Sacroiliac

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.

Hi Sarah,

Its all well and good releasing the sacroliliac joint, but unless you strengthen around the area to keep it in that position, then as it is doing, it will just revert back to causing you pain. Your opposite side will be working overtime to take some of the pressure off the injured area, which is why the muscles won't release.

I would initially strengthen the abdominals with pelvic floor type exercises, then stengthen Glut Med for stability.

Hi Sarah,

There are some articles on Diane Lee's website which you should read. The one about the stork test and Active Straight Leg Raise is one in particular that will be helpful.

It sounds like your deep hip external rotators are too active. Who knows why. Karen is right when she suggests to stengthen the deep abdominals.

Having said all of that, it does sound like your LEFT SIJ is dysfunctional...it may be causing the right SIJ to anteriorly rotate because the movement is not coming from the left hip, SIJ and L/S. Thus the pelvis is rotating from the right SIJ...

Good luck!

Hello there, thanks for your reply. My left side does tend to go into outflare and the right side goes inflare with anterior rotation too. I agree about my hip rotators, they hurt too but are refusing to release as the area is so unstable. I tried glute medius training but the medius just wouldn't respond and burnt when I tried to exercise it or the TFL completely took over instead so I'm struggling through basic core stability exercises right now. I find my transversus abs contraction is hit and miss right now, sometimes I get it right and other times I don't but I'm working on it! I have Diane Lee's book "The Pelvic Girdle" and it's very useful but my physio uses the stork test amongst others to check me regularly anyway.
Would the inflare/outflare situation cause the left side to rotate the right in hip extension do you think? I would have thought the outflare side would have had more extension than the inflare side but I'm not really sure.

Ok,

Firstly, you sound like a physio, esp if you have Diane Lee's text.

Secondly, outflare/inflare is based on muscular control. You will often find an outflare (PSIS moving laterally relative to the other side) will correct with a good lumbar multifidus contraction.

Thridly, it sounds like something else is driving your lumbopelvic hip problems.

I am not really an advocate of 'unstable' unless you can demonstrate on u/s that a good core contraction still leads to excessive, uncontrolled joint motion. However, having said tht, your hip muscles don't want to let go for some reason. They usually don't act in isolation - what is the co-contracting muscle?? It sounds like TFL is dominating the hip.

Your core stability exercises shouldn't be so difficult. If it is, there is an underlying issue that is unresolved, probably apart from the SIJ. Have your thorax checked. The answer may lie there. Also, how do you know if you are doing the exercises right or not? On what evidence are you basing this on?

In general, it sounds like you have a MET background but in my experience, if you have to keep fiddling with correcting your pelvis, you aren't hitting the right buttons - check your diagnosis and consider what other possible areas of dysfunction might be at play. i find that it should only take 1-3 sessions at the most to sort out a pelvic dysfunction - if i have to keep going back to it, i have missed the primary driving factor. If you read Diane Lee's text, you will find that there is not much emphasis on positional diagnoses but rather a functional one.

Where in the world are you from? Also, have you seen Peter O'Sullivan's work on classification of NSLBP??

Thanks - looking forward to more information from you. ACtually, can you please provide a more complete history on what your problems are? Thanks

Hi again,

I can assure you I'm not a physio, just a very long term patient so I've researched to try to help myself!

You're right about the TFL, it is seriously dominant, especially on the left side. My physio watches me do exercises to check what's going on and even with a contraction of the core the pelvis moves around during movement, especially during hip extension. She has also worked on my neck (which was very tight) to release that and manipulates my thoracic spine each time I see her as that gets tight too. One of my shoulders wings but she says that's not unusual with pelvic problems. A pilates instructor tried to help me stretch the TFL/IT bands but my pelvis wouldn't stay still to even get into position so she gave up, and the standing stretch I've been trying to do just ends up not hitting the TFL much but letting everything else twist out of place so I've stopped that.

I think one reason the muscles won't release is I'm in dire need of glute max and medius work but the hamstrings dominate the glute max during all extension exercises and bridging too and the pelvis rotates into anterior rotation and/or twists no matter what I do. Very frustrating! The glute medius seems to be under so much strain from the TFL and piriformis problems that it can't cope with small things never mind trying to strengthen, so it just seems to be a vicious cycle.

I did once have my physio do MET on the rectus femoris of both sides and the hamstrings and this helped but for a very short time.

During the stork test I am unable to balance on the right leg (worst side) and with the left side I can balance but not great. When I lift the legs up during this test I get a shuddering all the way up the torso which no-one has been able to explain too. ASLR testing is impossible, I can get the right side up but with a rotation of the pelvis towards the opposite side but the left side feels very heavy and won't even come off the table without the right side of the pelvis rolling forwards and popping painfully.

I live in the UK and I haven't read any of Peter O'Sullivan's work so if there's anywhere online I can have a look I'd like to, I'll google him.

My sacroiliac joints are sharply painful to the touch, lumbar spine is stiff with the right side erector spinae so tight my physio struggles to do the flank stretch (she also tells me the lumbar spine gets fixed in a rotated position), right shoulder (one that wings) is painful and IT bands also hurt both sides. My peroneals are also sore and tend to get cramp during any attempt to do glute medius work. My hips hurt but not deep in the joint itself more where the piriformis attaches and around the TFL area. Hamstrings are dominant but not painful, rectus femoris is sore and tight, glute max is weak and hurts, likewise with the glute medius. I hope I've told you relevant info and not just waffled on to you!

Thanks for the interest, after 3 physios, 2 osteos and 2 chiros all giving up on me it's nice for someone to try and help so thanks!

Hi again,

I can assure you I'm not a physio, just a very long term patient so I've researched to try to help myself!

You're right about the TFL, it is seriously dominant, especially on the left side. My physio watches me do exercises to check what's going on and even with a contraction of the core the pelvis moves around during movement, especially during hip extension. She has also worked on my neck (which was very tight) to release that and manipulates my thoracic spine each time I see her as that gets tight too. One of my shoulders wings but she says that's not unusual with pelvic problems. A pilates instructor tried to help me stretch the TFL/IT bands but my pelvis wouldn't stay still to even get into position so she gave up, and the standing stretch I've been trying to do just ends up not hitting the TFL much but letting everything else twist out of place so I've stopped that.

I think one reason the muscles won't release is I'm in dire need of glute max and medius work but the hamstrings dominate the glute max during all extension exercises and bridging too and the pelvis rotates into anterior rotation and/or twists no matter what I do. Very frustrating! The glute medius seems to be under so much strain from the TFL and piriformis problems that it can't cope with small things never mind trying to strengthen, so it just seems to be a vicious cycle.

I did once have my physio do MET on the rectus femoris of both sides and the hamstrings and this helped but for a very short time.

During the stork test I am unable to balance on the right leg (worst side) and with the left side I can balance but not great. When I lift the legs up during this test I get a shuddering all the way up the torso which no-one has been able to explain too. ASLR testing is impossible, I can get the right side up but with a rotation of the pelvis towards the opposite side but the left side feels very heavy and won't even come off the table without the right side of the pelvis rolling forwards and popping painfully.

I live in eastern UK and I haven't read any of Peter O'Sullivan's work so if there's anywhere online I can have a look I'd like to, I'll google him.

My sacroiliac joints are sharply painful to the touch, lumbar spine is stiff with the right side erector spinae so tight my physio struggles to do the flank stretch (she also tells me the lumbar spine gets fixed in a rotated position), right shoulder (one that wings) is painful and IT bands also hurt both sides. My peroneals are also sore and tend to get cramp during any attempt to do glute medius work. My hips hurt but not deep in the joint itself more where the piriformis attaches and around the TFL area. Hamstrings are dominant but not painful, rectus femoris is sore and tight, glute max is weak and hurts, likewise with the glute medius. I hope I've told you relevant info and not just waffled on to you! If I've missed vital stuff let me know.

Thanks for the interest, after 3 physios, 2 osteos and 2 chiros all giving up on me it's nice for someone to try and help so thanks again!

how are you going?

Hi there,
I have found a better TFL stretch to do that keeps a stable pelvis whilst I'm doing it and I've found my hip extension improves for long enough afterwards to do hip extension without using lumbar extension and a twist to get the legs back. Hopefully this will help the glute max to strengthen and the glute medius to remember to work! I'm pretty sure that the lack of isolated movement in the hips (especially the left one) is seriously contributing to keeping the problem going and although I know it will take me a while to begin to correct this I'm determined. Thanks so much for your interest and all the info you've given me. I'll let you know how I go.
Sarah

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

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.

Hi - your case sounds so interesting (and frustrating for you).

1. Was the clamshell exercise given to you as described above? Hip over hip, knees bent to 90deg, hips bent to 45deg, heels in line with bottom? If so, that exercise usually reinforces TFL/RectFem (RF) dominance in dysfunctional people. I advocate a position that has you quater-turned onto your tummy, only the top leg bent up and the top arm supporting some weight too (simple base of support reasons).

2. You say your psaos tested weak, not short. How did they test for that? If they did a thomas test, the TFL would drag your knee laterally and not allow for proper testing of your true psaos position. Also, with your pelvis anteriorly rotated, the psoas is lengthened but the RF is shortened so it may allow RF to dominate in that way.

If holding your knee above 90deg in standing is your Psoas test, then you may find that tight hip extensors might add extra "load" to the test etc. Also, your positioning during testing will determine what other muscles are being used.

3. Are you sure that it is upper traps that is overactive? It is usually levator scapulae which is overactive and drags the top inside edge of the scapula upwards and points the bottom of the scapula towards the spine. Upper Traps does lift the scapula but by jamming the clavicle into the sternoclavicular joint then pulling on the clavicle (it doesn't attach to the scapula as most people assume) to outwardly rotate the scapula. Lower traps helps this process by attaching to the spine of the scapula and giving the scapula a place to rotate around. THe biomechanics get a bit complicated but people think the lower traps is a depressor or retractor when in fact it stabilises the scapula then assists to outwardly rotate it.

4. I would like to know more about your movement patterns during bending over and leaning backwards and sideways. It is hard for my minds eye to see what is happening. There are many reasons as to why your L/S may not move much compared to your T/S. Are your erector spinae (ES) muscles co-contracting with your obliques to give you this pattern?

5. The ASLR test results are interesting. Can you tell me if your physio has used this test a lot in the past with other clients? I found it is a fine art to get it right in complicated people - the art is in figuring out what is the relevant information from the test.

Is your starting position in neutral spine. If not, then you are asking for biased results. I use pilows etc to get people in the a good position. If you are in too much extension/anterior pelvic tilt, then EVERYTHING will feel hard to do because it puts your TrAb in a weak pos.

Do the compressions of the ALSR make things harder?? i.e. the left leg is heavy and the pelvis lifts and rotates but is it worse with compressions? If it is, it may indicate EXCESSIVE compression by your muscles (eg multifidus/ES, inferior internal obliques with TrAb). Believe it or not, you can over do your "core muscles"!! The secret is to have ADEQUATE compression, not the most amount possible! Just enough to achieve stability with mobility.

6. Anterior pelvic tilt will drive your knees into hyperextension. Fix the pelvis and the knees whould follow...easier said than done by the sounds of it.

7. Have you tried Trigger point injection therapy? Apparently you inject local anaethestic into the trigger points of the TFL and ITB. It has really helped one of my patient's TFL...

Thank you for all your information. It is only 2 chapters of that book that are about what i am talking about - both by O'Sullivan. The chapter by Diane Lee is similar to the Pelvic Girdle book so it doesn't really matter.

Keep us informed of how you are going!

from your descriptions of symptoms you have an assortment of altered sensations and patterns of recruitment in your lower limbs, as would be expected from a low back stiffness problem, leading to irritation of nerves that arise near to joints. This is a common condition that is the natural and non pathological product of protective responses in and around spinal facet joints. The suggestions put forward that these events are somehow linked to perceptions of alignement or position of the sacro iliac joints are misleading. It would appear you have been mislead by a physio making claims about being able to interpret your condition on the basis of ilial or sacral postures. This is a spurious and nonsensical relationship which has only the loosest connection to the reality of SIJ dynamics. Sacro iliac joints are somtimes implicated as biomechanicaly connected to lumbar protective responses and thereby to pain etc. To suggest however that these largely immobile ( though important ) joints can be "aligned " is the stuff of the purest fantasy.
Find a physiotherapist who is able to , by measured and skillfull attentions to the lumbar spine , turn of protective events there and you will find the means to a realistic way out of your painfull ( and doubtless confusing ) situation

Hi Ginger,

From what i understand, Sarah001's physio has looked at the L/S but for illustrative purposes, would you try to mobilise the facet joint first to release the spasm of the ES on the right or would you try to release the muscle spasm first by some other means and then try to mobilise the joint?

I am wondering if you can get past the thick fascial layer of the ES and then past the lumbar multifidus down to the facet joint (which has some seriously strong ligaments at L5/S1) to begin to mobilise the facet joint...

Thanks :)

I have no trouble mobilising spinal joints through layers of soft tissues. The first proceedure that I would consider would be to restore normal lumbar facet mobility by reducing protective tone around them, this is best achieved with longest term effect with continuous mobilisation to fact joints. Further attentions to adjacent larger muscle ( MET or trigger point release ) may be warranted under some cirtcumstances , though I rarely find this necessary. By reducing focal irritants to nerve roots in this way , there will be restoration of normal patterns of recruitment to the lower limbs and the "muscle imbalances " will dissapear.

Thanks for your reply Ginger.

Is it at all possible that the initial period of your mobilisation is the effect on the paraspinal muscles (multifidus etc) before actually effecting joint mobilisation?

Also, in the case of chronic muscle imbalance and resultant morphological changes, do you think that the muscle imbalances will sort themselves out once the facet joints have been sufficiently mobilised?

An observation that tonic changes take place when muscles are stimulated with lateral stretch is of course common place . What is interesting in the physiological changes relating to continuous mobilisation however , is that the changes are more lasting. In addition , the nerve related events that would be presumed to be caused by focal irritants around the nerve root are routinely relieved with Cm in a way that I have not observed with muscle stimulus. Proponents of the trigger point approach have plenty of satisfactory reasons to follow this treatment , however I find best results occur with a combination of muscle and soft tissue release and guided specific passive movements at facet joints. Having not derived my own approach from analysis of others work , so much as rigorous and lengthy observations of cause/effect , it is my opinion, that both treatment methods have merit. Also that both deal to some degree with stretch reflexes. Mobilisation, when done according to the protocol I call CM, allows speedy and long term elimination of referred events. For this reason I use it as a first line therapy, followed up in some cases with attention to other soft tissues at or near joints.
I don't think it will ever be possible to fully resolve the question you pose. What gives me good cause to use mobs regularly and to zero in as best I can on specific lateral masses , is the sense that good results provided this way is best explained , not by stretch reflexes, but by somewhat more complex means.
I know that when my thumbs stray away from the lateral mass, results diminish, strongly suggestive of another physiological player beyond muscle in tonic changes.
Muscles don't become "unbalanced ", muscles only do what they are instructed to do. Patterns of recruitment however , are routinely altered by protective responses leading to joint/nerve irritation. This is routinely restored to normal with effective reductions in those protective responses leading to reductions in tone and subsequent reduction/elimination of focal irritants to nerve roots. I find that discussions heralding these so called imbalances are usually by those who have not experienced these immediate and lasting restorations to normal recruitment at the effect of CM.
One example of this is with PFS. ten minutes of L3 mobs and VMO dysfunction commonly observed, along with pat/fem pain , are gone. This is a permanent change , provided the protective events at L3 are completely turned off.

hi alophysio

i was wondering if you can tell me where you are in sydney? i'm also like sarah... i've been everywhere ... spent a house deposit on this stuff and am still suffering. i flew to brisbane to see mark comerford (who is a nice guy, just for the record), only to discover that despite teaching pelvic courses, didn't have much of a clue. i've also seen barbara hungerford, but although she helped me, i think she failed to take into account that my pelvis had been moved excessively because of incorrect diagnosis and treatment by some local physios which resulted in a seriously anteriorly rotated right innominate and a seriously posteriorly rotated left innominate and some what i think was anterior shear of the right ilium with respect to the sacrum .... which i walked around with for many, many months. so i think that she missed a couple of things and i went back and told her but well ... she kind of treated me like my problem hadn't become complicated ... clearly that didn't work so i gave up because of the cost and time travelling to sydney.

i never had SIJ pain but now i have pain in both SI joints. i don't walk like a normal person. after seeing a few more osteos and physios i now am the only person who diagnoses and treats myself which is difficult because it's hard to find people to help me (for them to do the techniques correctly) and it's hard to trust their interpretation of sacral sulcus depth, ILA posterior/anterior/inferior/superior etc., ASIS orientations etc. people say you can't diagnose yourself but i have had the best results from my own interpretation and correction of the misalignments. but i'm a bit stuck now ... and i'm wondering what role the QL, multifidus in particular are playing in what i see is going on with my sacral/ilium orentations.

my sacrum has been moved up and down and all around the place by myself and another lovely physio who tried to help. but like i said, i think the problem is that it's important to listen to the patient regarding their sensations and examine the muscles ... these are things i've learnt along the way. i've been reading the "malalignment syndrome" which has helped me understand the muscular aspects of my problem but despite my best efforts, my pelvis and sacrum sit in non-optimal orientation which causes knee pain and hip pain, back pain and a weird gait. i feel that if i could step out of my body and examine myself i would have more of a chance of nutting out what's going on.

i;ve started doing pilates. i'm guessing that the ligaments and muscles which hold the ilium to the sacrum are now structurally compromised.

so if you could tell me where you are in sydney, i can consider coming to see you. i'm currently doing a masters but plan to start a phd in the biomechanics of pelvic misalignment next year ... out of shear frustration and desperation.

thanks so much

i'd like to comment just on the technical aspect of the sacrum not being able to move with respect to the iliums ... i have experienced, with my previous physio, that if he pushed my sacrum down with respect to my iliums, i experienced a very interesting gait pattern (both femurs rotated laterally) and subsequent medial knee pain on both knees. upon pushing my sacrum up (which i had to do to relieve this gait pattern) the knee pain disappeared and my gait was retored to something more "normal". if the sacrum was pushed too high, i felt pain in the lumber spinal region.

however, i do agree that the muscles attaching to the iliums and sacrum can and do affect gait patterns ... which is now why i pay particular attention to muscles like my QL.

i understand that the muscles respond to something ... but i am also sure that my sacrum and iliums can and have been seriously rotated/moved in the past to directly affect my gait ... as, i suspect, a response of muscles to changes in structural orientation of bones.

if you think that your sacrum cannot move up or down or your ilums cannot be rotated, i propose you to try getting somebody to push down (inferiorly) on your sacrum, or anteriorly or posteriorly rotate one of your iliums using a muscle energy technique or brut force and see what happens. of course, first orientating the femur in such a way which facilitates opening of the SI joint.

i would love to see some of the experts have their SI joints manipulated as excessively as mine have been (out of a lack of understanding of the problem) and then try to tell me that restoring correct function and alignment is not that difficult... and that the ilium doesn't rotate THAT much. i understand that alot of the sensation of a rotation etc can be a result of a muscular response to a "slight" change in SI joint orientation, but i propose that hte ilium can move more than expected with respect to the sacrum... if enough force is applied.... which is what happened to me in the beginning by some unsuspecting health professionals

of course this kind of manipulation shouldn't have happened in the first place. but before all that happened, there was one sensation that i experience after the accident which confirms my belief that my sacrum had reorientated itself with respect to my left ilium in particular ... barbara hungerford corrected that "fixation" and now that side has the ability to pop like the other side does if i perform a certain test on myself... previously, this was not possible.

it seems to be that from being out of wack so badly for so long, i actually suspect that i do have some soft tissue changes in the facia or muscle attachments, in particular .. the iliac crest for glut medius, obligues, QL....it's kind of knotty ... which i believe could be forcing my weird gait sensations.

Hi sijproblems,

It would be of help for anyone reading this to have some of your history (when did it start etc) and treatment approaches.

Also, what is your professional background? Is it medical in nature or something else?

Thanks!

HI All,

I would like to ask the pelvic specialists amongst you about the merits of pelvic/trochanteric belts.

I have been interested to read the posts on this issue and know that pelvic girdle examination and treatment is not my strongest point. I have definitely found that troch belts can be really useful with SIJ pain in pregnancy and was wondering if something along these lines would be useful to provide some external stability to the pelvis thereby allowing strengthening exercises to be done more effectively if the pelvis is just too "unstable" to allow them otherwise??? but not as a long term solution as such.

Looking forward to your input.

Thanks
msk101

Hi sarah … sorry I was so self absorbed I forgot to look at what you wrote …

I think I know what your problem might be … you’re describing what happened to me which BH alluded me to. I can suggest that “perhaps” you might have your sacrum in anterior fixation on the left, which is accompanied by an upslip and a posterior rotation on the left. Or at least, at the very least, it sounds like you might have an upslip on the left which is causing all these muscles on the left leg to tighten up. Do you have knee pain on the left? Another question that I have is, no matter what you do, can you get your left SIJ to pop or not?

The symptoms you describe, shoulder pain on the right etc and all those tight muscles on the left leg is what I had … is it your left leg that feels shorter?

Regarding the right side, she told me that if the left is dysfunctional, the right side tends to “overactive” to compensate. But for me, this is all old news since now both sides of my pelvis are a bit of a dogs breakfast.

Anyways, hope this helps.

hi alophysio

firstly, sorry for my spelling. i'm an engineer so hopefully can be forgiven :-)

well, my history is long. but now, so much has happened ... i think i'd exceed my character limit on this website if i explained it all. originally it was a snowboarding accident in switzerland where i studied for two years. original pain was thoracic , left knee and left foot pain although i had no impact to the knee or foot in teh accident. i just realised that after the accident, i couldn't run at all without terrible knee pain. i realise now it was due to a biomechanical change in my gait as a result of a pelvic misalignment. initally i saw a few orthopedic surgeons and sports doctors, and chiros and physios in switzerland ... most of them associated with the swiss olympic ski team ... poor ski team. they'd do an MRI on my knee and couldn't find anything ... and and sports doctor and knee doctor finally refused to see me, they thought i was crackers. also i had this terrible shoulder pain and clicking of my ribs into my sternum and spine .. it was hell. then one of the doctors gave me a terribly lame diagnosis of arthritis and suggested a course of pain killers for like 3 months....funny hey.

finally i came back to australia out of dispair and desperation. went to see some chiros and physios again. until that time, i could still walk long distances with the misalignment (at this stage me nor anybody i saw knew all my problems was a result of a pelvic misalignment). anyways, in switzerlnad i was still able to hike for 7 hours in the mountains but i could no longer ski or run without knee pain.

anyways, back in oz, a few chiros, massage therpists, physios and exercise physiologist later, i saw a chiro who did an adjustment and created a very ugly situation in my left leg... i started to get symptoms like sarah was describing. then i went back to see him adn he did something which created an ugly situation in my right side of my pelvis. after that i could no longer walk for long distances... it was hell. that's when i started doing my own research ... three months later, i figured out that the problem originated in my pelvis. then i went to see some physios in my local area who had done a course ... but i think the problem was that htey failed to take into consideration teh orientation of my sacrum. what they did do subsequently created excessive posterior rotation of my left innominate and excessive anterior rotation of my right innominate. then i went to see well, MC and BH and then a few other physios and an osteopath and now i run on my own steam... since i got pain i never had before and i walk like ... really a bit funny... although, like it said, it's improved alot since i do my own diagnosis and adjustments.. the right anterior hip pain has practically gone.

my background is engineering ... i'm currently doing a masters ... but alot of my spare time and not so spare time is trying to get my hands on literature pertaining to lumbo-pelvic dysfunction ... so it's useful being at uni, having access to all libraries in australia and many on-line journals.

i plan to do a phd in the biomechanics of the pelvis starting next year. but obviously my supervisor has already suggested me doing many physio courses, which i will embrace with gusto. i have some understanding of how cells respond to load and tissue repair from my time studying biotechnology in switzerland.

thanx a mil

hi

sorry i was a bit mad yesterday ... as you can see. i went on a bit, can get like that sometimes ... where i put my focus upon the failings i've experienced so far. but that doesn't help me - blaming the shortcomings of others. i also know i'm not perfect and my impatience/desperation has probably gotten me in this worse situation... being persistant with physios etc. so i wanted to outline the problems now.

the original accident was january 1st 2005. i think that having my right ilium in excessive anterior rotation and possibly forward shear for about 8 months from nov 2007-june 2008 has created some soft tissue or muscle thing that's causing me to walk funny on the right (originally i felt no problems on the right for almost 3 years until i saw the chiro and physios towards the end of last year). walk funny ... well it's not so bad now but there's still something weird going on with the gait and i have pain in my right leg which seems to extend from hip to knee ... seems like a combination of ITB and lateral side of hamstrings type area. also i have SIJ pain on the right but that occurred after too much manipulation on the right to try to get these shear/rotation out of hte right side. there are some schools of thought that say that anterior shear of the ilium is not possible but i know what adjustment caused that sensation in teh first place so i don't know ...

my left leg feels short and my right leg long. despite the fact that i think now that my right side might be slightly posteriorly rotated and/or outflared (again ... i know some schools of thought who say on outflare is not possible ... but that's what i see). but i don't move it from that position at the moment.

lying down, also, no matter what, my right ILA is inferior (no matter how much i try to push it superiorly), and well, if i can trust what my friend says, anterior ... but there have been periods where it's been stuck posterior no matter what. i understand that this could be a piriformus thing and also i was wondering, since the multifidis attaches there ... if it could be keeping the ILA posterior at that location ...

i know BH also can attribute tightness in the coccygeus muscle to some things witnessed by some in the orientation of a sacrum. but i have't had enough experience to know.

my sacral suclus is deep on the right, no matter what i do. the ichial tuberosity on the right is inferior (so this combination of inferior right ILA and ichial tuberosity could be what's causing the right leg to feel long, despite it's slight/possible posterior rotation). so that leads met to think that there could be some ligament stuff going on at L5/S1 which is allowing the right side to be inferior.... but my QL is tight on the right ... which in theory lifts the back of the iliac crest superior, which could keep my right side in an anterior position despite when i see it posterior when lying down.

thoracic pain is excessive ... but BH corrected a right superior first rib and posteriorly fixated 3rd and 4th ribs. not sure if it worked, still feel a bit of pain there, which she attributed to overactivation of the upper abdominal muscles ... i know that i do overactive the upper abdominal muscles.

i am also hypermobile in some muscles and not in others. abductors are sore but hypermobile, hamstrings are tight, tight, tight on both sides. piriformis ... the stretch indicates left is tighter but the physio told me the right is tighter. ITB is tighter on the left, despite this right leg pain from hip to knee.

so for the moment i don't adjust more my SI joints. (oops, pubic symphis is ok). now i focus on pilates to strengthen core and lengthen and strengthen limb muscles. also i get some massage to help me identify tight and weak muscle patterns to see if i can explain from this what i see in my orientation of pubic bones. i also conciously concentrate on my gait patterns to override modified motor control... i notice if i go off guard, muscle compensation patterns kick in more .. hence a more funny walk :-)

thanx a mil

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

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.

Hi...

...before i forget, XR=X-Rays and RSA = Roentgen Stereophotogrammetric Analysis which is basically sticking small balls of metal into your ilia +/- sacrum then taking XR - it allows very small changes in movement to be assessed in 3D.

I do believe that you now have a significant SIJ issue but i always come back to the question..."who is driving the bus?"...the associated changes in your SIJ may well be from habitual postures driven by other processes.

I have not read the malalignment syndrome. However, i am personally not a fan of the term...but i do appreciate the sentiment - it is often easier for someone to understand that something is "out" than to go through the multitude of possible variations that could be causing the problem. My new assistant is going through the process of me asking her what the possible structures are - she is "muscle" trained so i am working hard to get her to see other structures. Physios, Chiros and osteos tend to be joint focused but we need to keep in mind all the systems that can cause dysfunction.

TO be honest, there aren't many physios that know how to fix motor control problems of the thorax (ribs and T/S). I try to do as many LJ Lee courses as i can on the subject because she is the world's foremost expert at thorax rehab.

Anyway, more information is good whenever you can...I jsut wanted to ask again...you did not have back pain for some time after the accident - it was leg and rib pains?

hi alo

thanx for your information, comments and questions ...

hmmm, well now i have a significant SIJ problem if i didn't have before, that's for sure! i should also mention that since about 6 weeks, i also have this sciatic type pain on the right side which started from too much manip (i think) on the right side .... when i lye on my stomach and lift my right leg up using my gluts, without knee bent, i have too much pain from bum to back of knee along lateral hamstring. when i bend right knee 90 degrees into air and lift right leg (lying on stomach), the pain is nowhere near as sharp.

i had so much pain in the rib area and spine area for 6 weeks after the accident, but it was something i had felt before with rib pain ... you know how it is. but after the rib pain subsided, i had a very sharp poking of my 3rd,4th rib into my spine and sternum ... like the rib had been moved out of place. well what i would do is ... the rib would be poking into my sternum and so i'd pull my shoulders back to relieve the pressure and it would then poke into my spine .... so yes, that was very localized back pain. it was predominately on the right side of the thoracic vertibrae at the 3rd and 4th rib connections and on the left and right side of the sternum at the 3rd sternal costal cartilage. an MRI of my sternal costal cartilage about a year after the accident showed that my sternal costal cartilage was inflammed (most of it, not just at the place where i felt pain) .... i was convinced it was a symptom of a change in the biomechanics of the skeleton and associated muscular response ... the doctors suggested this rediculous arthritis thing... i also had the sensation of having a short left leg and this knee pain ... which i also notice when i tried to run on flat ground about ... 5 weeks after the accident (because the 3 weeks after the accident, my running was being done up and down hills where i didn't notice anything wrong with my knees).

also, the scholiosis last year was showing that from L5 to about L1 there was a slight curve which made the spine sit on the right side of normal spinal centerline, then the curvature reversed and there was a kink at i think around T10/T9 which sat on the left side of my normal centerline spine position. from about T11 to T4 my spinous processes were bent to the left (like the spine was twisted). then there was another kink on the right side of my neutral spine position at about T1/C7. the physios in december and MC were pushing on those spinous processes to kind of move them back. but i don't know ... i wasn't sure that twisting could be fixed without correcting the orientation of iliums/sacrum. but then what do i know ...

oh and one other big thing ... since a long time, i notice that if i lye on my back and lift my left leg up in the air and then throw it over my right leg, so i'm twisting my spine .. you know what i mean ??? ... well my flexibility is alot less when my left leg is over my right (hence twisting my pelvis clockwise with respect to my head) than it is when i turn my pelvis anticlockwise with respect to my head (throwing my right leg over my left). i figure it's a combination of muscle and spine biomechanical changes which cause this...obivously...

the other issue is this ... with all this manip and prolonged bad alignment, i can't help thinking that some of the ligaments and soft tissues have remodelled to kind of set this bad orientation... i hope i'm wrong. but what i think is important is to understand how the muscles react to prolonged tensile stresses over time, which they are sujected to when there is a structural misalignment or muscular thing going on in nearby tissue ... or when they are forced to recruit for an area that they don't normally need to recruit for. for example .. looking at the other extreme, we see that when the muscles are no longer in a structural configuration which they are used to operating in, they waste .... like what happened to my right glut max at the end of last year after the exessive anterior rotation of my right ilium. i think it's regained some of its bulk again now ... but i know i recruit my hamstrings before my gluts when i think it should be the other way around...when lifting my legs when i lie on my stomach. but anyway, that's getting off the point... so i'm wondering if and how, just hte muscle (not considering ligaments for the moment) changes in structure due to prolonged periods of say being in spasm ... you know, sometimes for years. and hte same can be said for ligaments and extracellular matrix. i know that extracellular matrix remodelling .. the structure of the remodelled matrix is affected by the force on the surrounding matrix (and hence the fibroblast cells) during remodelling by fibroblasts. so, i think it's important to know how long (and short) muscles change in structure over time, if any, in order to figure out how to help them return to their original structure and ability to funciton. i know that might sound confusing. maybe i haven't explained it well enough. anyways, do you know any books about how muscles and other soft tissue respond to prolonged periods of tensile force or spasm? i mean, we know that in cartilage, it responds to modified loading patterns by breaking down over time ... which is a bummer!

hi again

i just wanted to bring up another point.... although BH picked up an anterior fixation of the left side of my sacrum which usually and was accompanied by the posterior rotation from december (although she said it happens anyway with an anterior fixation) and an upslip, which was hte case, all muscles of the left remain tight, tight, tight. especially hams, quad, ITB, and sore abductors. i think that now, since last november, there's this problem on the right ... of a weird and long right leg, which i now consider my primary problem ... thanks to mr. 30 years experience chiro and physios in december/april .... so i think that perhaps, the long right leg is keeping the left leg muscles tight... or changes have occurred in the left leg muscles and ITB tendon during the year (since seeing the same chiro earlier last july when all this muscular spasming on left kicked in) which make it difficult, despite correction of left SIJ and best efforts with heat, massage, stretching and pilates, to release them. or, it could be a combination of muscle changes (if that occurs) and long right leg.

when people check my leg length lying down these days, they don't see the right side long but it feels long to walk on.

Hi sijproblems.

wow - that's lots of good info.

i will use point form as i find it easier...

1. I am hoping to challenge the idea that the problem is solely in the SIJ/pelvis area. Your history SCREAMS thoracic spine involvement. However, i take your point about the soft tissue changes after all these years but let me relate a story i have told before elsewhere on this forum...(sorry if you have read it before)...

This lady had something like 12 years of chronic back pain. Had great physios treating her. Had difficult standing up straight for 5 mins after rising every day. For over 12 years! She got assaulted by a patient who threw an outdoor setting bench onto her (pysch ward patient). Anyway, her FF was to the knees only with pain limitation - again for 12 years.

Literally 1 treatment restored her ROM to touching her toes. That one case had made me rethink the whole adaptive change concept which you outline above - real changes are possible quickly. Literally mins. I had 2 physios who were witnesses to the assessment and treatment (i was being assessed at the time).

2. You are spot on with the whole biomechanical change thing. A torsion in the pelvis (or thorax) will create lots of strain on those cartilage joints.

3. scoliosis and short leg feeling etc...tough to judge on that one. I certainly don't believe pushing around on the spinous processes will change that. You are an engineer, do the maths! We might be able to put ?kg of force through a short lever arm (maybe 3cm) - would that counteract the torque of your whole body weight and the tension developed in the tissues?? i doubt it.

I would prefer to work out if your scoliosis is structural (due to the bones) or postural (due to the muscles). Most people have a scoliosis without any problems. It is usually postural and responds well to exercise.

4. twisting the body - the main rotation of the spine comes from the T/S. You only get 3deg from each lumbar vertebrae and maybe 5deg from the pelvis if you add the 2deg each way. Another reason why i was thinking T/S.

5. muscle imbalance and remodelling and response to stress. The body is an amazing machine. Like the story above, i have seen things that theoretically shouldn't happen. I like to find the areas of stress and fix them because then the muscles and other tissues will settle down.

6. Feeling the right leg long and seeing no change in leg length in lying down do not create a confusing situation - it just means that in lying down your legs are not much different in *apparent* length and when you walk, you *feel* the right leg is longer.

I have changed gait and apparent leg length discrepancy by joint means (manipulation of "stuck joints"), by muscle changes (stretches, soft tissue releases), my motor control changes (coordination exercises then reasses) and with visceral releases (changing the fascial pull on bony structures).

in summary, I like to keep it functional... any other ideas out there?

Hi everyone.

First of all I want to wish good luck to everyone with SIJ problems. I suffer from it too and I know how bad the pain is!

It all started from a fall on the coccyx 5 years ago. The pain was increasing by the minute. I seeked help with doctors, physios, massage therapist, Rolfers, acunpunctors, chiros etc.

I went through x-rays, scans, MRI and nuclear medecine nothing showed on the tests.

I met a sports doctor back in 2005, he assumed I injured ligaments in my right sijoint. I stress the fact that he said that I probably injured ligaments. He couldn't tell from a firm point because the tests he did didn't show anything, but the symptoms I had were pointing him towards the ligaments injury.

Those symptoms were and still are: feeling of short leg on right side, numbness in right foot sometimes in both (increased when I do cardio), a lot of coughing, light headed and vision of silver spot (like when you get up too fast), cramps in the abdomen and lower back, muscles pulling and tightness in lower back ,abdomen, legs and calfs, weird taste in the mouth, unable to sleep or stay in the same position for long periods, extreme fatigue, and the major one: pain around L5, sacrum and hip on the right side. If I touch my lower back towards L5 and my sacrum I can feel lumps, the Rolfer could undo them and it would bring my back to normal but it wouldn't hold. The doctor, also added that I would be hungry and would have to eat more than usual as the body required a lot of energy to heal this kind of injury.

He advised me to go to the gym and do as much cardio as I could. Ligaments are supposed to be healed by cardio workouts in order to stretch them back into place.

So I went to the gym, for 2 years I did a weight training program 5 days a week and cardio program 6 or 7 days a week. There is no words to explain the energy it took to do so, all the while working full time as a sales rep. on the road.

The doctor mentionned that I would go through the following phases:
1- improvement in my condition as I worked out
2- the lack of sleep would increase especially towards the end of the healing process
3- about half way into the healing process I would reached a point where I would no longer be able to workout due to the fact that my body would be too tired to recover normally -- I reached that point 2 years into the training in the summer of 2007
4- after that resting period I would have to go back to the gym to finish the process otherwise my condition would stay the same i.e with no more improvements
5- the remaining sensations and pains should go away as I keep working out.

I went through all these painfull steps and I was able to get back in the gym in August 2008 to start my cardio workouts and in September 2008 I started my weight training on top of the cardio. I don't work at the moment, because this is taking all of my attention and energy.

I am wondering if anyone out here experienced the same thing?

At this point, I still feel the pain and the numbness in my foot, but it is totally different then what it used to be. I see and feel improvements, but it is a very slow process. I still can not sleep well, I either can't fall asleep or I wake up 4-5 times a night. This is due to my back going into an active state. I can feel and hear the ligaments or tissues trying to get back into place, it comes with hot flashes or chills. If it happens during the night it wakes me up and must eat in order to go back to asleep, if it happens during the day I have to lie down and rest or sleep (if I can) and eat as soon as I wake up.

From all the specialists I have seen, the Rolfer acknowledged that something was wrong with my ligaments, but his treatments didn't work, all the physios couldn't figure out what was the root of the problem and kept working on muscles, 1 ostheopath acknowledge that something was wrong on my right side, but couldn't find anything else to help me, all acunpunctors found something on my right side but couldn't find anything to help me. All doctors I have seen except for the above mentionned, said that it was impossible that it could be my ligaments and didn't know what was wrong and wrote it off as a psychosomatic problem. Frustration frustation let me tell you.

I eat very healthy, 3 meals a day, 3 snacks a day (usually raw veggies and nuts) and sometimes eat when I wake up at night. I drink at least 3 liters of water a day. I avoid caffeine, sugar, unhealthy fats and processed food. Put it this way, I can not eat healthier or better, I took nutrition classes and seeked a lot of help, including a biochemist analyse to figure out what were my best options and I stick to it.

I welcome any comments, suggestion and so forth from everyone out here.

Deep down inside, my instincts tells me that I am doing the right thing with the workouts and that I am on the right path, but my mind always wonders. I would feel a load off my shoulders if I could find exactly what I have.

Thanks!
I look forward to your replies
Bikegirl

hi bike girl - OMG i wish i had more compliant patients like yourself!! I don't blame you for feeling frustrated.

Also, i haven't met such a "far-sighted" doctor before...but i think he might have had weeks/months in mind, not years like you have described.

A number of things...

1. something is irritating your autonomic nervous system - all the "wierd" symptoms and pains in your tummy can be from irritation of the sympathetic chain.
2. If you are getting treatment at the pelvis and back and it is not "sticking", then i would look elsewhere - like the hip or L/S or thorax. Hve a look at some anatomy pictures - the muscles that attach down near the coccyx also attach to the ribs and even to the back of the skull!
3. Your exercise programme is too non-specific for my liking. Try to find something more specific - but you will need a thorough assessment
4. You live in Canada - If i were you, and honestly i would do this, i would book a trip to Vancouver to see Diane Lee or LJ Lee and get some seriously decent time with them for a strategic plan - have them assess and diagnose you. Then have them treat you. Then have them teach you the specific exercises you need. Someone else can follow you up but have the people at the top design the strategy.

Perhaps they can recommend someone in Montreal...

Good luck - i don't think you are crazy - i think deep down, the doubts niggle away because your brain is thinking there must be a better way. There probably is...just got to find out how!

Good on you for persisting this long with it as well...

Cheers

Hi alophysio,

Thanks for your reply! Indeed I am known to do whatever it takes to solve something....and don't understand people that don't when it comes to their health!

I also think the doctor meant weeks/months of healing, that's why I am questionning what's going on here.

1- I figured that my nervous system was responsible for the sensations. I am assuming nerves are affected from whatever condition I have.
2- Thanks for that. I forgot to mention that the last physio I saw, performed a lot of manual therapy on me and always worked on my diaphragm, but never looked further. So this is something to keep in mind for the next one.
3-As far as specific exercices, I had a bunch given from all different physio I have seen, they never really worked. I understand that with the weight training program I am is focusing on back and abs muscles, but also on overall body. I always give a chance to new exercices, its only a matter of finding them. Perhaps you might have something to suggest?
4-I did call Diane Lee's clinic for a referal. I also contacted the Federation of Physiocal Therapy of Canada to get more. I was lucky to find someone 15 minutes away from my house. He did his advanced manual therapy course as well as Diane's Lee course, just not sure which one in particular. I am going to see him on Sept. 22nd...I can't wait! I also talked to someone else that confirmed me that the physio I am going to see is very good for this kind of injury.

Thanks for your kind words they are very welcomed on my part.

Now my fingers are crossed!!!!

I will persist until I find the answer no matter what it takes. There is just no way I am living the rest of my life like this...just no way!


Bikegirl

me again,

One thing I didn't mention before is my posture...its very bad. I am called a back hugger, I have a huge arch in my lower back and my tommy sticks out like crazy. I look pregnant (BUT I am not!). Strangers ask me if its going to be a boy or a girl. I can tell it is not fat, so I really wonder if it is muscles, ligaments or caused my the sacrum or something else.

I also can not tighten my stomach muscles, it just won't go in. It is important to mention that during my 2 years of training I had a 6 pack stomach.

My last physio worked on the muscles for that arch in the back, nothing was holding for more than a few hours. He disregarded the belly sticking out and only worked on my diaphragm saying that I needed to relearn to tommy breathe instead of breathing from the chest. I try to make him understand that I was chest breathing because the tommy breathing took so much energy since everything was stuck down there. I had to sit down and really think about it, it wasn't a stress response or anything like that. I was so short of breath from everything being stuck that my body naturally managed to breathe from the chest.

My walk is weird too from my right si joint. I feel my right leg being shorter (no one was able to see if it really was shorter or just felt shorter). My shoes wear differently too, my right heel wears a lot more than the left one. On the elliptical machine in the gym I notice my righ foot rotating inwards. I must concentrate to correct it. I really don't know what that means.

Any suggestion?

Thanks
Bikegirl

Hi - the last post was very informative!!

ok, firstly, good luck with that physio - it is ALWAYS good to get multiple people with relationship to each other telling you a physio is good.

With your exercises, sometimes it is not the exercise prescribed but HOW it is DONE that counts. A skilled teacher and a patient client are required.

You back with the arch and the tummy sticking out thing - is it a "hyperlordotic" back?

Another possible casue is that there is something causing your lower back muscles to be overactive or to become short. This can affect your breathing/thorax, L/S, SIJ, hips etc.

If this guy you wil be seeing is any good, he will explain it all to you.

Sounds like you are on a good thing - keep that determination up!!

Cheers :)

Hi again,

yes it is hyperlordotic back, I had forgotten the term.

Yes I understand about the exercices. I will keep looking, trying and hoping to find.

I hope the guy I will be seing will find the cause of those muscles being overactive...or whatever it is. But what can it be? Bones, ligaments, organs?

Thanks

Bikegirl

The leg length thing ...... you can have up to 1cm difference normally due to bone length, having a smaller hemi pelvis, that is know as a true leg length difference. you can also have an apparent leg this is more down to how everything interacts with each other, it can result in a relative difference in how the two halves of you pelvis move(think of it as your sacrum as an axel on a car.... with the two halves of your pelvis on either side. when you do a symetrical movement eg bending forward they should move together, when asymetrically they should move independantly eg walking. some sij problems are due to the fact that they move the wrong way round. ok physios its a simplistic view but bear with me)
when you walk look at are you taking a slightly shorter step with one leg (don't measure listen to your cadence/rhythum which should be even). there should be some stretches that can change this. however, this is a first aid fix to help wiht the discomfort, it won't sort the problem as you still need to find out why this happens

thanks for your post gwynnwallace.

I do have a shorter step on the right side.

I know about the stretches, I have tried them and I stretch on a daily basis for 20 minutes.

I am searching what's going in my SI joint.

hi Bike girl.

just looked at all of your previous posts, looks like you have looked at lots of different things. how about trying something a little different? Get hold of a nijmegen questionaire and fill it in and let me know the score
gwynn

Hi,

My score is 22.

What made you think of tha questionnaire? If I understand correctly this is for a breathing disorder? Can u tell me more about that kind of disorder?

Thanks