Tag Archive | si-joint dysfunction

Pelvic and Hip muscles imbalance and misalignment cause pain

Pelvicore-muscles-300x228s is your body’s center. Pelvic area problems are caused and contributed by pelvis and SI joint misalignment, improper loading and muscle imbalances. Usually a muscle imbalance shows the weakness of glutealis, deep back stabilizing muscles (transverse abdominus and multifidus), tightness of hip flexors, and hip internal and external rotators.

The neutral position of the pelvis is in the middle position – not twisted or tilted forward or backward. In the neutral pelvis alignment your spine gets its natural curves. When the pelvis alignment and center of gravity change, it can cause uneven loading and pain. When one part of your body doesn’t work correctly, other parts have to compensate for the weak point. Weakness of supporting muscles causes superficial muscles to be overworked, which may result in pain, excess muscle tension, and spasms.

Because your body works as a kinetic chain from head to toe, the upper body’s and foot’s function and alignments affect also your pelvis function. In walking and running, your rib cage and thoracic spine should be moving (rotating) naturally. If that movement is restricted then your lumbar spine will compensate with overloading and pain. If your foot elasticity and strength are missing, the kinetic chain from foot to pelvis can’t activate your muscles correctly during gait, which causes muscle imbalances and a risk of injury. As you see every body part is connected.

Incorrect pelvic alignment should be corrected as soon as possible because over time it may cause degenerative changes on your spinal structures, or even herniated disc and sciatica. Besides spinal structures, the SI-joint can be affected from pelvic misalignment. SI-joints are small joints between your Ilium and Sacrum which have very small but important motion. However, too much or too little motion can change your pelvis and SI-joint alignment and affects your gait. Si-joint pain is very local on one or both sides of the buttocks. SI-joint problems can be caused by weakness of supporting muscles ( muscles surrounding spine, pelvis and hip), which allow your pelvis girdle to tilt forward and causes excess pelvic motion while walking or running.

By correcting your muscle imbalances and misalignment are better treatment for your pain and dysfunction than passive manual therapy alone. Physiotherapist are educated to understanding your body’s bio mechanics, and help get you back in “balance”. Unfortunately here in the US, physical therapists rarely look and treat your body as a whole because usually they treat just a specific injury and pain. The reason for this is clear, physical therapist’s time is expensive and insurance companies are paying only for treatment towards injury and pain, not for prevention. However, the truth is that the source of pain and injury can be somewhere else than where the patient gets treatment, so it is important to take care of the body as a whole.

exercise-therapyPilates one-on-one training with a skilled physiotherapist or a very experienced Pilates Instructor helps tremendously for those who is suffering pelvic girdle dysfunction, low back, hip or SI-joint pain. Modified Pilates and Exercise therapy’s training goal is correcting your muscle imbalances and improving your muscles recruitment patterns. The Pilates approach is to work on your body as a whole and with “no pain is all gain regimen!” Be sure that your Pilates Instructor has the knowledge and education to help you. Even if they have 500 hours of training, it usually doesn’t include much training and modification for people with pain. Also the training usually has very little education on anatomy and physiology. But if you find a good one that is going to be PRICELESS!

For more about PhysioWise program in Carlsbad, California HERE


Sciatica Pain Caused by Piriformis syndrome and Treatment

Piriformis syndrome, Sciatic Pain and treatment

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The piriformis muscle is a small muscle located deep in the buttock under the gluteus maximus. The muscle runs very close to sciatic nerve and some people the nerve even can run through the muscle. Piriformis muscle function is assisting to rotate the hip, turn the leg and foot outward (hip external rotation).


Piriformis syndrome may caused by muscle spasm or excess tightness in the piriformis muscle, either because of irritation in the piriformis muscle itself, or irritation of a nearby structure such as sacroiliac joint ( SI joint) or hip. Most commonly, clients describe acute tenderness in the buttock and sciatica-like pain down the back of the thigh, calf and foot. Pain Increases after prolonged sitting, walking or running and it also may limit range of motion of the hip joint, especially hip internal rotation. Piriformius syndrome is very common in long-distant runners and those who’s sport requires repetitive external rotation of hip (ice hockey).

Many of my client who got a Piriformis syndrome, have also problem with their SI (sacroiliac) joint and visa versa. By saying that, SI-joint dysfunction may be sometimes root of pain, not piriformis muscles itself. Piriformis syndrome, SI-joint dysfunction and hip pain have very similar symptoms and they are hard to diagnose. Sciatica pain may also be caused by piriformis syndrome as well as SI joint dysfunction.

Almost every treatment approach for piriformis syndrome will include a focus on carefully and progressively stretching the piriformis muscle.
However, stretching only piriformis muscles may not be enough to treat piriformis syndrome. Piriformis syndrome may cause or caused by muscle imbalances in lumbo-pelvic-hip region. Stabilization of the pelvic may be affected by tight and short muscles hip flexors, hamstrings, piriformis and SI- joint dysfunction, resulting in overuse and spasm of the piriformis. So, muscle balance around your hip, pelvic and SI-joint are also important to treat. Faulty movement patterns are common for people who is suffering from piriformis syndrome. Piriformis spasms limit pelvic movement and in turn leads to gait deviations and compensations. If the muscle imbalances and faulty movement patterns left untreated, piriformis syndrome may return.

If you go to Physical therapy and did not get help, try Pilates with experienced Teacher. Pilates one-on-one training treats your whole body, not just a pain. So, you get help also your overall possible muscle imbalances and compensations – That is priceless.

For More about PhysioWise program in Carlsbad, CA, please visit http://www.physio-wise.com

IS YOUR BACK PAIN CAUSED BY MYOFASCIA? (by Pilates Wise Carlsbad, San Diego)

Fascia covers whole body and it provides structural support around our organs, muscles, joints, bones and nerve fibers. Fascia helps prevent and minimize localized stress in particular muscle, joint or bone. It is always under tension as long as gravity is present, and it also provides stabilizer components that helps our posture and allows us to perform movement automatically.

Fascia has been viewed clinically as a potential source of dysfunction. The research has found that chronic pain patients have some pathological changes in their thoracolumbar fascia. The thoracolumbar fascia is a tough fibrous sheet covering the back. It is tensioned by the muscles above, side and below. The fascia works as an attachment to several muscles and plays an important role of stabilization of the thoracolumbar and pelvic regions (as well sacroiliac joints). The thoracolumbar fascia attaches to the external obliques, internal obliques, transverse abdominals, latissumus dorsi and gluteus maximus. Because these muscles are connected through the same fascia, myofascia chains may contain restrictions and dysfunction in one area that influence another remote area. The thoracolumbar fascia also contains three nerve endings and may play a neuro-sensory role in lumbar spine pain mechanism.

Thoracolumbar fascia’s role as a cause of back pain is something that it is not shown by x-ray or MRI and is often underestimated by doctors. Chiropractors and spinal specialist treat spinal pain as a pain from vertebras or disc, but that is not always the underlying problem and may be a big reason why the back pain becomes, and continues, chronic. In most cases of back pain, especially in sub-acute or chronic back pain, the cause of the underlying problem may be more in muscle imbalances, poor posture or even myofascial dysfunction than spinal structure itself.


There are many specific stretching techniques about how you can release and mobilize the thoracolumbar fascia yourself, for example rolling with the foam roll. Besides releasing fascia, it is still very important to take care of your (deep stabilizer) muscles strength around your spine. Spinal stabilization training is specifically designed for people with back pain. It is scientifically proven to be very helpful exercise method for rehabilitating your back more safely and efficiently. For more information about Active Back Pain Rehabilitation, please click HERE

SI-Joint Back Pain and Treatment – Exercise Therapy in Carlsbad, San Diego


Back pain and SI-joint dysfunction treatment – Exercise therapy

Sacroiliac (SI) joint’s dysfunction is somewhat of a mystery and difficult to identify. However, SI-joint dysfunction is very often source of hip or low back pain but underestimated by doctors and chiropractors. It is much easier to treat hip or low back pain than Sacroiliac Joint dysfunction. People with SI-joint pain do not get relief if the underlying problems and real source of their hip and back pain are left untreated.

SI joint is located between Ilium and Sacrum. It is working as a shock absorption for lumbar spine. So, the sacrum is mechanically associated with the spine, but also affected by alignment and movement of femur.

Any lumbar spine, pelvic and hip region asymmetry, leg-length discrepancy or loss of motion in one joint might alter the forces and can affect abnormal mechanical stress and symptoms in the SI-joint.

ImageI have many clients who got lumbar spine fusion and many years later have painful SI-joint dysfunction. This may happen after L5-S1 fusion, but also people with L4-L5 fusion may have problem on their SI-joint. Naturally, sacroiliac joint is the place that compensate to missing spine motion after the fusion.

There are 35 muscles that attach directly to the sacrum and they produce synchronous motion of the trunk and lower extremities. Decrease in the length and strength of these muscles causes adaptive shortening and muscle imbalances and faulty, compensatory movement patterns of pelvic girdle. SI-joint manipulation by chiropractors or Physical Therapists does not probably work long term, but might get short-term pain relief. The muscles overall have more important role in treating SI-joint dysfunction. Most cases SI-joint problem is really caused by muscle imbalances and compensatory movement patterns than the joint itself. Also, a home-exercise might not work either due to pain and misalignment of pelvic and spine. People with SI-joint dysfunction need to get some “AHA”-moments about their body awareness, posture and alignments.

Our body parts are designed to work together and the best treatment is to treat the body as a whole, and people with SI-joint problems will benefit of that approach, too. Many back pain and SI-joint treatments fail because they only treat symptoms, not looking for how your whole spine-pelvis and hip are functioning together.

Si-joint dysfunction clients need very specific therapeutic exercise program which focuses on neuro-muscle integration by balancing overall pelvic and spine muscles. Pilates is a good exercise form, but not enough if you don’t have a Pilates instructor who has the knowledge about SI-joint dysfunction. Usually instructors do not have that expertise and I’m surprised that even many Physical Therapists have not enough knowledge how to treat people with SI-joint pain. In my experience SI-joint pain decreases tremendously when individual gets more stability and strength in their gluteal, deep core stabilization and pelvic floor muscles as well as flexibility in their hip rotators. Unfortunately, this will not happen overnight…it takes time, approximately 3-6 months. However, the end result is priceless – NO MORE PAIN or at least less pain and stronger muscles around the joints and spine!



For More about PilatesWise Active back pain and SI-joint dysfunction rehabilitation, please click HERE

Pilates and Spinal Stabilization training is the best way to relief the SI-joint pain


Did you know that 25% of lower back pain is sacroiliac joint related? However, sacroiliac joint pain and dysfunction is often misdiagnosed and overlooked by doctors and chiropractors. Si-joint pain may be referral pain into the lower limp, which can be mistaken for “true” sciatica from a herniated lumbar disc.

Si-joint dysfunction means Sacroiliac joint hypermobility (instability) or hypomobility which causes lower back and buttocks pain and stiffness. If there is hypomobility (too little movement) chiropractors manipulation may help, but if there is hypermobility (too much movement) chiropractors might be the last think what you want to do…you don’t want to increase movement which might cause even more pain. Unfortunately, sacroiliac joint pain is more often caused by SI-joint hypermobility (instability) than hypomobility. Sacroiliac Joint hypermobility may be traumatic, biomechanical, hormonal or inflammatory joint disease. I have been working with many Si-joint pain sufferers (mostly women) and they all have some issues about the lumbar-pelvis region biomechanics, which is very typical cause of SI-joint hypermobility and pain. Pain due to biomechanical injuries will usually come over a period of time and often due to increased activity or a change in occupation/sport.

Common biomechanical problems which cause SI-joint hypermobility are leg length discrepancy, overpronation, twisted pelvic and muscle imbalances. I’m helping people with the last two cases and podiatric job is to help first two. Usually Si-joint pain clients might have all of those problems. One of my client was a college basketball player who got first sprain ankle then two hamstring pulls and then a terrible SI-joint pain. When she came to me, she got pain all the time and the pain increased when she was active. It was hard to see how she was suffering, not only the pain but also being non-active. Working with her almost a year, she is today PAIN FREE and exercise again – that is the best reward what you can get! I have also been successfully worked with people with inflammatory SI-joint disease like Ankylosing spondylitis. Those clients have also imbalances and compensation of lumopelvic region because of pain. Surprisingly, proper motion is one of the best treatments for Ankylosing Spondylitis clients.

Pelvic & Spinal Stabilization training with Pilates together correct muscle imbalances and re-educate your body work more ergonomically, safely and efficiently. The both exercise methods are gentle and pain FREE.  The exercise/ rehab program has to be designed an individual special needs and focus on helping to strengthen the key muscles around your lumbopelvic region (deep back and abs muscles, glutealis muscles and hip rotators) and stretches tight muscles around your hip joint which are usually hamstrings, hip flexors and external hip rotators. If you are looking for Pilates program, please notice that not every Pilates instructor has enough knowledge about SI-joint dysfunction, neither back pain, so be sure that your Pilates Instructor has more education than just basic Pilates comprehensive certification program  before you start any Pilates sessions. Anyway, Therapeutic exercises and Pilates are great way to rehabilitate your Si-joint dysfunction and really increase your quality of life with less pain, or even better – totally pain free.

For More about PhysioWise program in Carlsbad, CA, please visit our website http://www.physio-wise.com.

Pilates for SI-Joint Rehabilitation

The Sacroiliac joint (SI-joint) is located between your pelvic (ilium) and sacrum (sacral vertebrae).This joint does not move very much but it is critical to transferring the load of the upper body to the lower body and provides shock absorption for the spine. SI-joint dysfunction is common source of back pain. The pain is dull, deep pain on your back or buttock and it may refer to the groin, down to the leg. The pain can be similar sciatica-like pain to herniated disc.

SI-joint dysfunction and pain may be caused by sacroiliac joints hypermobility (too much movement) or hypomoblity (too little movement). Si-joint hypermobility (joint instability) is typical for young woman during and after pregnancy. Abnormal or asymmetric forces to the hip and lumbar area may also cause SI-joint hypermobility or even torn ligaments around the joint.

One of the best “treatment” to the SI-joint pain and hypermobility is specific pelvic and spinal muscles strengthening and stabilization program. Pilates and lumbar spinal stabilization training are both very efficient and safe exercises for people with SI-jointdysfunction.

The exercises should focus on strengthening the “inner unit”. The inner unit includes the deep back and abdominal stabilizers; transverse abdominus and multifidus muscles as well as pelvic floor muscles and diaphragm. These muscles are your Pilates powerhouse: roof, walls and floor around your spine and pelvic. The Pilates powerhouse muscles provide stability for the SI-Joint and lumbar-pelvic girdle.

The “outer unit” is also important to stabilize your pelvic and spine. The outer unit consist of the obliques (external & internal), latissimus dorsi, erector spinae and gluteus medius & maximus muscles with thoracolumbar fascia. These muscles and fascia contribute to load transfer through the pelvic region with rotational activities and during gait. Also muscles around your hips such as hip abductors, adductors and rotators are important because they are involved in a proper function of the pelvic girdle while walking and standing.

Many Si-joint dysfunction sufferers compensate their movement (due pain) thus resulting more pain and problems also to their spine and back. To avoid further pain and problems Pilates is a wonderful tool. Only challenge is finding a good Pilates instructor who has knowledge and hands-on-skills to work with SI-joint dysfunction.

People can often get rid of SI-joint pain when they start to practice Pilates with a good teacher. A professional Pilates instructor has an eye on correcting client’s compensation patterns and underlying problems. Individually customized Pilates program can also help increase body awareness which is important part of correcting many postural habits in daily life and activities. A proper posture is extremely important for healthy SI-joint and pelvic alignment. Private Pilates training may be pricey, but it provides big help for anyone to alleviate pain and keep strong. The results will be priceless!

For more about PhysioWise back pain therapy program for SI-joint dysfunction, please visit http://www.physio-wise.com