What's your opinion on prolotherapy?

[loft33]

You sound like you're suggesting a core and glute strengthen program is pointless if the SIJ is unstable? Is that correct?

[Crystal R. Westergard]

well, core programs are always good for overall strength. but they will not stiffen your SI joint up, no. Can you possibly compensate for an unstable SI with good glutes and core, maybe, but you'll be compensating, not fixing the underlying problem.

[loft33]

I take it "fixing the underlying problem" means prolotherapy since the medical world doesn't have a way to regrow ligaments yet?

[Crystal R. Westergard]

Well the SI joint is tight enough and built for conformity that it does "regrow" it's ligments at times, meaning that if you bring the two sides together with a belt it stands a chance that the two ends of broken ligs will "find each other". You will see this done with ankles, when there is no break, "just" a sprain or tearing of ligs, they'll pop the person in a cast boot to try to get the ends to meet again. But yes, if the ligs are completely shot, nowhere to be found, we can't regrow them. the prolo causes a reaction that I'm not an expert on, but mimicks ligaments I believe by making everything stiff.

[loft33]

I really appreciate your replies, Crystal.

RE: my SIJ. The PT said it was a little bit unstable on the right side. But there are no torn ligaments - as in ruptured or completely severed. The SIJ belt seems to help a lot and it's become more stable over the last few weeks.

I'm still at a loss as to how this could have happened. I didn't have any traumatic injuries (falls, car accidents, etc). But I did do a lot of walking (2 hours a day) over the last year. Maybe from that.

Oh, by the way, is it generally okay to do isolated glute max strengthening exercises to help realign the SIJ and hold it in place? Someone told me you don't want to do glute max strengthening until the SIJ is perfectly healed. That didn't make sense to me since the glute max - as I understand it - tends to pull the pelvis down and keep it level.

[marj]

Dynamic stabilization exercises including those that activate glut max are the gold standard. In most cases the Si is hyper mobile from genetics or pregnancy, rarely unstable from trauma. This is common in gymnasts and dancers but with balnced exercise
they are able to function at a high level.

Consideration must also be given to avoiding end range positions.

If this approach fails prolotherapy should be considered but all the same principles apply re exercise and education in conjunction with prolotherapy and it is not a quick fix. It frequently requires a series of injections over several months and if people are
deconditioned it will be a very slow process of recovery.

Diane Lee and LJ Lee have an excellent book that includes many exercise ideas and is available through Diane Lee's website. Be patient.

[loft33]

Hi marj. Thanks for your input. I have a few questions based on your reply.

1. I'm a man, so my one sided instability can't be gender related. If it were genetics related could I expect laxity in my other joints as well? (I don't have any other instability)

2. I've heard others say don't take your SIJ through "end range of motion.". What exactly is this end range? Can you give me some functional examples?

Thanks!