel like you are sticking your butt out behind you, and you have a big arch in your low back. Now try walking while maintaining this pelvis position. Notice how you have no choice but to use the front of your hips to move your legs? Notice how effortfull this is? Not good. Hard on your SI joint, hip joints, low back, turns off your local stabilizers and your gluteus maximus, and way over uses the hipflexors and quads. If you have SI joint or hip pain or if this is how you tend to walk, it may be worth your while to try a different way.
First, stretch your hip flexors gently for a minute or two. Then, while hanging onto something, try standing as tall as possible on one leg on a small stable stool or a stair, tucking the tail under slightly (hold the bucket level so no water spills out) without squeezing the buttocks, so that the other leg can hang down completely suspended from the hip socket. You should be able to swing the leg like a pendulum with no muscles gripping the leg bone at all - it pretty much moves by itself with no muscle effort. That is how one's leg should feel in the swing phase while walking - loose, like it's hanging, and pretty much moving by itself. So, now get down from the step and try walking. The trick is to walk while standing as tall as possible - this will frequently be enough to bring your pelvis to a neutral position. If you can't get that "hanging" feeling at the hip joint while you walk, stretch your hip flexors again, stand taller, and tuck your tail under a bit more by using your lower abdominals to gently pull up the pubic bone. If you are walking correctly, you will not only feel like your legs are floating, but you will also feel that any work that is happening is coming from the back side of the body rather than the front side.
Related Posts
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Lee, Diane The Pelvic Girdle Churchill Livingston, 2004.
Lee, Diane and Lee, Linda Joy An Integrated Approach to the Assessment and Treatment of the Lumbopelvic-Hip Region DVD, 2004
Lee, Diane and Lee, Linda Joy Postpartum Health for Moms - An Educational Package for Restoring Form and Function after Pregnancy CD ROM 2006.
Lee, Diane Assessment Articular Function of the Sacroilac Joint VHS
Lee, Diane Exercises for the Unstable Pelvis VHS
Richardson, C, Hodges P, Hides J. Therapeutic Exercise for Lumbopelvic Stabilization: A Motor Control Approach for the Treatment and Prevention of Low Back Pain Churchill Livingston 2004.
DonTigny, Richard Pelvic Dynamics and the subluxation of the sacral axis at S3 The DonTigny Method.
Myers, Thomas Body Cubed, A Therapist's Anatomy Reader "Poise: Psoas-Piriformis Balance" Massage Magazine, March/April 1998.
Myers, Thomas Body Cubed, A Therapist's Anatomy Reader "Fans of the Hip Joint" Massage Magazine, Jan/Feb 1998.
Myers, Thomas Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists Churchill Livingston, 2001
Chek, Paul CHEK Level 1 Advanced Back Training Chek Institute.
Johnson, Jim The Multifidus Back Pain Solution: Simple Exercises That Target the Muscles That Count New Harbinger Publications Inc. Oakland CA, 2002.
Lee, Diane Understanding your back pain - an excellent article explaining the concept of tensegrity and its importance in stabilizing the pelvis and spine.
DeRosa, C. Functional Anatomy of the Lumbar Spine and Sacroiliac Joint 4th Interdisciplinary World Congress on Low Back & Pelvic Pain, Montreal, 2001.
Gracovetsky, S. Analysis and Interpretation of Gait in relation to lumbo pelvic function 4th Interdisciplinary World Congress on Low Back & Pelvic Pain, Montreal, 2001.
Dananberg H. Gait style and its relevance in the management of chronic lower back pain 4th Interdisciplinary World Congress on Low Back & Pelvic Pain, Montreal, 2001.
Online at www.kalindra.com A fantastic website devoted to sacroiliac dysfunction.
Copyright 2007 Vreni Gurd
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I have always been interested in what we can do to make ourselves as healthy as possible. We cannot change our genetics, but there is much that is within our control that can have an impact on whether we are healthy or whether we suffer with pain and disease.
I was the top graduating student at the University of Toronto in Physical and Health Education in 1992, where I studied anatomy, physiology, exercise physiology, nutrition and how exercise can improve health. In 1997 moved to Vancouver and started a personal-training business.
I became frustrated by my inability to help my clients through their various aches and pains, and pursued further education through the CHEK Institute in San Diego. I learned an incredible amount, and became far more effective with my clients suffering from low-back pain, but still found some clients did not respond as I felt they should and I didn't understand why.
I began to read and read. I began to appreciate how nutrition and other lifestyle factors can have a huge impact on healing or the lack of healing. It became obvious to me that there is a lot more to orthopeadic problems than simply looking at the physical. I took the CHEK Holistic Lifestyle Consultation course which solidified what I had been learning. Disease is a function of bodily systems being out of balance, and when we do what is necessary to bring the individual back into balance our health is restored.
My hope is that through this site you can travel the wellness journey with me and prevent illness, or if you are ill, you can learn some ways to become well again.
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Comments (83)
Hi there,
Glad to know you got over your SIJ problems.
I agree that when there is a malalignment at the SIJ, whether one-sided or bilaterally, problems may occur either up the chain into the lower and upper back, ribs, shoulder or neck, or down into the hips, knees, ankles or feet. I also agree that many scoliosis problems are more likely to be based in a malaligned pelvis causing muscle imbalances in the hip muscles rather than an actual leg-length discrepancy and I think scoliosis almost always comes from below (although it is possible that the neck, particularly the upper two vertebrae, may be driving the pelvic malalignment, which is in turn causing the scoliosis.)
No matter what the SIJ malalignment, whether an upslip, rotation, outflare, inflare - whatever, the first step is to correct the alignment. I find Richard DonTigney's program works quite well for that (I have a link to it in the post above). Then the second step is to stabilize the joint with transversus, pelvic floor and multifidus work as well as to correct any muscle imbalances through appropriate stretching, and the 3rd step is to look at all movement patterns and ensure that the motor recruitment is good, so that the SIJ is not being pulled out of alignment by poor motor recruitment habits.
Thanks for your comment, and giving more info on the topic!
Vreni Gurd
Health and Vitality Coach
BPHE, CHEK 3, HLC 2
www.wellnesstips.ca
Hello Vreni,
I agree with your comment about Scolios starting from below.
I have had lower back pain for since age 19 or so. I am now 36 and it is much better.
I used to be a competitive runner (400 and 800 metres) and have had several lower back and knee related problems (ilio tibial tendon syndrome, lateral lordosis, SI joint dysfunction, poor pelvic movement, prolopsed / herniated discs - L4 and L5) . I also did used to cycle bent over, racer style and had a trauma three years earlier direct on my tailbone when someone kicked my feet out from under me from behind. In my opinion, though, the immediate cause of the pain was the daily running training with poor coaching.
Of course, of the injuries, only the last (L4, L5 discs) could be verified for myself through imaging technologies, the rest also depended greatly on doctors' opinions through the the SI joint problem responded to manipulation) . The lower back pain was much more on the right side with very slight numbness behind the thigh on occassion.
I was told to give up running - while I was willing to drop compeitive track, totally giving it up was something I was not prepared to do.
With lots of reading and talking to open-minded doctors and physios, the following things helped me:
1) Greatly increasing lower abdominal strenght (i.e. being able to keep both legs raised and horizontal for almost a minute while hanging).
2) Increasing gluteal (?) strength and flexion by doing deep squats with light weight.
3) Cutting down on stretches that could encourage hypeflexion in the back of the legs and hip.
The three above did reduce pain during exertion and movement while running but didn't reduce postural or immobile pain e.g. while standing or sitting (assuming your feet can rest firmly on the floor).
2) The 2nd problem was taken care of by shoe inserts. This was based on a few assumptions: a) the assumption that an incorrect foundation or alignment in an load bearing column will cause misaslignements further up. Think of a column of bricks. If one brick is displace forward, then the next one above to be displacedbackward to keep balance, and the next one furher above has to be displace forward again and so on. b) Physics law of action and reaction. If weight pressing down on the SI joint exists only when there is a supporting force pressing up through the feet and legs. If that chain incorrectly transmits the force of impact on foot strike the effect could be felt anywher above including the SI joints. My own estimate, based on back of the envelope calculations is that when running full speed (say 100 m in 13 seconds) on a hard surface your feet can strike down with rebound force of 15 or more time your body weight.
Anyways, going forward with the above assumptions, I thought that there may be something wrong with my foot. It is then that I remembered that in early childhood around age three years I was diagnosed with flat feet and had to wear orthopaedic boots for two or three years.
Armed with this information, I purchased orthopaedic insoles with a posted heel and arch support. The heel is thicker on the inside i.e. the raised arch support continues to taper gradually towards the heel.
That days was my first entire pain-free day in years. I had in fact spent all day on my feet visting museums and in the evening went for a short run too. That was also pain free even though it was on a tarred road surface, not a soft surface.
In short, you did mention that there are some patients of yours who don't get cured of SI joint dysfunction. I would suggest that the problem could be due to over-pronation or flat feet causing anterior tilt of the shin bone along with some lateral rotation of starting from the ankle joint in turn causing an inward lateral rotation of the femur in turn causing an anterior tilt of the pelvis causing SI discomfort. If one foot is flatter or more pronated than the other, it will cause apparent leg-length discrepancy, lateral pelvic tilt and corresponding focus of back pain on one side.
Here's the link to an article which talks similary (para 8)http://www.chirosmart.net/rst/sone.txt . These is the shoe insert I purchased, a Podiatrist at Eneslow was able to disgnose in half an hour what back and spine experts had missed for years. L420 insole (see http://www.eneslow.com/html/launch.cfm?siteid=4&itemcategory=111&priorId=27) and L620 insole (http://www.eneslow.com/html/launch.cfm?StartRow=9&itemcategory=111&priorId=27&siteid=4) . This is not a commercial plug, if you like you can redirect to any link pointing to similar shoe inserts, it's just that I know that the ones advertised here work.
Regards,
Vikram
Hi Vikram,
I completely agree with you that SIJ dysfunction can come from the feet, and it often does. If the feet are flat, that will usually cause an internal rotation of the femur, medial instability at the knee, weak gluteus medius muscles at the hip, and frequently an anteriorly rotated pelvis, which would lead to the SI joint unlocking. This can be particularly problematic as you point out, if one foot is flatter than the other, which would create a torsion in the pelvis.
The trick in all this is figuring out what is driving what. Is it the feet? Is it the upper two cervical vertebrae? Is it a breathing problem which throws the head forward causing problems lower in the back? Is it standing on one leg more frequently than the other? Is it working as a cashier where you are rotating in one direction all day long causing a muscle imbalance in the pelvis and trunk? Was there some acute trauma to the joint? Is a poor diet causing a leaky gut problem, which would then through the neural reflexes turn off the neural control to the deep local stabilizer muscles that control the motion at the SI joint? An SIJ problem can be caused by any of the above, and probably a myriad of other reasons.
Only once the cause of the problem is dealt with will the orthopedic pain issue be resolved for good. Yes, we can align the pelvis and spine through chiropractic, muscle energy techniques, massage or what-have-you, and we can teach people how to stabilize their pelvis using the correct muscles, but these may only be stop-gap measures until the ultimate driver of the problem is found and corrected. That is why I think it is extremely important to look at body in a very holistic way. If someone shows up with a painful SI joint, usually the issue will not be resolved by looking only at the SI joint. The SI joint is the victim, and the challenge is finding the cause. Frequently the cause is far away from the SI joint itself, as you so clearly pointed out in your comment.
I'm glad the orthotics worked so well for you. You may also find it helpful to work on strengthening the arches of your feet. If your feet are extremely flat, you may never be able to get to the point of being able to run without them, but perhaps you will be able to tolerate walking if you happen to forget to put them in your shoes ... And you may also find it helpful to check with a knowledgeable physiotherapist to make sure you are using your transversus, multifidus and pelvic floor correctly, as these muscles dissipate forces away from the SI joint, which would be extremely important when you run. Just an idea.
Thanks for your helpful comment!
Vreni Gurd
Health and Vitality Coach
BPHE, CHEK 3, HLC 2
www.wellnesstips.ca
Dr. Andrew Levy of Center for advanced medicine, New Jersey
I just wanted everyone to know- stay away from this guy. After having my PCL replaced from Dr. Edward Decter (another Dr. to stay away from) Dr Levy was fast to shoot down Dr. Decter, as he said I never needed the PCL operation in the first place- and why he calls him “Quick Eddie” Dr. Levy said the cartilage in my knee was dead and needed to be replaced- and performed the operation.
After the operation, my knee was actually worse then before the operation, Dr Levy told me a screw came lose and he needed to take it out. When I told him I was in between jobs and my insurance wouldn’t start for another month, he said that he would do the surgery for free- as long as I help him get the full amount from my insurance, for the first operation. I told him that I would see what I could do-and I appreciated him doing this operation for free.
After removing the screw which he said he would FREE, my knee was still killing me and I was barely able to walk- but figured I would give it some time. I kept my promise and contacted my insurance company. I was told- what they pay the Dr. has nothing to do with me and I shouldn’t call again. After 3 months- my knee still killing me and having trouble walking, I was shocked when I received a bill from Dr. Levy for the amount of $16, 376.00. The bill was for removing the screw, plus the difference my insurance didn’t pay him for the first operation. I tried calling him for 1 month, to try and find out why I received a bill for something he said he was doing for free- He never took my call.
After receiving a letter from his attorney a few months later- I started speaking to attorney’s to see what I could do. They all said the same thing- you signed a waiver from the first operation and you have no proof that says he was doing it for free. I had the pleasure of finding out yesterday, that Dr. Levy’s attorney put a Levy on my on my bank account, which withdrew EVERY penny I had. My mortgage payment and many other checks I wrote bounced- leaving me scrambling to find out how I am going to pay all these bills- since my once a month commission check is now gone, along with my entire savings.
Dr. Levy is a POS that did nothing for my knee and has now turned my life upside down- just in time for the holidays. Happy Holidays Dr. Levy!! Stay away from him- he is a liar the worst Dr. in the tri-state area!!
Please pass this letter to anyone who is thinking of getting orthopedic surgery- so they don’t find themselves speaking to Dr. Levy
You can also have problems if you drive with your wallet in the back pocket of your pants.
#7: Good point!
Yes, if the joint is unstable, and depending where the wallet is pushing on the pelvis, I can see that it may push the ilium forward unlocking the joint. Also, with a wallet there, one would be sitting in a torqued position in the seat which in itself may cause problems. Thanks for bringing this up!
Vreni Gurd
Health and Vitality Coach
BPHE, CHEK 3, HLC 2
www.wellnesstips.ca
Hi, What might you recommend when custom orhtotics, physical therapy and core exercises fail to restore si joint function??? I have run the gamut of physicans and traditional medicine and still can't get much better. Here is a brief synopsis and history: I am 37 years old. I had my second c-section 16 mons. ago and just weaned my son. It has been 10 months since I learned I had SI problems after starting a walking, jogging, and gradual running program after the ok from my obstetrician. I started running more and then one day I could barely walk. My back, hip, and knee was also hurting. I did have some hip pain during the pregnancy and saw a chiropractor. From what I understand, the hormones during pregnancy, postpartum and during breastfeeding contribute to relaxed ligaments. My physical therapist told me she personally believes postpartum ends a year after stopping breastfeeding. She feels only then will my SI ligaments fully return to normal. She said she can't do any more for me since I can at least return to some exercises and do daily chores even though I still have pain. She said everyone has some pain and inferred that at my age pain is expected?? I feel that my chiropractor contributed to the problem after reading some of Mr. Dontigny's info. : a forceful adjustment called "million dollar roll" I believe. I have been told I have idiopathic scoliosis and that by one sports med doctor said I needed a heel lift. The chiro. told me I didn't need a heel lift. The podiatrist said I needed custom orthotics because I had the beginnings of bunions and bunionettes. I wear them, but am not convinced they are helping as far as SI function is concerned. I have been told I have IT band syndrome as well. I have had an mri on my knee an emg on my leg. I have had one round of prolotherpy performed by a physiatrist so far and will be returning for another soon. I feel that is probably my last hope??? I can't even do the eliptical machine or walk without pain. The pain is usually in my butt. Sometimes it becomes so bad I have to take pain medication and lay down. A few days ago my hip was hurting so badly I was limping for a few hours. I have begun doing the DvD " Better Abs, Buns, Back by Chek to strengthen my core. I believe it will improve my posture as well. I am aware of Mr. Dontigny's self corrections and I have self taught them. At times they do help. I have read all of his info. on Kalindra's SI resources. I have a Serola belt but when I have tried to wear it, I walk strangely and it rubs my upper IT band and makes it more inflamed so I have not worn it. Any info. is greatly appreciated. I hope this all makes sense. I have tried to be brief yet detailed. Thank you for your time!! Sincerely, Dee
Hi Dee,
It's great to see how proactive you have been in trying to help yourself recover - that bodes well! The only way to tell for sure if you have a leg-length discrepancy is through an X-ray, but most of the time there is an appearance of a leg length discrepancy, but it is actually caused by a subluxation in the SI joint and muscle imbalances in the hip. Developing SIJ problems after pregnancy is VERY common, and especially after a C-section, as the stabilizer layer (transversus abdominis) of your abdominal wall has been cut. Even though the muscle has been sewn back together again, function is often disrupted, and you need to relearn how to use that muscle to stabilize your pelvis. So, my bet is your problem is more related to the front part of your stabilization circle than the back. You did not have SI joint problems before having children?
I completely disagree with your physio that pain has to be something we accept as we age. And you are only 37! I would continue to work with the Dontigny corrections, as the first step to recovery is to get that SI joint aligned properly. The next step is to find your transversus abdominis, and get good at using it. You may need to find a physiotherapist that is familiar with how to cue TA, and better yet, find one that uses a real time ultrasound to help you through biofeedback. (That is probably a very tall order!)
Try lying on the floor on your back, and gently try and take the tissue just above your pubis, and SLOWLY draw it in, as if you want to wrap that tissue around the back of the pubic bone. You should feel a muscle contract in the centre, just above your pubic bone. Another cue that may work, is to try and draw the two pelvic bones (ASISs) towards each other. You should feel a deep tensioning across your lower abdomen. Pulling up your pelvic floor by lightly squeezing your anus, stopping urination, or gently pulling up your vagina should create a transversus contraction as well.
You can try this while standing. Let your gut hang out completely, and then try and draw in the part well below the navel. If when you draw your belly in it is happening at the navel or above, you know you are doing it wrong. And don't be surprised if you manage to do it once or twice and then can't anymore - your nervous system will tire very quickly. Just take a break and then go back at it a bit later. Better to practice for a minute once an hour than to try for an hour a day all at once.
Once you can find the muscle, try and hold a light contraction and breathe. Work on extending your hold times. Incorporate holding into standing, walking, sitting, lifting etc. And keep doing the Dontigny exercises at least in the morning and at night if not more frequently.
Prolo can be very helpful if the ligaments are loose, and yes pregnancy loosens them, but they will tighten up again. It is impossible to know, not seeing you personally, but my suspicion is that the ligaments in the back are not the source of your problem, but rather your stretched out abdomen from the pregnancy, and the problem caused by cutting the transversus. I worry that if you get too much prolo now, when your ligaments do tighten, they will be too tight, which may create a different kind of problem. You may want to discuss this with your prolotherapist.
As for a SI belt, I like this one, because with the velcro strap, you can add the compression where you need it. I think you may need it at the front. This article may help you understand your back pain from a different perspective.
You may find it helpful to stretch your IT band and TFL (personal trainer), and toe spreaders may help you avoid bunions. You should have complete control over all your toes, and an ability to spread them and make your feet wide. Toe spreaders can help you find your toes again, if that is an issue.
Good luck in your journey!
Vreni Gurd
Health and Vitality Coach
BPHE, CHEK 3, HLC 2
www.wellnesstips.ca
Dear Vreni,
Thank you so much for your feedback and help!! I appreciate your time very much!
I do not recall having any SI problems prior to my 2nd child and c-section. The only problem I have had prior is the IT band diagnosis and overall alot of flexibility.
I will talk to my physiatrist about becoming too tight from the prolo. He had told me my left side SI is tight and becomes "stuck" and my right is loose. My p.t. said the front of my pelvis is slightly forward and down on the right side, my back (si) dimple is slightly deeper than the right.
What you say makes sense to me. That may be why I also get some pubic pains at times also. I will start working on the TA as well as continue Dontigny's exercises/corrections.
I am very far from B.C. I just located a CHEK Level II and Holistic/Nutrition Lifestyle personal trainer in my area, Ohio, U.S.A. I will contact her. I hope she is as knowledgable in these areas as you are.
Thanks again so much! You have given me hope and encouragement!
Sincerely,
Dee
#11: Glad to help!
Hi Dee,
Do remember that my comments are only based on what you told me and no assessment, but at least it gives you a place to look!
If it is the R side of your pelvis that is forward and down, that is the side to concentrate the Dontigny exercises on. Once the pelvic bones seem even, do the other side, and keep switching back and forth until they no longer shift, but stay even.
Glad you found a CHEK Practitioner /Holistic Lifestyle Consultant to work with! She'll assess you and move you in the right direction ...
All my best!
Vreni Gurd
Health and Vitality Coach
BPHE, CHEK 3, HLC 2
www.wellnesstips.ca
Hi Vreni
I have been in physical therapy for 8 months now - mostly treating my si joint. We have tried othothics, gait modification, hip flexor, quad and hamstring stretches. We have worked the multifidus, and TA, and PF. I am still hypermoble. An adjustment lasts for 1 week at the most. I have been given self correction exercises but can only get the joint to go back into position about 10% of the time. I have tried a SI joint belt but it caused my back to hurt more so I quit using it. My PT has moved my limitations down over that last 8 months to the point that I am only suppose to lift 10lbs max from waist high. I have done the exercises religiously just as the PT assigned them. I have increased my calcium magnesium, and vitiamin C to help promote ligament healing. My PT is at a loss for what to try next. . When I have asked the PT why it is taking so long I am told that my age is a factor - I am only 45. Prior to this injury I was always active doing hiking, biking, skateboarding, cross country skiing, kayaking, road and mountain biking. I really want to be active again and hate the limitations that I now have. I hate to see my muscles atrophy from lack of use. Do you have any other things that I could try. I am very discouraged.
Any advice that you can give would be greatly appreciated.
John
Hi John,
It sure sounds like you are doing all the right things. Are you doing bridging exercises to strengthen your glute max? How about glute medius exercises, sidelying? These muscles are both very involved in not only moving you but in stabilizing the hip and SI area (especially glute medius, which lifts the opposite side of your pelvis up so you can swing your leg through in gait). Lats too, connect to the fascia that comes across the lower back. I imagine your physio has these covered ...
Another consideration may be the position of your top vertebrae. Sounds whacky I know, but often so goes the atlas, so goes the sacrum. Perhaps your physio can feel the transverse processes of the atlas and see if they feel even side to side, or if the bone feels rotated or translated. You may need to see a nucca chiropractor to get that bone gently nudged into place.
If your ligaments have loosened to the point that the muscles are not able to take up the slack, then you may need prolotherapy. A doctor injects a sugar solution (I think) into the ligaments, which tightens them up. Usually you need to go for a few treatments, and I don't think the treatments are much fun, but they can really make a difference to your stability in the long run. I've had a few clients that have found that's the only thing that worked.
I can imagine you must be very frustrated, if you are accustomed to an active lifestyle ... Good luck!
Vreni Gurd
Health and Vitality Coach
BPHE, CHEK 3, HLC 2
www.wellnesstips.ca
Hi, I'm a 23 year old male and have been dealing with back pain and hip pain for almost two years and have seen chiropractor and pt's, with little results. I have been told I have a torqued pelvis, my right hip feels like it sticks out to the right and my right leg always feels longer than my left. I have recently pinpointed that the muscles on my right side pull my joints and my pelvis out of alignment. I feel the worst pain when I get up from using the toilet. My right it band and tfl feel like they tighten up while I'm sitting down on the toilet and I have tried all positions to try to get myself comfortable but the pain is still there. I use a lift on my left side but my body still feels out of balance. I've been adjusted many times and found little to no relief. I feel like my entire pelvis is shifting to the right side of my body and I cannot run or walk without pain or uncomfortableness on my right leg and hip and when I stand for a long time it hurts to the point where I need to sit down. I've just started a new job in the DC area and all I could think about is the pain. I've tried to stretch out my IT and my TFl but it keeps tightening up.Does anyone know any good IT/tfl stretches or exercises to fix the pelvis,or even any specialists in the area, I'm running out of ideas and forgot how it feels to walk normal without pain. Please, any ideas would be appreciated. Thanks....
Danny
#15: Hip pain
Hi Danny,
It sounds like you may have a muscle imbalance in your hips, which results in one hip appearing higher than the other, or one leg appearing longer than the other. I would suggest looking at the Dontigny exercises (click the Dontigny link in my post), and see if the bracing exercises help you to level your pelvis. Leveling your pelvis is the first step. Can your chiropractor or massage therapist manage help you with that?
Next you need to learn how to stabilize the pelvis, and low back, so perhaps a physical therapist can help you find and connect to your transversus abdominis, pelvic floor and multifidus muscles, as well as your strengthen your right gluteus medius and TFL (I suspect the R side would be weaker than the L).
At the same time as you are working on your pelvis stabilizers, you can work on stretchng the tight muscles. I suspect that it is your left TFL and IT Band that is tight and needs to be stretched, and not the right one, whereas your right inner thigh may be tighter than the left, and your right side muscles (QL, obliques) that run between your pelvis and your ribs are probably tighter than the left.
Once you can connect to your stabilizer muscles well, you need to integrate those muscles into movement. You need to learn how to stand on the right leg without the hip collapsing out to the side. Then you need to learn how to bend that knee and stay strong through the right hip. A good physical therapist can be very helpful with this. Or look for a Chek Practitioner www.chekinstitute.com near you to look at your posture and design an appropriate exercise program that will balance your muscle system out for you.
Please understand that I have not examined you, and what I am suggesting is only based on your description, so I can't be certain that what I am suggesting is accurate. But it may provide a starting point. I do think you can get better, especially if you find the right help.
Good luck - you are too young to be in so much pain ...
Vreni Gurd
Health and Vitality Coach
Corrective Exercise Specialist
BPHE, CHEK 3, HLC 2
www.wellnesstips.ca
#16: hip pain
Thanks...there is a chekinstitute in my area... I'm going to give them a call today and ask if they have any experience dealing with my condition. It is actually my right IT band and TFl that are constantly tight. How can I level my pelvis? I 've recently been doing some of dontigny's exercises and pelvic tilts as well, what technique would I need to ask a chiropractor to perform on me in order to straighten my pelvis?I've spent hundreds on chiropractors who used That "million dollar roll" on me and it felt ok as soon as they did it but I was back in pain that same day. I forgot how it feels like to walk normal without pain on my right hip.Also my right hip makes this pop sound when I lean over and keep my legs straight, it is congruent with my right hip feeling like it sticks out. Also, would an osteopath be able to help? again thank you very much for your help.
#17: tight vs taut
Hi Danny,
Yes, your right TFL, IT band may feel tight, but I expect it is actually closer to taut - something like when the elastic is completely stretched out. You can't stretch it further, but it feels really tight.
The roll will help it feel better, but unless you can staiblize your own pelvis using your own muscles, the relief won't stay. You need someone to teach you how to connect to your stabilizers. A Chek Practitioner would be a good idea.
An osteopath may also help, but I don't know how much exercise they do.
Vreni Gurd
Health and Vitality Coach
Corrective Exercise Specialist
BPHE, CHEK 3, HLC 2
www.wellnesstips.ca
Thanks so much for your article! I have had hip pain in my right hip for about 2 years + after an instructor over stretched ,my right hip flexor. I felt like it was streched too far, but didn;t think much of it until I started training for a half marathon, and then I experienced pain in my pubic symphysis and it was horrible. That has subsided, but the pain in my right SI joint/ low back has been getting worse over the past 3 weeks or so. I have been doing exercises given to me by the Athletic trainers at my university, but they have not seemed to help. I do walk like Donald duck and I have been working on strengthening my lower abs, but it doesn't feel as though it is working. If you have any input on exercises or stretches, that would be great! Also, it feels as though I have a lump above my right hip tha I assume in inflammation- it isn't locates over the SI joint, but in the muscle in around the lumbordorsal area. Also, my SI joint on the right pops a lot- and I would like that to stop! Any input would be great as I do not have access to a PT. Thanks- Emily
Hi Emily,
Please understand that I am pretty much guessing, based on what you said here. I think you need deep stabilizer work too - did you read the description of some of the transversus exercises above (comment 9)?
Probably your sacral R multifidus is not doing its job, and so the lumbar erectors may be in spasm, creating the feeling of a lump or swelling in the lumbodorsal area. (I'm not too sure about this, but it may be something to explore). And you may also need R inner hipflexor motor control/muscle endurance work, as those fibers attach both to the vertebrae and the lumbar disks. Try lying on your back with your knees bent, and imagine you are sucking the leg bone into the socket, buttocks and sit bones wide. This will engage the iliacus and psoas, which may be helpful to you.
The other thing you can try is to lie on your stomach, and place your fingers in the soft tissue between the pelvic "bumps" in the back (PSISs), and imagine you are trying to squeeze those pelvic bumps together without gripping your butt. You should feel a muscle (multifidus) swell under your fingers, without the big lumbar erector firing up. My guess is that one of the sides of multifidus may not be functioning as well as the other. You need to get good at an even, low, gentle contraction, that you can hold for at least 3 minutes without it fading out. Once you can engage multifidus and psoas gently, and integrate these holding exercises into your movements, I am hopeful that the popping may stop.
A gentle pelvic floor contraction should stabilize the pubis. If you put your hand on your perineum, as you do a pelvic floor contraction you should feel your perineum lift up and away from your hand. If it pushes into your hand and you can't figure out how to pull it up, you may need to seek more specialized help from a pelvic floor specialist.
Good luck - hopefully your athletic trainer can help you with at least some of these ideas ...
Vreni Gurd
Health and Vitality Coach
Corrective Exercise Specialist
BPHE, CHEK 3, HLC 2
www.wellnesstips.ca
Once you can connect to your stabilizer muscles well, you need to integrate those muscles into movement.
#21: Absolutely
I can't believe I left that out. Not much good only doing this stuff lying on the floor!
Vreni Gurd
Health and Vitality Coach
Corrective Exercise Specialist
BPHE, CHEK 3, HLC 2
www.wellnesstips.ca
Walking is not just a simple recreation anymore, we need to pay attention to how we walk.
Hi, Ms Vreni Gurd.
I am so happy to have found this site. I began having groin pain in 2005 and it got so bad that I went to the orthopedic who found that I had a labral tear in the left hip. After having the operation(arthroscopic repair) and during physical theraphy, I began developing pain in the other hip(right). I had some more test done to make sure I did not have another tear. Finally I found out that I had a herniated L5/S1 and bulges and annular tear in the L5/L4. I then had epidoral shot, Facets inject/prolotheraphy and had no relief. I then went for theraphy on the back and all the exercises seemed to make it worse. Bridges, side lying abductions and such. I then and am presently doing decompression. I am realizing after reading your post that a lot of my issues are coming from my SI joint. I am also getting myofascia theraphy which truly helps. The therapist finds that my Si joint is always stuck on the right side. I have been paying attention to my gait patterns for about over a year and have had minimal changes in pain.
Yesterday was the first time I engaged in muscle work in the gym in two months. I did light leg extension(five pounds) light hamstring curl(5 pounds and light horizontal leg press making sure that my knees does not pass my hips on the return. But yesterday I had a lot of soreness deep inside the inner groin and stomach extending into my inner thighs to my knee. It has causes difficulty in walking. It feels better today. I also believe that my Si joint issues increased after doing a yoga class. I feel I over stretched. The therapist also noticed that my hip rotators are super tight and I have began to stretch them more.
Can you please help me on starting a home program to help and heal from this issue? I am a personal trainer and feel as if I have no knowledge when it comes to this issue. Also during all my physical therapies not one pt looked or addressed my Si joint issues. It has alway been my hips and lower back. I am only 42 and has have this issue since the age of 38. I also have two children and with my last child did experience some knee pain. I also picked up running right after pregnancy and feel that might have added to my issues. I also have a hard time doing abdominal work, although the hanging leg lifts seem to not bother me too much. Swimming has also been a problem and that is why I looked into decompression.
This is such a confusing injury and the fact that I have so many issues leave me at loss on what to do first. Please help me. Thanks so much Ms Sloan
#24: Some ideas for you
Hi Ms. Sloan,
Wow, sounds like you are going through a very rough time. First thing I would do is see if you can find an Integrative Neurosomatic Therapist (a type of massage therapist trained by Paul St. John) to assess you for a leg-length discrepency and/or a small hemi-pelvis (one side of your pelvis being smaller than the other). If you have either of these conditions, you may need a lift in your shoe, or a lift under one butt cheek when seated in order to keep your pelvis and therefore your SI joints and spinal column level. That alone can go a long way to reducing pain syndromes, and preventing SIJ and disk herniations. Far more people than we realize are suffering because of leg length inequalities or a smaller hemipelvis.
The other thing I would do is look for a physical therapist / CHEK Practitioner that can help you connect to your transversus abdominis, pelvic floor and multifidus muscles, to ensure you are using the correct muscles to stabilize your pelvis and spine. Often after child birth, the transversus and pelvic floor has been completely stretched out, and the pelvic floor may have been torn or cut, so half the body's stabilization system is gone. Reconnecting to these muscles is key to getting out of pain, as doing glute work, sit ups etc. works muscles that are meant to move you rather than stabilize you. That can create spasm and pain if the underlying stabilizer muscles are not working adequately. Only once the stabilization system is functioning well can one exercise the moving muscles without problems. One easy trick you can try, is to stand and sit as tall and wide as you can at all times. That will go a long way to decompressing you. We are meant to stand in tension, not compression, so fight gravity all the way! Often that will get your stabilizer muscles to work, too.
Where do you live? If you are in the Vancouver BC area, I'd be happy to help you.
Good luck!
Vreni Gurd
Health and Vitality Coach
Corrective Exercise Specialist
BPHE, CHEK 3, HLC 2
www.wellnesstips.ca
Thanks so much for your quick and helpful response. Alas I live in United States, Florida ,otherwise I would be right at your clinic. Is there a link for me to find a chek practitioner? I found something but I am not sure. When you said sit tall and wide, did you mean sit with my legs open? Also, I forgot to mention that my surgery for the hip labral tear was the beginning of my right side issues. The position I was put in was on my back, the operated hip/leg was pulled a few millimeters and the other leg/ hip was put into a very wide abduction position. After surgery I also have been dealing with a chronic hamstring problem. I woke up to a huge lump on my hamstring connection where it inserts into the inner back knee. It would cause so much pain when touching it and would spazz for three days after making it so difficult to sleep or concentrate on what I was doing. With physical theraphy it finally calmed down a little. The last orthopedic doctor told me that it was not a cyst since it did not show up on an mri. He said it was a chronic muscle bunching of my hamstring. He also said that I had a weak medial quad muscle and to strenghten them. He said that my hamstring issues will subside if I do. I agree when I stretch it which I do several times a day it helps but it is right back to the same the next day. I roll on a roller a lot also. Before they found the herniation I was diagnosed with a hip strain and periformis syndrome. I am still dealing with all of that. Swimming and biking are out of the question. The left knee(operated side) burns like crazy after and my groin would get really tight. Bending to tie my shoelace I would get a pulling feeling in my groin.I have had a lot of mixed advice for my leg length and my arches. My left arch have collapse but with advice from a great website "The Fitness Fixer" has helped me to correct my gait and to concentrate on using the right muscle to stabilize the arches.The last foot scan I had told me that my left arch(the problem arch) was fine but my right was collapse. It seems that everyone I see has a different opinion. The last chiropractor I was seeing for three months, three times a week seemed to be confused because each time I went in the leg length discrepancy would change from one leg to the other. The most relief I have received so far is from my myofascia relief therapist. All my issues seem to be coming from the glutes,groin and outside hip area radiating to my knees. I am especially sore there after my decompression theraphy. I have three more to go and feel deep down that maybe all my issues are not from my herniation. Thanks again for your advice . Cordially Mrs Sloan D
#26: Tampa?
Hi Mrs. Sloan D,
Are you in/around Tampa? I would suggest you book an appointment (or a few) with the St. John-Clark Pain Treatment Centre in Clearwater. They would probably do wonders for you. Paul St. John is very well known in the massage world, and Randall Clark and Tracy Allan Jones are fabulous therapists as well. 727-347-4325. Or if you are not in Tampa, call the number and they will give you the name of the Integrated Neurosomatic Therapist nearest to you. You can hopefully find a CHEK Practitioner here.
I did not mean to sit with your legs spread wide, but rather to relax the butt muscles so your sit bones can spread. You may find it helpful to actually use your hands to manually spread your sit bones when you sit. This will give you a wide, stable base of support while seated. Your thigh muscles and hip flexors should be (soft and gushy) while you sit, so if they are not, you can work on relaxing them.
Good luck on your journey, and don't give up! I would bet your pain can be much reduced.
Vreni Gurd
Health and Vitality Coach
Corrective Exercise Specialist
BPHE, CHEK 3, HLC 2
www.wellnesstips.ca
#27: SI Joint pelvic pain
I suffered for years and years with chronic pelvic pain that seemed to be orginating from my right ovary and uterus. This pain almost wrecked my marriage, as you can imagine. I finally found an OB/GYN who believed it was a muscle problem and sent me to a physical therapist. She discovered that the ligaments on the right side of my sacroiliac joint were very loose and my hip rotater muscles (esp obtrurator internus) on my right side were inflammed. She suspected this was from on old injury. The only one I can remember occured when I was about 9 or 10. I'm now 47. Mt PT worked on me off and on for a year and the muscles did respond. However, because the ligaments remain loose, the muscles repeatedly get inflammed. Now my insurance no longer covers treatment. I have a sacroiliac belt to help hold the joint in place, which is only somewhat effective. What else can I do? Will a chiropractor help? Massage therapist? I'm in a rural area with few resources. Thanks, Charlotte
#28: pilonidal cyst
i doubt anybody will be able to help me, but just incase...four and a half years ago i had surgery for a pilonidal cyst. the cyst was not painful at all as it had opened and drained on its own. last year, the cyst became infected again, but did not open and drain on its own and was excruciatingly painful. i could not walk, sit, or stand without wanting to cry. i got it drained (after a horrible 2.5 hr drive to my doctor) and felt incredible relief. he suggested surgery to decrease chances of another infection but said it wasn't absolutely necessary. b/c i couldn't take that much time off from my summer internship i decided to delay it until winter break. witner break came around and since i was experience zero pain or problems from the area i decided to forego the surgery. now, THIS summer, the pain came back. at first it was very subtle but eventually i realized it would not go away on its own and i had to go to a doctor. i thought for certain it was related to the pilonidal cyst b/c the pain was in exactly the same area, and similar pain but not nearly as intense. well, the doctor looked at it and said the area looked fine and he didn't think a surgery was necessary. he gave me an Rx for antibiotics b/c i was going abroad and i expressed concern that it would get worse and i wouldn't have a doctor to go to, but he told me to take them only if it looked bad and the pain got way worse. well, that didn't happen while i was abroad fortunately, but the pain did pop up every once and awhile and though it was mild it was pretty annoying. so anyway, a few days ago, it started getting sooo annoying b/c it started interrupting my sleep. no matter what position i'm in i feel mild pain in my lower back. i also feel it when i sit (the worst probably) or even stand. the only time i DON'T feel is if i stand on my right leg. otherwise if i'm on both legs i feel a pain go down my left leg. it has gotten so ridiculously annoying and the past few nights i've had to take tylenol pm. yesterday i went back to the doctor and he said the pilonidal cyst is NOT infected. he also poked around that area and it didn't hurt with him putting pressure there. (last year when the cyst was infected it was VERY tender to the touch.) so..i am so confused. it seems like my pain is not related to the pilonidal cyst but then what??? the pain is minor (relative to the pain of an infected pilonidal cyst which i would not wish on my worst enemy) but it is NOT pleasant. i wonder if it could be sacroiliac joint dysfunction? and if maybe my pilonidal cyst or surgery caused it? i have no idea..i just want answers b/c i don't know how much longer i can live with this discomfort.
#29: SI Joint Dysfunction
Hello,
I am a 23 y/o female and I have been diagnosed with SI dysfunction(3 years ago). I was in boot camp when a female fell from a 5ft platform and I caught her wrong and we both landed wrong in a rocky terrain. I did not seek treatment right away and when I did I had 3 pelvic stress fractures and one in each foot. I did not get treatment until 6 months after my diagnosis and continued to train(bad idea). I have went to Physical therapy 2 separate times for a period of 12 weeks and both methods that they used did not help only aggravate my SI joint. The chiropractor was the best source for me but only lasts for a little over a week. Any time I lift something to heavy or step wrong I get a flare up and I cannot do anything. Being in the military you have to be physical. I am to the point that a brisk walk almost has me in tears. I don't like taking meds and I had a shot and it only made it worse. I have done acupuncture and myofascial release. I am in a environment now and I don't have access to a chiropractor. I need some advice??
Your site is great and I really appreciate it! I have always enjoyed reading your site.
#31: Regards
Hello. Nice day. I have reading your site. It's realy necessary and useful. Regards.
Jefry Morgan
Cars and insurance writer
Hi Charlotte,
If the ligaments are loose, prolotherapy may help. You would need to find a physician that does that kind of treatment - basically injecting sugar water into the ligaments to tighten them up. Usually a few treatments are needed, and the they certainly are not fun. But it can help a lot. Try googling prolotherapy and your home town or nearest city and see what comes up.
Otherwise, getting very good at connecting to your transversus abdominus, multifidus and pelvic floor may help take the strain out of the other muscles, and wearing the SIJ belt.
Vreni Gurd
Health and Vitality Coach
Corrective Exercise Specialist
BPHE, CHEK 3, HLC 2
www.wellnesstips.ca
#33: Cyst?
To be honest, I'm not too sure what to suggest. The fact that you can get yourself out of pain by standing on one leg makes me think that the problem is mechanical rather than from the cyst. So it could be SI joint, or possibly an issue with your lumbar vertebrae, or possibly the organ fascia is "glued" to the muscles, and pulls when you are in particular positions. I would suggest you see a physical therapist or orthopeadic physician have see what they think as a start, and then possibly see a visceral massage therapist to make sure the colon is not stuck in any way.
Vreni Gurd
Health and Vitality Coach
Corrective Exercise Specialist
BPHE, CHEK 3, HLC 2
www.wellnesstips.ca
#34: Military gal
Hi Military gal,
I feel for you - SIJ pain can be horrible. I suggest stabilization work would help a lot. I think you need to connect to transversus abdominus, pelvic floor and multifidus. Read comment 9, and comment 19 above and try and do the exercise suggestions. If you have access to a physical therapist that can help you learn how to do these exercises correctly, that would help a lot!
Vreni Gurd
Health and Vitality Coach
Corrective Exercise Specialist
BPHE, CHEK 3, HLC 2
www.wellnesstips.ca
#35: Muscles
you need to concentrate on your health specially on your muscles.
Your site has very much liked me. I really appreciate it!
#37: SI Joint Pain
Great post Vreni. I've been dealing with some serious nerve pain cause by a herniated disk - while getting treated for it, I learned my si joint was completely locked up and a few other things that I was doing in my day to day life that were fueling the condition. A few things that helped me were walking backwards for a few minutes everyday (sounds weird, but it helps) and moving my feat into a 45 degree outwards angle when standing still and walking - this was the big one for me - I guess I had been walking incorrectly for years? who knew! I give most of the credit for my healing to a massage therapist who uses special techniques to unlock the joint - this helped the disk move back into place and the pain was relieved (still not 100%)
Your advice here is really good, hope others get some relief from your suggestions.
Cheers
Hi Health Guru,
I bet walking backwards helps - what a brilliant idea!! I think I'll start using that with people. Glad to know that you found someone to help you, and give you the tools to help yourself.
Richard Dontigny (see the link above), believes that disk issues originate from SI joint dysfunction, as this would torsion and tilt the sacrum which would then lead to the vertebrae being tilted, aggravating the disks. This does make sense, although I don't think all disk issues originate as SI joint problems.
So Dontigny's system is all about putting the SIJ in the correct position. I use his techniques every day. I think he published first in about 1963! And I bet these are the techniques your massage therapist is using ...
Glad you liked the post! :)
Vreni Gurd
Health and Vitality Coach
Corrective Exercise Specialist
BPHE, CHEK 3, HLC 2
www.wellnesstips.ca
Hello, I'm 28 and have been dealing with sacoiliac problems for at least 10 years. I was pretty physically active in shape. I spent 6 years in the Marine Corps. Typically i could visit a chiropractor and have it adjusted and be fine in about a week or two. This episode i have now has been going on for 3 months. The right side is locked up and painful to even put weight on my right leg. I'm suppose to start physical therepy next week. I'm just hoping there is something i can do to prevent this from happening again....
thanks
matt
#40: SIJ pain spreading!
Hi Vreni, i've been reading the posts and it has provided me with alot of info. I am 27 yrs old, male and race triathlons. About 1 year ago I began experiencing left side glute pain, it gradually spread to the hip joint, QL, TFL, glute med. My left side lower back muscles are also overdeveloped compared to the right side. Excercise (run, swim, bike) aggrevates it and sitting for long periods or standing still it is irritated mainly left QL area (very deep) and stretching the hip joint feels like it is "tearing" and has some sharp pains. Recently, my mid back and shoulder blades are feeling very tight too. I have been doing some of the stretches and corrections found at DonTigny, but even some of those stretches cause a deep hip pain. I just had an MRI done and waiting for results. Left thigh front and side are also numb, a very superficial numbness but it's always there like meralgia paresthetica. Please help!!!
#41: SIJ pain spreading!
Hi Vreni, i've been reading the posts and it has provided me with alot
of info. I am 27 yrs old, male and race triathlons. About 1 year ago
I began experiencing left side glute pain, it gradually spread to the
hip joint, QL, TFL, glute med. My left side lower back muscles are
also overdeveloped compared to the right side. Excercise (run, swim,
bike) aggrevates it and sitting for long periods or standing still it
is irritated mainly left QL area (very deep) and stretching the hip
joint feels like it is "tearing" and has some sharp pains. Recently,
my mid back and shoulder blades are feeling very tight too. I have
been doing some of the stretches and corrections found at DonTigny, but
even some of those stretches cause a deep hip pain. I just had an MRI
done and waiting for results. Left thigh front and side are also numb,
a very superficial numbness but it's always there like meralgia
paresthetica. Please help!!!
Hi Matt and Irvin,
I gotta say I feel a bit helpless, and am not sure how I can really be of much help without actually seeing you personally. Without actually being able to examine you and see what position the bones of your pelvis are in, whether or not you have a leg-length discrepancy, how well you are activating your stabilizer muscles etc., I don't know what new I can suggest that has not already been mentioned above.
I think the key is finding someone that can assess where you are at now, and can then work with you to formulate a recovery plan. There is no doubt that there is a lot you can do to help yourself, once you have a working diagnosis. Is one ilium more flexed than the other, and if so, which one is more flexed? Do you have an inflare / outflare going on, and if so, which way? Do you have an anatomical leg-length discrepancy? Is the problem simply instability of the SIJ?
I would suggest you call 1-866-597-3772, and ask if there is an Integrated Neurosomatic Therapist near you, and then go see them. Or discuss the issue thoroughly with a chiro to get an idea what he/she thinks is going on, and what exercises he/she thinks may be helpful and which you should avoid. A KMI Practitioner is another excellent alternative, or a Rolfer, or any other structural integrator may be helpful. CHEK Practitioners can help you with the stability side. So can a good physical therapist. There are lots of good people out there - it is a matter of finding them.
If you are in the Vancouver BC area, feel free to contact me. I'm really sorry that I can't be of more help. I hope you can understand that generalities are not good enough, and everyone needs their own personalized plan.
I really hope you find someone good to help you...
Vreni Gurd
Health and Vitality Coach
Corrective Exercise Specialist
BPHE, CHEK 3, HLC 2
www.wellnesstips.ca
Your site has very much liked me. I really appreciate it!
#44: Located in Van BC
Hi, I am actually in Victoria BC!! I am very interested in seeing you and believe you may be able to provide me with some good insight and direst me in the right direction. How ma I contact you and where is the clinic you work at located? thanks!!!
#45: Located in Van BC
Hi, I am actually in Victoria BC!! I am very interested in seeing you and believe you may be able to provide me with some good insight and direst me in the right direction. How ma I contact you and where is the clinic you work at located? thanks!!!
#46: Located in Van BC
Hi, I am actually in Victoria BC!! I am very interested in seeing you and believe you may be able to provide me with some good insight and direst me in the right direction. How ma I contact you and where is the clinic you work at located? thanks!!!
Your site is great and I really appreciate it! I have always enjoyed reading your site.
#48: sij related hip pain
Hi Vreni,
I am so impressed! You are really so full of knowledge and have given so much help!
I'm hoping maybe you have some advice for me as well. I am a 35 y.o. yoga teacher and I began having sciatic pain about 9 months ago. I thought at first it was from tight external rotators (piriformis etc.) so I tried to stretch them more and be patient. The pain lasted, so I had an MRI. The report said my L5/S1 was herniated.
What I noticed most during this time was that when I lay on the floor, brought my knees up to my chest and rocked from right to left, I could feel the left side si joint press against the floor. When I rocked to the right (the problematic side), my si joint felt like it was caved in, almost like nothing was there.
I went to a physical therapist who gave me exercises to balance my pelvis - lying on my side and squeezing a pillow, pushing my right leg back and my left leg forward. This seemed to work at making my pelvis look even, but was also the beginning of incredible hip pain. Its the worst after sitting. When I stand, it takes about 5 seconds and then I get this wave of pain from deep in my hip joint that makes me feel like I'm about to pass out. It lasts about 10 seconds and then I can breathe again. It hurts a little now while walking, but not so bad. mostly its transitions like from standing to lying down.
I've been to a good chiro, and he thinks I may have facet joint syndrome since I continue to have pain even after the adjustments. He also popped my right si joint back in place but it doesn't seem to want to stay. I finally tried the cortisone injections (that hurt incredibly to get!!). That was just a few days ago, so I am not sure yet if they will help.
The sciatic pain I first felt started after doing (I think) too many and too
intensive backbending postures in yoga. Do you think bending back and
flexing my spine could have caused my si joint to go out of wack?
I feel like I understand a lot of the mechanics, but am unable to heal myself - so frustrating!! Any input would be so appreciated.
Eva
Hi Eva,
The reason I ask the question is that I had SI joint pain for a number of years, without any fall or car accident or anything to set it off. The stabilization exercises that I speak of above took away my pain, but I never understood why I developed the pain in the first place. This July I learnt that I have a 15mm leg length discrepancy. Therefore my pelvis was always tilted in standing, creating a torsion within the pelvis between the sacrum and the illiums, irritating my SI joint. This can also create disk problems and facet joint irritation, as the tilt is usually corrected somewhere in the spine.
So, you may want to investigate that possibility. I find that most health professionals think that leg length discrepancies are very rare, whereas the appearance of a leg length discrepancy is common. I beg to differ. According to the research of Knudson, up to 60 percent of us have an anatomical leg length discrepancy, and I suspect that this is frequently the undiagnosed cause of many painful syndromes from knees, to hips, to back, to neck, to headaches. A simple shoe lift can go a long way to remedying the problem.
Forward bending postures may aggravate disks, and back bending postures may aggravate the facet joints. Based on your description, your sacrum is torsioned within your iliums, (I think your right ilium is inflared, left outflared - but you would need to be assessed for this) which would clearly impact the position of the acetabulum of your hip joints too.
Perhaps seek out the help of an Integrated Neurosomatic Therapist to assess you for leg length discrepancies, assess your pelvis, atlas ( top vertebrae) and cranium, and come up with a treatment plan for you. Staying connected to your bundhas, particularly mula bundha would clearly help as well.
Hope this helps a bit!
Vreni Gurd
Health and Vitality Coach
Corrective Exercise Specialist
BPHE, CHEK 3, HLC 2
www.wellnesstips.ca
#50: pain!
Thanks so much for getting back to me!
There was no trauma right before the pain started. Maybe a month before, I did "throw my back out" after doing a few intense yoga classes w/ lots of upward facing dog, and then using the abductor machine at the gym (would that make sense as a cause?). That was scary, but it went away after a few days. I stopped all backbending for a while, and then when I started again the sciatica came.
The chiropractor I've been seeing said my atlas/axis was way off, and that he could palpate something that he shouldn't have been able to (scary again!) but he adjusted it so hopefully that will help
I will definitely investigate the leg length idea. Do you know of anyone good New York City or Brooklyn?
One more question ~ I started doing the exercises from the pdf by DonTingy. The one where you squeeze the knee in and push against the hands seems really good, but I'm still really hurting. Is there a basic time frame for these exercises to notice improvement by?
In the meanwhile, bandhas engaged!
thanks again,
Eva
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Author: Details
First Name
Vreni
Last Name
Gurd
Degrees
BPHE, HLC 2, CHEK 3, CSEP-CEP, NSCA, ACSM
Short Bio
I have always been interested in what we can do to make ourselves as healthy as possible. We cannot change our genetics, but there is much that is within our control that can have an impact on whether we are healthy or whether we suffer with pain and disease.
I was the top graduating student at the University of Toronto in Physical and Health Education in 1992, where I studied anatomy, physiology, exercise physiology, nutrition and how exercise can improve health. In 1997 moved to Vancouver and started a personal-training business.
I became frustrated by my inability to help my clients through their various aches and pains, and pursued further education through the CHEK Institute in San Diego. I learned an incredible amount, and became far more effective with my clients suffering from low-back pain, but still found some clients did not respond as I felt they should and I didn't understand why.
I began to read and read. I began to appreciate how nutrition and other lifestyle factors can have a huge impact on healing or the lack of healing. It became obvious to me that there is a lot more to orthopeadic problems than simply looking at the physical. I took the CHEK Holistic Lifestyle Consultation course which solidified what I had been learning. Disease is a function of bodily systems being out of balance, and when we do what is necessary to bring the individual back into balance our health is restored.
My hope is that through this site you can travel the wellness journey with me and prevent illness, or if you are ill, you can learn some ways to become well again.
SIJ dysfunction is very common disorder. SIJ pain is just one symptom of many it can cause. Some say it is mostly women's disorder. They are right, but many men have it too. About 80% of people have it causing them many different Muscular Skeletal Disorders.
Most common SIJD case is upslip: Other ilium has moved out of it's natural range and got stuck because of a trauma, fall, slip, or other accident. usually it is also rotated forward (anteriorly). When stuck it has no schock elimination and all those forces from down to up go to spine and causes countinuous stress there: wear and tear of spine and discs.
When pelvis is not functioning symmetrically it stresses the spine. There you get scoliosis, extended lordosis, wear and tear in discs and vertebra. Also altered pelvic ring posture causes piriformis tightening, back muscles tightening, bad body posture, neck problems, shoulder problems,.. And to legs not only hip problems but also knee, ankle, achilles and many others too because it changes the way you walk.
But because the pain usually comes after yers of walking with SIJD that is difficult to diagnose. The trauma that caused it is so far in history. And it is not only a disorder for adults but also for children too. To children it causes ie. idiopathic scoliosis. See those pictures they use describing scoliosis: 9 out of 10 have pelvic bones malaligned. They say scoliosis causes that. But if your pelvis is not levelled the spine can not be straight. Can it? It was corrected from me at the age 35 and I had had mild scoliosis, short left leg and unleveled pelvis for all my life. Not any more!
And when they diagnose that rotation scoliosis, it means your other ilium is more forward than other (uplip and rotated). It causes that twisting force to lumbar spine. And up in shoulder level you willingly fight against it trying to compensate that twist...
And when you have both SIJS upsipped you will get very exteded lordosis and you walk like Donald Duck ...
This was a short message about SIJD