Sacroiliac

[alophysio]

No Problem.

I could have sworn i replied to the earlier post...

OK..

1. TFL dominating... Don't do standard "Clams" exercises for glut med - usually the position taught is sidelying and hip over hip, shoulder over shoulder. If you are TFL dominant, this will reinforce the pattern. I am glad you have found a stretch but as you have probably found out, it is only a short term solution. It is unlikely it needs to be stretched, more like it needs whatever is making it dominant sorted out. Excessive L/S lordosis, anterior pelvic tilt or tight hip flexors (rectus fem) will do that.

2. Shuddering is likely to be the psoas grabbing and trying to stabilise at the same time. Likely to be overactive as well.

3. The thoracic spine needing manipulation all the time is likely to be the long erector spinae muscles pulling excessively and jamming your joints. This might also cause a flattening of your natural thoracic kyphosis and causing your scapula/e to wing.

4. Have your tried either the stork or ASLR tests with a "core" cue? If not, see how you go. Also, have you tried the compressions for the ASLR?

Overall, you sound like an excessive compression/active extension pattern of pain. If you can find a book by the name of "Grieve's Modern Manual Therapy - 3rd edition", Peter O'Sullivan has an excellent chapter on "clinical instability" that i think you find illuminating. Try to borrow it from a university library where there is a physio school or from a physio who has it.

Can you detail more about what is going on or maybe a photo side on of your posture? Thanks

[sarah001]

Hello again.

With regards the clamshell, a physio gave me this to do over a year ago and I discovered it didn't hit the glute medius with me but not before I'd done lots, I no longer do this one. The rectus femoris is very tight, it feels like a rod of wood in my legs (especially the left side of course) and I suspect I have an anterior tilt to the pelvis as I seem to over extend at the L5 level in place of hip extension.

The psoas doesn't test short but it does test weak. I struggle to hold my leg over 90 degrees for even 10 seconds but each time it's tested for length it's not restricting hip extension. One physio suggested it was seriously weak and being inhibited further by the TFL and rectus femoris?

My thoracic spine doesn't looked particularly rounded but is very flexible into flexion when I bend forward whereas the lumbar area is reluctant to flex much. The shoulders seem to be kept going by overactive upper trapezius which I've been working on by encouraging the lower traps to work, this has helped a little.

Contracting the core makes lifting the right leg in ASLR easier but not the left. Even with the core activated the left leg will not come off the floor without the right side of the pelvis twisting round to the left and rolling into anterior rotation, compression applied at various points on the pelvis doesn't seem to help this either. I always assumed it was because the TFL and rectus femoris of the left leg were far tighter than any of the abdominals, particularly the right external oblique which seems to be weaker than the left.

Posture wise I used to stand with hyper-extended knees but no longer do this (not through fabulous retraining of the muscles but through refusing to let the knees slide into that position), my feet pronate slightly but more so on the right side (weakest glute medius on that side), a bit of anterior pelvic tilt to both sides, lumbar spine seems to look like it is curved only at the very bottom and this is the only area that moves noticably when I extend the spine. Thoracic area looks normal except for my shoulders are rounded forwards but not so much they cause a hump if you know what I mean (?!) I suspect I'm guilty of forward head posture a bit too.

I really find that any movement of the left leg (whether flexing it or attempting to extend the hip or trying to rotate the femur without pelvic movement is impossible and I know that keeping the pelvis still is vital for me. These things happen even with a core contraction, although to a lesser degree. My IT bands are so tight they feel solid, there's absolutely no give in them at all and this is after a good year of trying to get the glute medius to strengthen.

I will try and read a copy of the book you mentioned, I'm very interested in the whole subject but just wish I didn't have to live it! Thanks again for all your help so far.