Sacroiliac

[alophysio]

Ok,

Firstly, you sound like a physio, esp if you have Diane Lee's text.

Secondly, outflare/inflare is based on muscular control. You will often find an outflare (PSIS moving laterally relative to the other side) will correct with a good lumbar multifidus contraction.

Thridly, it sounds like something else is driving your lumbopelvic hip problems.

I am not really an advocate of 'unstable' unless you can demonstrate on u/s that a good core contraction still leads to excessive, uncontrolled joint motion. However, having said tht, your hip muscles don't want to let go for some reason. They usually don't act in isolation - what is the co-contracting muscle?? It sounds like TFL is dominating the hip.

Your core stability exercises shouldn't be so difficult. If it is, there is an underlying issue that is unresolved, probably apart from the SIJ. Have your thorax checked. The answer may lie there. Also, how do you know if you are doing the exercises right or not? On what evidence are you basing this on?

In general, it sounds like you have a MET background but in my experience, if you have to keep fiddling with correcting your pelvis, you aren't hitting the right buttons - check your diagnosis and consider what other possible areas of dysfunction might be at play. i find that it should only take 1-3 sessions at the most to sort out a pelvic dysfunction - if i have to keep going back to it, i have missed the primary driving factor. If you read Diane Lee's text, you will find that there is not much emphasis on positional diagnoses but rather a functional one.

Where in the world are you from? Also, have you seen Peter O'Sullivan's work on classification of NSLBP??

Thanks - looking forward to more information from you. ACtually, can you please provide a more complete history on what your problems are? Thanks

[sarah001]

Hi again,

I can assure you I'm not a physio, just a very long term patient so I've researched to try to help myself!

You're right about the TFL, it is seriously dominant, especially on the left side. My physio watches me do exercises to check what's going on and even with a contraction of the core the pelvis moves around during movement, especially during hip extension. She has also worked on my neck (which was very tight) to release that and manipulates my thoracic spine each time I see her as that gets tight too. One of my shoulders wings but she says that's not unusual with pelvic problems. A pilates instructor tried to help me stretch the TFL/IT bands but my pelvis wouldn't stay still to even get into position so she gave up, and the standing stretch I've been trying to do just ends up not hitting the TFL much but letting everything else twist out of place so I've stopped that.

I think one reason the muscles won't release is I'm in dire need of glute max and medius work but the hamstrings dominate the glute max during all extension exercises and bridging too and the pelvis rotates into anterior rotation and/or twists no matter what I do. Very frustrating! The glute medius seems to be under so much strain from the TFL and piriformis problems that it can't cope with small things never mind trying to strengthen, so it just seems to be a vicious cycle.

I did once have my physio do MET on the rectus femoris of both sides and the hamstrings and this helped but for a very short time.

During the stork test I am unable to balance on the right leg (worst side) and with the left side I can balance but not great. When I lift the legs up during this test I get a shuddering all the way up the torso which no-one has been able to explain too. ASLR testing is impossible, I can get the right side up but with a rotation of the pelvis towards the opposite side but the left side feels very heavy and won't even come off the table without the right side of the pelvis rolling forwards and popping painfully.

I live in the UK and I haven't read any of Peter O'Sullivan's work so if there's anywhere online I can have a look I'd like to, I'll google him.

My sacroiliac joints are sharply painful to the touch, lumbar spine is stiff with the right side erector spinae so tight my physio struggles to do the flank stretch (she also tells me the lumbar spine gets fixed in a rotated position), right shoulder (one that wings) is painful and IT bands also hurt both sides. My peroneals are also sore and tend to get cramp during any attempt to do glute medius work. My hips hurt but not deep in the joint itself more where the piriformis attaches and around the TFL area. Hamstrings are dominant but not painful, rectus femoris is sore and tight, glute max is weak and hurts, likewise with the glute medius. I hope I've told you relevant info and not just waffled on to you!

Thanks for the interest, after 3 physios, 2 osteos and 2 chiros all giving up on me it's nice for someone to try and help so thanks!

[sarah001]

Hi again,

I can assure you I'm not a physio, just a very long term patient so I've researched to try to help myself!

You're right about the TFL, it is seriously dominant, especially on the left side. My physio watches me do exercises to check what's going on and even with a contraction of the core the pelvis moves around during movement, especially during hip extension. She has also worked on my neck (which was very tight) to release that and manipulates my thoracic spine each time I see her as that gets tight too. One of my shoulders wings but she says that's not unusual with pelvic problems. A pilates instructor tried to help me stretch the TFL/IT bands but my pelvis wouldn't stay still to even get into position so she gave up, and the standing stretch I've been trying to do just ends up not hitting the TFL much but letting everything else twist out of place so I've stopped that.

I think one reason the muscles won't release is I'm in dire need of glute max and medius work but the hamstrings dominate the glute max during all extension exercises and bridging too and the pelvis rotates into anterior rotation and/or twists no matter what I do. Very frustrating! The glute medius seems to be under so much strain from the TFL and piriformis problems that it can't cope with small things never mind trying to strengthen, so it just seems to be a vicious cycle.

I did once have my physio do MET on the rectus femoris of both sides and the hamstrings and this helped but for a very short time.

During the stork test I am unable to balance on the right leg (worst side) and with the left side I can balance but not great. When I lift the legs up during this test I get a shuddering all the way up the torso which no-one has been able to explain too. ASLR testing is impossible, I can get the right side up but with a rotation of the pelvis towards the opposite side but the left side feels very heavy and won't even come off the table without the right side of the pelvis rolling forwards and popping painfully.

I live in eastern UK and I haven't read any of Peter O'Sullivan's work so if there's anywhere online I can have a look I'd like to, I'll google him.

My sacroiliac joints are sharply painful to the touch, lumbar spine is stiff with the right side erector spinae so tight my physio struggles to do the flank stretch (she also tells me the lumbar spine gets fixed in a rotated position), right shoulder (one that wings) is painful and IT bands also hurt both sides. My peroneals are also sore and tend to get cramp during any attempt to do glute medius work. My hips hurt but not deep in the joint itself more where the piriformis attaches and around the TFL area. Hamstrings are dominant but not painful, rectus femoris is sore and tight, glute max is weak and hurts, likewise with the glute medius. I hope I've told you relevant info and not just waffled on to you! If I've missed vital stuff let me know.

Thanks for the interest, after 3 physios, 2 osteos and 2 chiros all giving up on me it's nice for someone to try and help so thanks again!