An Update on my Sacroiliac Joint Saga, Part 2

In Part 1 of this series, I explained how the learning the “muscle energy technique” from my physical therapist Paula marked a turning point for me in my SI joint journey.

Above, I’m including a Youtube video of a physical therapist demonstrating this technique.  (I actually use a few different variations on the moves she does, but the principles behind it are exactly the same).

By using this approach regularly, I’ve not only been able to keep my SI joints better aligned, I’ve also developed more of an understanding of how the pain and sensations I feel correspond to the anatomical reality of what’s actually happening down there.

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For me, this whole process has had to be very intellectual.  The movement patterns of the sacroiliac joints are some of the most complex in the body.  It wasn’t a matter of simply doing my exercises and getting stronger, because this joint is like a puzzle.

The SI joint reminds me of those old metal “tavern puzzles” they made in the Colonial days (http://www.tavernpuzzle.com/).  I don’t know if most of you would have ever seen one—I grew up in a town with a lot of Revolutionary War history, so I feel like I grew up playing with these things.

They are impossible to figure out by just looking—they’re too complex.  Instead you have to just start moving the different parts around, hoping the solution somehow becomes clear as you go along.  Half of the time, you move a piece and realize it actually just made things worse.

That’s been my experience with the SI joint.  It’s been so unpredictable, the things that will cause my SI’s to “slip” and lock. Walking on a flat, well-maintained trail at my favorite conservation land?  No big deal.  Going to a party and sitting on someone’s dilapidated old couch?  I sink in instantly, and my hips are locked again.

It doesn’t help that everyone’s SI joints are different.  Obviously we all have the same bones down there, but the shape of these bones and the way they fit together can vary widely from person to person.

For this reason, things that can work well for one person might not work at all for another.  I’ve tried techniques and exercises that other people have sworn by, and found they made me worse.

Only by learning, and developing a sense for exactly which types of motions and textures are going to create instability in my pelvis, have I been able to make sense of my own SI joints at all.

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What about mind over matter? a lot of people have asked me.  Why can’t you just push through it, even if it hurts?

What I wish they could see is that it has been mind over matter, just not in the way they think.

There’s no pushing through an SI joint that has locked.  Anyone who’s experienced this will know what I mean.  It makes about as much sense as trying to use brute strength to unlock one of those tavern puzzles.

But you can use your mind to learn about the anatomy of the joint, and solve the puzzle that way.  Technically it’s still mind over matter, but in this variation it’s about being open, receptive, and mindful, rather than trying to harness sheer force of will.

To be continued in Part 3!

 

9 Comments

  1. Hello: I just came across your blog and love it. My nightmare started four months ago when I fell and twisted my back the wrong way. The pain gradually worsened. I went to the spine doc and he recommended PT and chiro; so I did; it didn’t work. Then the doc suggested I had SI joint dysfunction and offered a diagnostic injection on my left side. He warned of the side effects. Unfortunately, I was in the small percentage that the injection didn’t work at aIl. I went back to the chiro, and it seemed it aggravated it. I do have other issues on my lumbar area like osteoporosis and osteoarthritis, mild bulge/spur/tear, some pinching. So my doc really doesn’t now where the pain is coming from but I feel the SI joint is compromised like he thinks it is in addition to everything else. . I had been without pain for years and had been super active. I am a swimmer, yoga practitioner, and aqua fitness enthusiasts . Now I can hardly do any of that and feel depressed. I have resorted to some medication, anti-inflammatory and they. help temporary. I am now trying an SI belt and it does help a little. My issue is that I haven’t been still either; so both my spine doc and chiro are asking to just rest, rest for now. Of course, the chiro wants to continue seeing me. But after reading your comments about this, I am not sure anymmore. I don’t have the issue of my SI locking up on me; but now I think that I may have something going on with my ligaments. The chiro also recommended icing the area; but the acupuncturist tells me heat is better. So I feel like ice helps me better, but then massage also helps; and the pain meds. Did you use an SI belt? and did you take meds along with your therapy? I am waiting for the inflammation to go down to start doing the aqua exercises you suggest. I love the pool in my gym. Do you do any other type of exercise now?

    1. Hi Maritza, I’m so glad my blog has been helpful to you– thanks for letting me know!

      As you know, I am only writing from the perspective of a fellow patient, but since your SI joints aren’t actually locking up, I think it might be worth it for you to experiment with skipping the chiropractor for a while. It sounds as though your joints are hypermobile, which means the ligaments have been stretched out and need some time to rest and calm down. In my experience, the chiropractic adjustments can prevent the ligaments from healing, even if they are technically putting the joint “into the right place.” https://sunlightinwinter.com/2016/06/30/could-my-frequent-chiropractor-visits-be-making-my-si-joints-worse/

      I also think that rest alone can make things worse, because you also need to strengthen your muscles, so they can sort of “take over” for your injured ligaments.

      This is why I think the pool is the best thing– it allows you to strengthen without putting as much strain on your ligaments. So maybe your goal shouldn’t be “complete rest”– it should be “exercise that doesn’t make things worse.”

      I still do the majority of my heavy workouts in a pool, to reduce the risk of reinjury. These days I do walk, or go for short (one hour) hikes, but it took me a LONG time to get here, and I had to build up a lot of strength in the pool first.

      I also have exercises that I do at home– core exercises, in particular. I would recommend that you have a physical therapist teach you how to activate your transverse abdominis muscle– it’s a major muscle in your core that acts as sort of a “corset” and gives your trunk stability.

      Here is a post I wrote about it: the second and third videos show how you can exercise this muscle while you’re lying down on your back, so it should be gentle on your SI joints: https://sijointsaga.com/2017/06/19/core-training/ ). That is the number one place I recommend everyone start strengthening.

      In terms of heat or ice– go with what you feel helps you. Ice would be to reduce inflammation (mostly for your ligaments). Heat would be to calm muscle spasms, but can also increase inflammation, so be sure you’re monitoring your symptoms. Your body should let you know.

      I personally tried a belt, but felt it made my joints more likely to “lock.” Everyone is different though, so it’s worth trying.

      I sometimes took a pain med called Tramadol for this problem, but I found that my pain was very significantly correlated with what activities I was doing, and whether or not my joint was locked. I felt like it was more effective to try to manage pain by managing my activities and joint positioning.

      The biggest thing that stands out to me about your story is the fact that people are telling you not to exercise at all. I never had anyone tell me that– in fact, my chiropractor is the one who finally convinced me to join a pool. So I think it might be a good idea for you to consult a physical therapist who’s comfortable treating the SI joint (which is not always easy to find). I think you should definitely be able to get started at least with the gentle core exercises I linked to above. If you are lying on a surface that works for you, I would not expect it to make your SI joints worse. https://sijointsaga.com/2017/08/26/sierra-comfort-stretching-table/

      Hope that is helpful! Let me know if you have any other questions!

  2. Wow, thank you so much for saying that the Muscle Energy Technique has helped your SI problems! My SI joints have been unstable since a fall 22 years ago and have caused weird off-balance sensations when I walk and a lot of shoulder and neck tightness. Doctors thought I was quite mad when I described it all and so I did the rounds of chiropractors and osteopaths etc, then, a couple of months ago, an orthopedic surgeon sent me to a PT who is teaching me this same technique along with some others. I’ve been in despair finally knowing what’s been wrong for so long and wondering if it can ever be resolved now, so I’m really pleased to know that you think this works and I’m so glad I found your blog tonight!

    1. Hi Annie– Thanks so much for stopping by my blog, and for your comment! I’m sorry to hear about everything you’ve gone through, but it sounds like this PT is going to provide you with some great advice.

      Yes, the muscle energy technique has made all the difference in the world for me. It did take me a while to really get the hang of it (especially when it came to learning how to identify which way my pelvis is rotated), but now that I (mostly) know what I’m doing, it’s really given me my life back.

      Right now I am actually at the point where I am trying to rely completely on adjusting my SI joints myself, because I’ve started to think that chiropractic adjustments are actually putting too much stress on my body. So far, it’s been working pretty well. I’ll have to write an update on that soon!

  3. Thank you for your inspiring story. I have Ehlers-Danlos syndrome. I can feel my hip bones cracking against each other & popping in & out constantly (in addition to all my other joints.) The pain in my tailbone is what led me to your blog. I have head-to-toe osteoarthritis as a result of the Ehlers-Danlos. I’ve never had physical therapy & I gave up on doctors. Your post is encouraging, to not give up on finding help.

    1. Hi Helen, thank you so much for your comment. It means a lot to me to know my blog is helping others. I don’t know much about Ehlers-Danlos, but I am curious if aquatic physical therapy might be helpful for you.

      Where I live (Boston) there are a lot of PT’s who have been trained in a type of aquatic therapy called the Burdenko method. I know it has been really helpful for many people, myself included. I don’t know if this is something you would be able to do, but it might be worth looking into.

      One part of the Burdenko approach that has really made a difference for me is doing my exercises wearing an aqua belt, letting my legs hang beneath me in the deep end. This lets everything in your hips and spine stretch out a little, and you can regain some of the healthy space in your joints that you may have lost due to tight muscles and the wear and tear of everyday life.

      This is just a thought, but I hope it might be helpful to you! I wish you the best of luck on your journey.

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