Richard Don Tigny , used by permission

Richard DonTigny SI Solutions used by permission

This  SI Joint information was graciously supplied by  Richard DonTigny, a well known leader in this field from Havre Montana.  Many individuals constantly go to a chiropractor to have them adjust this area but it can be very effective to learn how to gently and accurately self correct with the advantage of bringing almost immediate pain relief. Richard DonTigny has a great website where you can get detailed well explained  information and even purchase  video materials on how to get these corrections working for you.  

On the right are basic  techniques to reset the SI area. The first one will look familiar to those of you familiar with post-isometric relaxation or muscle energy technique. This series of images, shows different positions in which to do the same basic exercise. They can even be done standing up in an airplane corridor! 

 The instructions are to bring your leg up to the chest, grasp the leg with both arms, and push outward with the leg against resistance. DonTigny recommends pushing outward hard for five to 10 seconds, then alternating legs, doing each side three to five times. Note that this can be done supine, sitting, standing using a chair, or in a doorway 

 The next offering is a self traction correction.  I like this one as it can even be done lying in bed. When doing any of these exercises in the supine position be certain to hold your abdominal muscles tight when raising or lowering your leg to prevent anterior rotation of the pelvis.  There is a first class video  available for Richard Don Tigny with print out exercises which is available from the  Dynamic Core Program CD for patients. 

 Richard DonTigny  makes excellent additional  seldom heard points regarding SI dysfunction.1)Periarticular injections are superior to intra-articular injections for diagnosis of SIJ dysfunction.(2) Murakami Fukushima (3) found that many times cervical strain will not release until the SIJ is corrected. (I have certainly found this to be accurate) 

 The last form of correction is in the color photo on the left hand side. You can  self-correct any time during the day no matter what position he happens to be in at the time. Just by pulling the knee into the axilla or bringing the axilla down to the knee. Stretch firmly several times on each side, alternating sides each time. Remember to hold those abdominals tight as you raise and lower your leg for protection against an anterior pelvis rotation. 

  Stretching the psoas is usually counter productive as a dysfunction of the SIJ will cause the psoas to become tight while correction of the dysfunction will loosen it.  If you stretch the psoas you will increase the dysfunction in anterior rotation of the psoas. Similarly the SIJ dysfunction will cause a vertical shear on the piriformis at the S3 segment. Correction of the dysfunction corrects and relieves the vertical shear.  The piriformis, the G. max and the iliacus all have origins on both the sacrum and the ilia.  The shear is the cause of the piriformis syndrome.   Similarly the sacral origin of the G. Max will tend to separate from its ilial origin and the ilial origin of the iliacus will tend to separate from a small slip on the sacrum. 

 References: 

 1.DonTigny, RL: A detailed and critical biomechanical analysis of the sacroiliac joints and relevant kinesiology: the implications for lumbopelvic function and dysfunction.  In Vleeming A, Mooney V, Stoeckart R: Movement, Stability& Lumbopelvic Pain: Integration of Research and Therapy. 2nd edition. Edinburgh, Churchill Livingstone, 2007, Chapter 18, pp 265-278 

 2.  Murakami E, Tanaka Y, Aizawa T, Ishizuka M, Kokubun S: Effect of periarticular and intraarticular lidocaine injections for sacroiliac joint pain: Prospective comparative study.J of Ortho Science  12(3):274-280, May 2007 

 3.  Fukushima M: Radiographic findings before and after manual therapy for acute neck pain. International Musculoskeletal Medicine, 30(1): 1-19, 2008

Relieve nerve pain and trigger points without surgery or chemicals

By Amy Price PhD

IMS is similar to acupuncture except that the treatment does not rely totally on meridians but is based on a physicians training in anatomy. trigger points and the central nervous system. It can be treatment orientated as well as a useful minimally invasive diagnostic tool for neuropathic muscle pain.

Trauma and chronic pain often produces muscle shortening. These shortened muscles can press on and irritate the nerve. Even though this pressure may seem slight and be difficult to measure it can be the source of excruciating pain. This pressure builds up over time causing all kinds of problems like making the nervous system super sensitive. This can cause sensitivity to pain in other areas of the body. To get an idea of how this works think about wearing a pair of slightly snug shoes. At first you feel nothing but as the day goes on that slight pressure becomes something that can not be ignored. With the shoes you can rip them off and toss them into the trash, but when pressure mounts inside the muscle pushing on the nerve there is nowhere for it to go.

IMS works on the premise that supersensitive area can be desensitized. IMS releases muscle shortening by dry needling the sensitive areas with tiny acupuncture needles. Penetration of a normal muscle is relatively painless however an afflicted muscle responds to the needle with a slight cramping sensation. This stimulates a ’stretch receptor’ which produces a reflex relaxation response resulting in a lengthening of that muscle fiber. The needle also causes an electric potential which travels to the nerve and potentially resets it to normal function. The other thing that happens is the needle produces a minute wound which causes increased blood flow to the area to enhance circulation and initiate healing. For FAQs about IMS or research links click here Does it work? The answer seems to be that for some people it does. For research links  New treatments with prolotherapy and adult stem cell treatment may produce results. Diet can help with pain Specific supplements can help ligaments and tendons heal to take the stress off overworked muscles

Psoas Muscle Location

By Amy Price PhD

 

Stretching Psoas can alleviate back and hip pain

                                       

The psoas muscle starts in the lower back at which point the paired psoas muscles act as anchors on either side of  the spine. These muscles wrap around the pelvic area attaching at the knobby part of the hip with several strong tendons. The psoas muscles are considered to be crucial among the hip flexor muscles. Hip flexors allow people to bend their bodies into their hips and to pull their hips into their bodies. Low back or hip pain can come from  contracted psoas muscles which fail to provide  support. They can gently stretch to elongate their muscles and make them more flexible, as well as seeking medical attention if the pain continues, grows worse, or changes. Engaging in a regular physical fitness routine which includes stretching such as Pilates or Yoga will help to keep the psoas muscle aligned, strong, and flexible, along with other vital muscles of the body.

  A gentle psoas stretch, involves lying on your back on the floor. Make sure that your pelvic position is neutral, your shoulder blades are flush with the floor, with your spine and head aligned, forming a straight, smooth line. Gently bring one knee up to your chest while extending the other leg along the floor, breathing deeply and evenly. Hold the position for 10 breaths before switching sides, and repeat 3 times. You should feel a gentle stretching action but not pain

 For a deeper psoas stretch, adopt a lunging position with one knee forward, forming a 90 degree angle, if possible, between the hip and the calf. Extend the other leg behind you, kneeling slightly, and lower yourself slowly into the stretch, which you will feel in the front of the hip. Make sure you don’t increase the curve in your back as you come forward (the Psoas connects the back with the front of the hip).  Sometimes it helps to tighten the stomach muscles as you come

Please Consult Your medical professional before stretching the psoas, In some cases psoas stretches can be counterproductive

Richard Don Tigney  referenced below states,  “Stretching the psoas is usually counter productive as a dysfunction of the SIJ will cause the psoas to become tight while correction of the dysfunction will loosen it.  If you stretch the psoas you will increase the dysfunction in anterior rotation of the psoas.

Similarly the SIJ dysfunction will cause a vertical shear on the piriformis at the S3 segment. Correction of the dysfunction corrects and relieves the vertical shear.  The piriformis, the G. max and the iliacus all have origins on both the sacrum and the ilia.  The shear is the cause of the piriformis syndrome.   Similarly the sacral origin of the G. Max will tend to separate from its ilial origin and the ilial origin of the iliacus m will tend to separate from a small slip on the sacrum.(1)

Periarticular injections are superior to intra-articular injections for diagnosis of SIJ dysfunction.(2)Murakami

Fukushima (3) found that many times cervical strain will not release until the SIJ is corrected.”

References:

 1.   DonTigny, RL: A detailed and critical biomechanical analysis of the sacroiliac joints and relevant kinesiology: the implications for lumbopelvic function and dysfunction.  In Vleeming A, Mooney V, Stoeckart R: Movement, Stability& Lumbopelvic Pain: Integration of Research and Therapy. 2nd edition. Edinburgh, Churchill Livingstone, 2007, Chapter 18, pp 265-278

2.  Murakami E, Tanaka Y, Aizawa T, Ishizuka M, Kokubun S: Effect of periarticular and intraarticular lidocaine injections for sacroiliac joint pain: Prospective comparative study.J of Ortho Science  12(3):274-280, May 2007

3.  Fukushima M: Radiographic findings before and after manual therapy for acute neck pain. International Musculoskeletal Medicine, 30(1): 1-19, 2008

Detailed Treatment Strategies for the Prevention
and Treatment of Piriformis Syndrome

If you suffer from piriformis syndrome or are seeking to prevent its occurrence it is important to follow the information in this article. In addition, making stretching a part of your fitness regime will have a significant impact.

What is the Piriformis?
The piriformis is a small muscle located deep within the hip and buttocks region. It connects the sacrum (lower region of the spine) to the top of the femur (thigh bone) and aids in external rotation (turning out) of the hip joint.

Piriformis

As you can see from the diagram to the right, there are many muscles and tendons that make up the hip and buttocks region. The diagram shows the posterior (rear) view of the buttock. The piriformis is the horizontal muscle in the center of the picture running over the top of the sciatic nerve.

What Causes Piriformis Syndrome?
Piriformis syndrome is predominantly caused by a shortening or tightening of the piriformis muscle, and while many things can be attributed to this, they can all be categorized into two main groups: Overload (or training errors); and Biomechanical Inefficiencies.

Overload (or training errors): Piriformis syndrome is commonly associated with sports that require a lot of running, change of direction or weight bearing activity. However, piriformis syndrome is not only found in athletes. In fact, a large proportion of reported cases occur in people who lead a sedentary lifestyle. Other overload causes include:

• Exercising on hard surfaces, like concrete;
• Exercising on uneven ground;
• Beginning an exercise program after a long lay-off period;
• Increasing exercise intensity or duration too quickly;
• Exercising in worn out or ill fitting shoes; and
• Sitting for long periods of time.

Biomechanical Inefficiencies: The major biomechanical inefficiencies contributing to piriformis syndrome are faulty foot and body mechanics, gait disturbances and poor posture or sitting habits. Other causes can include spinal problems like herniated discs and spinal stenosis. Other biomechanical causes include:

• Poor running or walking mechanics;
• Tight, stiff muscles in the lower back, hips and buttocks;
• Running or walking with your toes pointed out.

Symptoms
Pain (or a dull ache) is the most common and obvious symptom associated with piriformis syndrome. This is most often experienced deep within the hip and buttocks region, but can also be experienced anywhere from the lower back to the lower leg.

Weakness, stiffness and a general restriction of movement are also quite common in sufferers of piriformis syndrome. Even tingling and numbness in the legs can be experienced.

Treatment
Piriformis syndrome is a soft tissue injury of the piriformis muscle and therefore should be treated like any other soft tissue injury. Immediately following an injury, or at the onset of pain, the R.I.C.E.R. regime should be employed. This involves Rest, Ice, Compression, Elevation, and Referral to an appropriate professional for an accurate diagnosis.

It is critical that the R.I.C.E.R. regime be implemented for at least the first 48 to 72 hours. Doing this will give you the best possible chance of a complete and full recovery.

The next phase of treatment (after the first 48 to 72 hours) involves a number of physiotherapy techniques. The application of heat and massage is one of the most effective treatments for removing scar tissue and speeding up the healing process of the muscles and tendons.

Once most of the pain has been reduced, it is time to move onto the rehabilitation phase of your treatment. The main aim of this phase is to regain the strength, power, endurance and flexibility of the muscles and tendons that have been injured.

Prevention
Prevention is the key when it comes to piriformis syndrome. The more you can do to prevent it, the better off you’ll be. There are a number of preventative techniques that will help to prevent piriformis syndrome, including modifying equipment or sitting positions, taking extended rests and even learning new routines for repetitive activities. However, there are four preventative measures that I feel are far more important and effective.

First, a thorough and correct warm up will help to prepare the muscles and tendons for any activity to come. Without a proper warm up the muscles and tendons will be tight and stiff. There will be limited blood flow to the hip area, which will result in a lack of oxygen and nutrients for the muscles. This is a sure-fire recipe for a muscle or tendon injury.

Before any activity be sure to thoroughly warm up all the muscles and tendons that will be used during your sport or activity.

Second, rest and recovery are extremely important; especially for athletes or individuals whose lifestyle involves strenuous physical activity. Be sure to let your muscles rest and recover after heavy physical activity.

Third, strengthening and conditioning the muscles of the hips, buttocks and lower back will also help to prevent piriformis syndrome.

Fourth, (and most importantly) flexible muscles and tendons are extremely important in the prevention of most strain or sprain injuries. When muscles and tendons are flexible and supple, they are able to move and perform without being over stretched. If however, your muscles and tendons are tight and stiff, it is quite easy for those muscles and tendons to be pushed beyond their natural range of movement. When this happens, strains, sprains, and pulled muscles occur.

To keep your muscles and tendons flexible and supple, it is important to undertake a structured stretching routine. I’ve included two effective piriformis stretches below.

	Sit with one leg straight out in front. Hold onto the ankle of your other leg and pull it directly towards your chest.
	Lie face down and bend one leg under your stomach, then lean towards the ground.

Stretching is one of the most under-utilized techniques for improving athletic performance and getting rid of those annoying sports injuries. Don’t make the mistake of thinking that something as simple as stretching won’t be effective

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Article by Brad Walker. Brad is a leading stretching and
sports injury consultant with nearly 20 years experience
in the health and fitness industry. For more articles on
stretching, flexibility and sports injury, please visit
The Stretching Institute.
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