Tag Archive | Si-joint pain treatment

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!

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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!



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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.