Sacroiliac

[sarah001]

Hello everyone, I'm hoping someone can shed some light on a very longstanding and painful problem I have. My right sacroiliac joint is very loose and frequently gets stuck in anterior rotation, I see an excellent physio who aligns it but it doesn't stay there for more than a day. My concern is the left side, the muscles of the leg (all of them, hamstrings, rectus femoris, vastus lateralis, adductors, peroneals and calves, TFL) are all much stronger and tighter than the right side and will not release, I also find when I try to do hip extensions on the left side the leg always laterally rotates and abducts, I have less range of extension when compared to the right side and it feels like it drags the entire pelvis with the leg and twists my back, it also hurts the right SI joint each time I try to extend the leg. When laying supine I cannot lift the left leg in a straight leg raise without the whole pelvis shifting and the right side rotating anteriorly and with a bent leg it does the same but to a lesser degree. In your opinion does this imply the left side is stuck? And what position would it indicate from the details above? Thanks in advance.

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[Bikegirl]

I do tend to agree with physiodace. you have a really long history and you likely would gain just as much if not more benefit with say a pilates program for your aforementioned problems (perhaps an orthotic would help with the supinated foot althought that might come right with correct pelvic function) as you would with hands on treatment. you are at a stage where you need to retrain your nervous system to work correctly. hopefully you can manage one supervised pilates session a week or fortnight with unsupervised sessions between, saving either you or your health fund a whole heap of cash!

keep us posted. if you are involved in a pilates program could you please send me some exercises you are doing as i am very interested in pilates for pelvic dysfunction. somewhat of a novice in the area

You have the right to agree with physiodace, but are wrong too. The pilates is not helping at all, in fact, it is doing more damage ( I've been through it many times! I tried yoga, pilates name it I have tried it). I am not at the point of retraining my nervous system to work properly yet, I am still in too much pain and I still need a lot of manual therapy.

Everyone I met prior to meeting my current physiotherapist advise me just the way you did and it just caused a lot more damage and pain. A LOT of pain and damage. Perhaps, it is question of perception or just understanding what manual therapy is as opposed to all other types of physiotherapy...

Anyway, at this point I do believe that some people just don't get it or will only get it no other way but theirs....and that's why it took so long to find a good pt to help me out of this. It just happens that I found the best PT in the province, that's why I am getting results. Results I was expecting from all the others I've seen before, but they just didn't have the experience needed and the knowledge needed to work with me. They got stuck in their way of seeing things instead of evaluating, observing, trying things and getting results.

(...)

[Physio Dace]

Thanks for this.
Your opinion is just wrong in my case, I need the manual therapy.

Opinions are just that - they are neither wrong nor right in any case. I did not say that what you or your physio were doing was wrong - it sounds like your are improving and thats all that counts; I was merely showing my concern regarding long term hands on and thus passive management of persistent pain states and that in most people (not all) this approach tends not to work in the long term. However I hope you prove us all wrong. Best of luck and sorry for any offense.

[neuromuscular]

Dear Bike girl and all:

I do not agree with the SIJ being a big causing factor in the majority. Conditioning of viewpoint has lead to most looking for this in patients.

To use one example, the book Movement, Stability and Low Back Pain has over three pages on SIJ and nothing on the adductors.

In a recent issue of a Helath magazine, it was reported to me that there is new research other than my own that indicates that the adductors may be the larger cause in low back pain than previously considered.

There are numerous factors.

I just gave a presentation on the test that I have been using in assessing the pelvis to a group of physiotherapists in Seattles. Washington, USA, who had Masters and Docturate degrees. The reaction is very positive and they are incorporating the test in their routine.

You might consider having a physio check you for asymmetry of pelvic angles or differring of innominate bone positions as you do hip ABD.

My idea is forget SIJ and look elsewhere. It has been my experience that SIJ problems are the effect and not the cause of the problem.

Best regards,

Neuromuscular.

[gwynnwallace]

Dear all..... we all (physios/chiros etc) all have our own pet theories as to which bit is dysfunctional, and consequently our favourite techniques are directed towards them. However, there is more then one way the crack a nut (or treat and sij! - if you believe in them). The key point for us as therapists is to be open to new ideas and others perspectives, as may not be wrong, they just have a different view.

[neuromuscular]

Dear Gwynwallace:

Well said.

Ths person bikegirl seems frustrated that she is sent back to the same idea over and over again.

I might suggest that the newer test for innominate bone position be tried. By the physio mapping the bone position as the patient does hip ABD another approach might result. Maybe something has been missed.

Best regards,

Neuormuscular

[alophysio]

Dear Bikegirl,

I want to, in my heart, suggest that such long manual therapy is not necessary but i have seen too much in my professional career to be able to suggest it.

The reason why most people tell you things like that is because there are plenty of studies to support that position. However, in NONE of those studies did they suggest that NO ONE gets better.

Therefore as far as i am concerned, if you feel better, then great!

As for my on ego - i would love to think that i could "do a better job" but the reality is that i can't fix everyone and sometimes people have to see someone else with a different approach. That is ok because my main aim is to a commitment to lifelong learning... as you have no doubt learnt a lot from your experience.

Good luck to you and i hope and pray you get better soon.

Cheers