Sacroiliac

[alophysio]

Thanks msk101 and sijproblems.

msk101 - pelvic belts help but the issue is whether the SIJ needs compression or not. I think you will find that in pregnant ladies, they will often help because it is usually a combination of the relaxin and baby's head pushing the joints apart. But in non-pregnant patients, it depends on your assessment findings.

sijprobelms, thanks for your history. It would be interesting to assess you because of the fall - i have some questions if i may...

1. You seem convinced that the primary lesion is the SIJ - no doubt after all this time, there is a lesion (problem) there but i am wondering if it is induced from something else...

2. When you do a self-adjustment or other form of treatment to yourself, how long, on average, does the relief last - the more specific you can be here the better. Usually if the relief is seconds, minutes or hours (less than 24-48) than the problem is usually from somewhere else.

3. i believe you when you say you ilium is twisted a certain way and your sacrum is twisted in a different way. The difficulty for anyone who is going to assess you is that *normal* morphology in bones is more likely to asymmetrical than symmetrical. Therefore things like ILA, SS depth, etc *might* be unreliable. I say might because i still use them, i just understand their limitations. Research has shown that "correction" with a manual therapy change agreed upon by experienced therapists showed no change on XR with RSA. The reference is Tullberg T et al (1998) Spine Volume 23(10), 15 May 1998, pp 1124-1128.

4. Apart from BH, has anyone else ever looked at your T/S properly? To me, from your history, that is the first place i would expect to treat. You still have pain there - you use the word "excessive" to describe it. It is entirely possible that IT is the primary which is why no matter what you do, your sacral treatments do not change the orientation. The muscles that attach to the ribs attach to the sacrum and iliac crest. The abdominals like external oblique attach all the way up to rib 5 and interdigitate with the serratus anterior. Also, fascially, there are connections from the T/S muscles down to the feet. I once fixed an "ankle sprain" that wasn't getting better by treating the rib on that side - the pain in the ankle stopped...

5. "Tight" and "overactive" are often used interchangeably by people (including physios who should know better!). Often a muscle described as "tight" is just overactive because it is in a protective spasm. A truly tight muscle will be the same length when you are passive - best done under aneasthetic (but impractical!).

ANyway, these are just some of the issues that came to mind when reading your posts...

Cheers

[sijproblems]

hi alo

thanks so much for your time.

well you bring up some interesting points there. actually i had reflected on some of these points myself...remembering back to the beginning ...

1. after the accident i had terrible rib pain on the right .. couldn't sleep on that side, and i couldn't lift my right shoulder. that rib pain lasted for about 6 weeks or so. after about 3 weeks, i started to run again .. despite the rib pain. i ran for a couple of weeks up and down hills without noticing much pain until i moved closer to the lake in lausanne and starting running flat along the lake. i remember it was the first run along the lake ... flat, that the knee pain kicked in like there was no tomorrow. i did wonder during that time if this poking of my approx 3rd of 4th rib into my sternum and spine would and the right rib pain could have set up something in my pelvis. after about one year, the popping went away in my thorax and just cronic pain in thorax and neck remained.

the reason i thought this rib gig wasn't the cause of my pelvic problems is that i'd taken three other falls when i lived in colorado and france ... two snowboarding and one with a heavy backpack where i slipped on the ice. but that was years before and those three rib incidence healed without giving me grief. so i just thought this 4 rib incident would be the same. i didn't realise the pocking of my ribs into my spine until several months after the accident. also... "the malalignment syndrome" talks about the reorientation of the ribs in that exact area as a results of a pelvic misalignment. also after the accident i remember thinking that i left leg felt shorter. apart from the other original pain after the accident, the other thing i did notice was pain in the top right of my hip, which was taken away by a physio with some resistance to teh muscle ...i'm guessing the TFL was where the pain was coming from.

2. after manipulation, the orientation does stay in it's new position. actually what i notice is that after the manipulation, it takes a day or so for the joint to settle to its new orientation, which is not the same as the previous orientation. however, over time, i think the ligaments and muscle have become compromised and i haven't been playing around with hte joints as much lately (for about a month) so i can't say what they do these days. i got scared when my SI joints started to hurt ... quite alot at one point. now i feel alot of referred pain to where i think is my right glut medius. also, my left knee has started to give me grief again .. but i've been through periods of almost a year without any knee pain. i know that due to the misalignment, both knees have tears in them, but the patella cartilage is wearing more of the left... and has since the accident ... also i think my quad is tighter on the left ... which would make sense re: the patella wearing.

3. thanx for that reference. i should check it out. "the malalignment syndrome" shows that you can see structural differences after adjustment. sorry i don't know what "XR with RSA" means :-) i don't profess to be an expert :-)

4. MC also examined and messed about with my thorax. actually so did the physios in december... mobilizing my spine with their thumbs and rotating my torson. he confirmed that my right side of my ribs sit higher and are more bunched together. BH also saw that but said she corrected that. one thing i do notice since 9 months is that my right rib/lats area isn't as tight as it was. last year, that right side area was tight, tight, tight. before the accident i had no scholiosis (i have xrays from a few years before), i was buff. however, last year on a set of xrays i got done here i see a scholiosis has been set up. actually after the accident i had an xray a couple of times of my spine but an absent minded (speaking from experience with her) doctor's secretary in switzerland left those two sets of xrays by her rubbish bin and the cleaner threw them out, never to be seen again despite my best efforts to try to get them back/find them, so i don't have those iterum period xrays and i was pretty clueless at the time, and so don't remember trying to examine those xrays myself. however, my SI joints have been moved so much since then and i want no more xrays (one doctor told me i'd been over-radiated), so i don't know how this "Functional scholiosis" is going now.

yes, i've examined these muscles closely in my cadaver and anatomy books... that's why i started to focus on the muscles above my pelvis which attach to the pelvis and my core muscles. you sound like you've got a good grip on that stuff.

5. thanx for the tips there. i need to read more about how muscles react to misalignment and when they are placed under constant tension or a lack of tension, which can be the case when face with changes in surrounding bones and muscles.

i've become a bit like my own guinea pig lately. so i'd be all up for getting knocked out in the name of nutting out this probem :-)

thanx a mil for your insight. i'm a bit like sarah ... very appreciative. i can't imagine i'd be as enthusiastic as you if my life didn't depend upon it.