Sacroiliac hell, any ideas anyone?

[leashy11]

2 and a half years ago I started with severe right buttock and low back pain. My GP gave me NSAIDS which didn't help, saw 2 osteopaths who didn't help, then onto a chiropractor who diagnosed right side ilium was stuck in anterior rotation. 5 sessions later it was still stuck and much more painful and the left side was hurting too. A second chiropractor had a try using passive alignment, no help. Onto a physiotherapist, she agreed with the diagnosis and rotated the ilium back on the right side but it wouldn't stay there. I also didn't get the huge amount of pain relief from this people had said I would but this physio said to keep unlocking it myself (she showed me how) and follow an exercise programme she gave me.

Fast forward 9 months and after many, many sessions and mobilisations of this joint I still had severe pain in the right joint, pain in the left sacroiliac joint but also inflamed Iliotibial bands, tight painful rectus femoris, posterior hip pain, super tight hamstrings especially medial, heel pain and right side shoulder pain. She gave up so I moved on. The next physio said the exercises had been a waste of time as I was doing glute maximus ones with the hamstrings and glute medius ones with the TFL or sartorius. She also said the SI joints weren't locked but weren't stable and advised glute medius exercises (done carefully to avoid other 'helpful' muscles) and core stability training.

After 8 months of core training and glute medius work I've got very little improvement, the right glute medius hasn't got any stronger at all although the left one has improved. My transversus abs are working alot better but my multifidus at sacrum level is still very reluctant to work, my right side external oblique does not contract when it's supposed to but the left one is very strong. I have nearly no muscle on the right side of the spine as opposed to the left, and I tend to stand with the left foot forwards and externally rotated, left side of pelvis forwards and left shoulder forwards so it's almost like I'm standing sideways but with my feet and head facing forwards, when I'm stood like this I feel straight unless I actually look at what a twisted mess I'm really in!

I feel like my spine and pelvis are badly rotated but nobody seems to be able to advise me, I've had a lumbar MRI and this is fine but I can't get my GP interested in referring me anywhere. I still do core stability training, and wear an SI belt all the time, but my pelvis isn't stabilising. Anyone got any ideas? I'm desperate for help and still in alot of pain and don't feel like I'm ever going to get better.
Thanks in advance.

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[physiobob]

Where in the UK are you situated? Perhaps we can suggest an expert on this issue in your area.

[leashy11]

Hi, I'm located in lincolnshire in the UK so it's quite rural with very few therapists to go at and I have huge problems with sitting, but any advice would be greatly appreciated.
Thanks

[jwilso]

What is all this about locking and unlocking the SI joint. i thought that the SI joint only moved a matter of millimetres. did your trouble start for any reason such as an accident ? i would have thought that a problem with the Si joint would usually follow an accident of some sort. can you give more information?

[leashy11]

It started when I went to work for a company who gave me a work station with the phone and computer about 6 feet away from each other and a chair that sometimes rolled and sometimes didn't so I was constantly kicking (or trying to when the chair didn't want to roll) the chair back and forth between the two, practically always with the right leg and within 6 weeks of working there I was in agony on the right SI joint.

[asha]

Its very important to screen the lumbar spine before treating the SI joint. There may be some adaptations there which may need to be seen. If there are positive findings there, that has to be taken care of before treating the SI. from your posture it appears you are standing in a FRS(RT) position. That is your facets appear to be locked into flexion with right side bend & right rotation. Here your internal obliques on right would be over working & obviously your externals on right will not contract. You probably have a multisegmental affection. Whether there is a neutral dysfunction also can be judged only with an intensive assessment of the lumbar spine. Check if you have a physio anywhere close by who is trained in doing manual therapy using muscle energy techniques. You will have to be tackled into all the movement planes. Once you are unlocked, you will have a whole lot of exercises to keep you from going back to the dysfunction, as you would be contracted on one side & stretched on the other, giving you stretch weakness on one side & tight structures on the other.Good luck.

[leashy11]

Hi asha,
I just wanted to say thanks for your reply, I saw a new therapist last night who agreed my spine was stuck rotated and released the entire spine which amazingly has seriously helped the piriformis pain I have on both sides. He isn't sure it will last or if it's the only problem but it has definitely helped somewhere so thanks for giving me some information to ask about.

[asha]

hi leashy, its great to know that you have atlast found help. Just keep doing your exercises. re-modelling would take atleast 6 weeks. there would be some stretch exs & some strengthening exs to be done which will be shown by your physio. You would have to rebuild your transversalis reflex back. good luck & get well soon.

[Jay Luttes]

Dear Sir

I am sad to hear of your pediment as I also have a similar problem and have had it for some 30 years. With this said I may be able to help if you have not already tried the following.
If there is a physician that practices trigger point therapy in England he or she may give you some relief. The mother of this technique was Janet Travell x president John F. Kennedy's doctor. She was a sort of friend of mine when alive and a really supper lady, unfortunately she passed away some years ago. Janet authored two books ( Myofascial Pain & Dysfunction the Trigger Point Manual) #!. upper body #2 lower body. I suggest you locate these books and read on the chapter that addresses your problem. If you wish to chat about your problem you can email me at [email protected]. I may be able to give you some further pointers. Good luck.