Unstable Sacroiliac Joint has gotten worse...

Hi, my name is Jonathan and I injured my back way back in 2007 and have yet to fix it to this day. I read your post about your unstable SI Joint and I was wondering if I could bother you with some questions as I am in the same situation you were.

Trying to keep it short, basically my SI joint is very unstable and needed to be corrected almost weekly. The physio I was seeing for 2 years now failed to help and my condition actually got worse and it went along.

I tried prolotherapy and had high hopes but it did not work after about 6-7 treatments. The prolotherapist that I saw was baffled as he told me he never had a case like this where he couldn't help at all.

Late this December, I saw a new physio who was a recent graduate from Australia who diagnosed me with the same problem (unstable SI joint/ weak core muscles) as the rest of the doctors/therapist that I saw. The only difference with him was that the exercises he had me do to retrain my core muscles were more specific and seemed to be working as my SI Joint was stable for about 2 months without needing to be manipulated.

Unfortunately at the beginning of March I put my SI Joint out of place again. But this time it was different. It suddenly became so unstable that I find it popping out every other day or sometimes even on the day that I have it readjusted.

This makes my rehabbing extremely hard to cope with.

My main question and concern is seeing as how my si joint has gotten to the point that adjusting it back in place will only last a few hours or so, is it okay to stick with the exercises knowing that I have slight misalignment? Or does even slight misalignment exercising make it worse/not better?

I feel really alone and that I'm like the only person in the world with an SI Joint this bad and I'm out of ideas on how to fix it.

Thank you for listening and sorry for the long message. It's been frustrating times.

Hi! what type of mobilizations were done on you?
Because the sidelying manipulation in which there is a forward thrust on the pelvis and a backward thrust on the shoulder is more harmful than beneficial

The following is an extract from an article:

'Unfortunately, the traditional approach to mobilization of the sacroiliac joint has been an attempt to correct a high iliac crest by extending the innominate on the sacrum. This is usually done with the patient side-lying and with the operator behind the patient pulling backward on the shoulder and thrusting the innominate forward and downward on the sacrum. This is done in the mistaken belief that a high crest is caused by an upward dysfunction of the joint when, actually, the high crest is caused by anterior dysfunction and concurrent apparent lengthening of the leg. This maneuver could serve to open the joint slightly at which time the taut sacroiliac ligaments would rebound the innominate into its proper position, usually with a disconcerting thud. If this method of mobilization in the wrong direction is continued for any period of time, one of two things will happen: the joint will be jammed much more tightly, or it will become unstable requiring frequent adjustment usually at great cost and inconvenience to the patient.'

Hi Jonnogunn.

Yes if the diagnosis is correct and you benefited for a brief time following intensive stabilisation training - then pick up the exercises and really work on it.

Excessive manipulation is not warranted in instability, and of course will do nothing for you in the long term. There is a school of thought that you could stretch the ligaments by overzealous and repeated manipulations. However there is no sound evidence for this and frankly Xplando, I think you are being a bit alarmist. There is no reporting of harm in the evidence literature for increasing laxity of the sacrobiliac joint following manipulation - this is just an opinion. The sacroiliac ligaments are the strongest ligaments in the body the force required to cause structural change to their length would be enormous - much more than what a manipulation could ever achieve.

However it may be wise to err on the side of caution as you already have a deficient mechanism. if you are experiencing discomfort when the joint "goes out" you can often be taught how to perform a gentle mobilisation to "realign the joint" so you don't have to use untoward force and don't have to keep going back to the therapist.

An alternative treatment that works well with the strengthening/ stabilising exercises is to wear a Sacroiliac Belt. This may or may not work with you but it would be worth a try. The belt is a very simple device that provides firm but comfortable compressive pressure across the hip bones and pelvis and may prevent the joint subluxing. If this works this may prevent or at least reduced the number of episodes you are having while you get on with the business of improving the strength of the muscles. Reducing the number of subluxations in combination with the strength training may have a beneficial effect on the length of the ligaments and help them work better but you have to keep it up for several months

I'd have to agree - return to stabilisation exercises, try a sacroiliac belt in the short term and avoid further manipulation. Stabilisation exercises should include hip, pelvis and lumbar spine as well as abdominals. An exercise called "waiter's bow" is also a good exercise. Have you had an xray?

Quote:

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Originally Posted by jonogunn

I feel really alone and that I'm like the only person in the world with an SI Joint this bad and I'm out of ideas on how to fix it.

Thank you for listening and sorry for the long message. It's been frustrating times.

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You have my complete sympathy....and let me tell you that you are not alone! My pelvis is out of alignment too - and will pop out of alignment within a couple of hours of being corrected. I've been told its been out of alignment for so long that there is no chance of it being corrected permanently :( I have a mild scoliosis which I know is connected to the pelvis problem - what I don't know is which came first....no-one really seems to know.

It sounds like you are in the same situation - so its really just a case of trying to manage the pain rather than fix the problem. I still have regular physio sessions with a fantastic physio, but she doesn't even try to correct the pelvic alignment any more, she just does things like myofascial release and acupuncture to help with pain relief.

I hope you can find something to manage your pain - I know how miserable it is to be in pain all the time xx

hi. I am sorry to hear that you have SI joint pains.
I used to have that for 10 years after almost all professions fail to diagnose correctly. As I did research treatment on myself,
I found those of things are possible cause of my body.



Unstable SI joints are due to
1)ligament damgage(posterior long dorsal, etc)
2)compensation for muscle and fascia dysfunctions close to joints(attached to illium and sacrum)
3) misalighment of upper cervical
4) compensation from knee instability
5) compensation from altered function of ankle(less dorsiflextion)

SI joint instability sometime is not an issue of its joint. rather than compensation from other structures.
I am guessing all treatments are done for 2), and maybe 3) and 4) and 5). if not receive proper treatments.
for muscles and fascia, active release technique type works well. but you need to have a good provider. The best one and average one's difference in terms of diagnosis and treatments are like distance between california and newyork. Skill really varies. For manipulations, diagnosis and treatments vary.
Good one can achieve long terms result and bad one can last only 25min. for maintenance of your joints movements, i recommend Gyrotonics.



Treating 1) case can be done Blocking procedure in spine position. so sacrum can become closer to iliam.
When it comes to SI join stability caused by 1), any treatments(exercise, stretch, manipulation) will fail and result in only relief for temporary 25min- day.
When i started to treat myself with blocking for 4-6 weeks,
my SI joint becomes stabilize along with Gluteus medius stretching and strengthning)
When receiving blocking correction, you should not receive a manipulation or excessive load exercises on joints. you have to let ligaments heal or you will not ever get fixed.
if you have instability and also fixation of si joint because of surrounding muscles(fascia) are dysfunction, you need to treat those muscles(fascia), or receive really light manipulation done by instrument such as activator for temporary pain relief.
I wouldnt recommend to use blocking by yourself because you can hurt yourself if done improperly on wrong side or done too much.
Blocking specialists are called SOT practitioners in chiropractic worlds.
There is always good and bad in any manual medicine practitioners, and i highly recommend to do research to find the best provider possible.
I hope you the best

sincerely

Hi Johnathan and everyone else, I'm a new member as I have literally just stumbled on this site while trying to find some answers for my own problems, and an imminent appointment with a physiotherapist (due in Jan).

I have a cariety of problems, but unstable SIJ is amnogst them, I have no stability at all, so can completely sympathise with you Johanthan. It's a miserable life with no SIJ stability, severly affecting mobility and causing a great deal of pain that seems to move from place to place, legs and lower joints, and back and shoulders.

The way I describe it is to imagine your arm extended, and the elbow being the anchor/pivot for the upper and lower arm, now imagine the elbow joint is instead of being fixed and stable allowing the arm to bend from a fixed position, is actually loose and moves up and down a couple of inches, meaning that the biceps/triceps and muscles of the forearms have no fixed point on which to gain traction....

Now imagine that same scenario but in the lumbar/pelvic region, where instead of having a fixed point for the leg muscles, and back muscles to use as a centre, instead everything is loose and moves up and down.... the legs (hips/knees/ankles) and back (L5-S1/T12-L1/C7-L1) joints/junctions and associated musculature, have no fixed point on which to have any traction... so everything is constantly shuffling about trying to work without the central pivot point....

This is how it feels to me at least.... maybe you can relate to that or not, we're all different after all..

My own problems seem to stem from a number of sinal problems which in turn affect my lumbo-pelvic stability (incl. SI Joints)...

I too am hoping that I can get some help or advice here, as to what I can expect from phsyiotherapy... any benefits or what sort of examinations/treatment I can expect...

I have MRI results after a fractured spine, which include, marked degneration of the spine, congenital failure of segmentation of the lumbo-sacral junction(L5-S1), posterior hemi-vertebra at T12, with fusion reduction of a burst unstable T12 (I believe the fusion spans T10-L2), a limbus vertebra at L3, schmorls nodes throughout, dystophic facet joints at T12-L1 and L5-S1 levels, increased thoracic kyphosis, and recently also coccygodynia as well..

Those are the clinical findings, to use a less clinical description, to me it feels as though my spine is like a bow ( as in bow and arrows) and that it's curved just like a bow, almost as if all the muscles in the front are too tight and are pulling both ends of the bow together, and that it's almost impossible to straighten the bow... where the bow is the spine, but on top of this, its as if I can't get any traction/grip with my legs and feet... my lower legs and ankles swell up on a daily basis, that resembles a sprained ankle but both feet at the same time.

Any help or advice that can be offered here, or any insight into what I can expect from physiotherapy would be greatly appreciated...!!

Johnathan I hope that you too get some help and find a way to manage with the pain and disability that you find yourself in, you're not alone, I'm sure that there are many others who have similar or worst, though it offers little solace, the number of times I've heard family members say "there are people much worst off than you"... I always say that I'm well aware of that, but that it doesn't make my problems any the easier for me, it doesn't ease my pain to know that somewhere someone else has more/worst pain, I can imagine only too well your frustration... and wish you all the very best, if you can find someone who will listen to you without trying to say things to make you feel better, I find that to be the most helpful someone who will just listen to you from time to time, to let you get things off your chest, without feeling the constant need to try to comfort you or feel bad for you etc....

Good Luck with everything....

Hi there - a very good and healthy debate about a very complicated issue. What comes first - the instability or the muscle imbalance. The SI-joint function is depending on a great amount of variables - breathing (diaphragm/psoas-connection) - could be an ascending problem, or a descending problem - stress from organs - or a combination of them all. Complex !!! Handling of the issue is therefore not an"easy fix" - it's lifestyle - it's like going on a diet - it only helps when you're on it. You have to continue the rest of your life with the exercises - the right exercises !!! It is about muscle-imbalance - stretcing and strengthening - an occational adjustment (ME or direct) when done the right way is not the issue. CORE strength and stabilization is the key - work work work. Good luck.

Hello- wow, I am so scared reading this. Has anyone ever heard of a long term success story for this? Also, I hate to say it, but what is the difference between this sacroiliac dysfunction and scoliosis?

Any success stories (from someone over say 40?)

I ask this because I have begun looking for help with this. For me the problem showed up in my feet with one foot over pronating and various foot complaints that I now know were neurological- (I have had the nerve conduction studies and it has show l4 is denervated- maybe more, they only tested L4.)

My feet are now much much better. But I am now hugely aware of my rotated pelvis. I don't know how long its been like this. I suspect it has been rotated for awhile but then furthur rotated this winter, causing the radiculopathy.

I hear what one poster was asking re trying to exercise while out of alignment- I fear that too, because wouldn't that just be strengthening the malaligned configuration? I can "force" alignment on myself by sucking in my guts as very hard as I can but its hard to maintain when I am out of alignment- which is the large majority of the time (and fyi- I am not overweight or unathletic though yes, we all can imporve our core strength)

In my case, my pelvis has begun to "derotate" periodically after a couple of months of core work. Like someone said, for a couple of hours here and there but then it springs back. It first derotated on June 15. Then this week it stayed derotated for 2.5 days but for whatever reason sprung back to where it was 2 months ago- just so incredibly scarey for me. Not just because it feels so bizarre but when it is fully rotated like that I guess it is stretching the nerves etc and that is when I feel it in my leg and foot.

It has been an emotional rollercoaster for me - elated when aligned and just so demoralized when it springs back.

I have noticed that it is in my spine and shoulder too- my pelvis is rotated to the left and so too is my left shoulder. And they seem to get better/worse together. My spine on the other hand is rotated to the right- I can rotate left but it is much harder (try it by making absolute sure you don't move your pelvis and you will be surprized!) This week when I stayed derotated, I cheated by keeping my left shoulder tucked forward (deliberately) and by sitting in a chair with my legs crossed the opposite way and with a facecloth under my shoulder- I am not sure if this is why I stayed "aligned") I am really scared. I am only 49.

I got simple standing spine xrays and they came back saying my spine is rotated to mid-thoracic level- but it just says that- just a statement that it is rotated- no reason or anything. And it says no lateral deviation. So my GP , who really has no idea, says maybe its just muscle imbalance and I need to derotate myself? I hope she's right but if you could feel my body, it feels like it really really fights against being aligned. One physio said theres nothing she can do, another has me doing Functional exercises to achieve muscle balance but I often feel wosre after doing these (basically steping front and side with a theraband resisting). And it is very complicated- one chiroprator stretched my left psoas and it felt so wonderful but the next day I was worse than ever and I can't help thinking that he stretched a muscle that was holding my alignment- like just because a muscle is tight- maybe it shouldn't be stretched! And I need to be very careful doing pelvic bridges- that is what made things worse, when a PT prescribed these without knowing my pelvis was rotated- imaging doing bridges with one hip lower that the other- that was when I felt my upper back go out of whack.

Man, I mean, this is a nightmare really, like, I feel like Frankenstien.

sorry for the ramble but personally I have learned so much from internet forums that I feel I should add my 2 cents in case anything I say may help someone else. But do be careful with the exercises for sure!

Also, I am just so shocked at the lack of information/knowlegdge on this. I had one chiro and one massge therapist even deny that my pelvis was rotated. My GP is clueless. The raidiologits obviously- I dunno, outside his scope. After doing research on tyhe internet I see that this is a pretty common problem .

Does anyone have any comments on this?


here is a something I found:

Addressing Pelvic Rotation | Myoforce Addressing Pelvic Rotation | Not for the Weak

thanx :)

Sometimes the SI Joint is misaligned due to improper sitting ( for men sitting on a large wallet) can greatly affect this joint. Massage /chiro can help to relax the tight pelvic and lower back muscles while guiding the joint into better position. It is a sliding type of joint not a lot if movement in it but the SI nerve that runs thru the pelvis and can cause so much discomfort is about the size of your pinkie so once irritated it takes a bit to settle it down. Good luck nothing worse than the back pelvis pain on top of a hip revision

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