The lack of movement in the sacroiliac joint is a myth. When walking the pelvis moves obliquely to the line of travel, to increase the length of the stride. The sacrum moves on the asymmetric pelvis to drive counter rotation of the trunk to decrease loading forces. Pelvic dynamics has profound effects on normal gait.  

The joint is vulnerable to injury through minor trauma only in anterior rotation of the innominates on the sacrum.  Idiopathic low back pain is a commonly overlooked, reversible dysfunction in anterior rotation, usually bilateral.   A diagnosis of dysfunction can be made simply by identifying a single painful point at the posterior inferior iliac spine that is caused by a vertical shear on the conjoint origin of the piriformis muscle and tearing of the capsule at S3. See pain patterns here. The anterior rotation will loosen the iliolumbar ligaments, destabilize L4,5-S1 and increase shear and torsion shear to the disks.  Correction restores stability.

Full correction in posterior rotation will provide immediate relief of pain.  More than three treatments are seldom necessary.  Stabilization of the unstable SIJ can be obtained with five to six sessions of prolo specifically to the long posterior sacroiliac ligaments.  Prolo to the iliolumbar ligaments without correction of the SIJ first can tighten the joint in the uncorrected position and may prevent correction.

Anyone not properly treating dysfunction of the sacroiliac joint is perpetuating chronic low back pain.  X-rays of innominate movement on the sacrum are published on-line at www.thelowback.com/how.htm#movement

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

By Amy Price PhD

SI Pain is often caused by sacroiliitis (inflammation of the SI Joint) and can cause low back pain which often hurts on one side. The pain can be extreme aching sensation which is referred to the low back, buttock or thigh.  This is called  sacroiliac joint (SI) dysfunction The reason it hurts is because there is too much or too little movement in the joint which  causes strain because the bones are not adequately supported and the anatomy becomes  asymetrical. It is estimated this area is painful for as much as 15% of the population at any one time. 85 % of us will experience significant back pain in our life times

The sacroiliac joint or SI joint is the joint in the bony pelvis between the sacrum and the ilium of the pelvis. The joint is a strong, weight bearing synovial joint. These joints are shaped much like kidney beans.The joints are covered by two different kinds of cartilage; the sacral surface has hyaline cartilage and the ilial surface has fibrocartilage.  Prolotherapy is often used to strengthen the cartilege and provoke a healing process, it is important that the joint is mobilized and positioned correctly before prolotherapy and that prolotherapy be guided by flouroscopy so that treatment is accurately placed. The dermatome map can show pain patterns   Cortizone  injections are sometimes used to treat this area but release can be short lived unless the structural problem is addressed.

There are other conditions such as disk herniations, lumbar nerve compression,  hip degeneration or sensory  motor  proprioception deficits that can mimic this difficulty so it is important to be examined and treated by a qualified medical professional.  With an SI joint dysfunction present it is not a good idea to do psoas stretches as this can increase movement and instability.

 Richard Don Tigny has developed some excellent methods for treating this problem through correct positioning and strengthening exercises. I have personally found this method very beneficial. I was erroneously treated for piriformis syndrome and other things for years before I finally found relief using these simple effective corrections I could do myself. I know of several individuals who were recommended for surgical procedures, tried this method instead and became pain free without surgery. Don Tigny has validated his method with research. There is a video available for purchase by patients and professionals which is well worth the investment. He has granted permission to show three corrections and there is also a link  supplied to his website. He has made available multiple materials, research links, explanations and solutions. A link to his site and some useful corrections are available here.

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