Forum / Let's Discuss! / sacroiliac joint dysfunction

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On: September 23, 2015 11:37 AM
I have a client who has sacroiliac joint dysfunction, believed to be caused by her having one leg longer than the other. She also has extremely tight hamstrings and compared to the rest of her body she has a weak center. She is triathlete and is very strong in her arms and legs. She came to me looking to increase her core strength and and stretch her hamstrings and had accepted the pain from the sacroiliac joint dysfunction. I have never worked with anyone with sacroiliac joint dysfunction but I want to help her in anyway I can. What should I be doing with her to help alleviate some of the discomfort she feels and what should I avoid to make sure to limit any necessary pressure on her sacroiliac joint? Thanks!
On: September 25, 2015 05:23 AM
Hi Lauren, This is such an important question. There are so many people ( especially high performance athletes) that just accept and live with SI joint pain and discomfort. This is a huge sign to the body that there is imbalance and that movement is non optimal. The pelvis is a gateway for forces to pass through the body. The ground forces from our feet and our legs are brought through the pelvis to our spine. When we counter gravity during standing and sitting those forces have to be organized and supported by the spine and the pelvis. When someone has a constant SI joint dysfunction these forces cannot travel and one part of the body is having to bear the load. For instance in gait someone with SI joint pain is usually walking with their lumbar spine because one SI joint is over mobile and the other is stuck. In this instance because the natural rotation of the pelvis , sacrum and spine can't happen and the pelvis and femur ( at least on one side) is not experiencing a disassociation of movement and the lumbar spine takes over the task of moving the leg so one can walk. Over time , this is a bad scenario for the body. It cannot sustain this compensated movement year after year and soon the person will have much more to contend with than just SI pain. So addressing the SI joint pain right away and figuring out strategies out of that pain is very important. Athletes are used to pain and can tolerate it pretty well but let her know that over time this will lead to more pain, immobility and jeopardize her ability at some point to perform her sport. This will get her attention! The main protocol for you and this client is Back to Basics. Get her bones moving optimally and this will mean the smaller, subtle movements to start to message the smaller, intrinsic joints of the pelvis. This will take patience and brain work. This will involve exercises like Pelvic clock but you must be very detailed with her. Using the reformer to move the legs while keeping the pelvis parked in an easy neutral is also a great idea. Again you must be clear and detailed on what you want so you are sure that you are getting a disassociation of her leg moving inside the still pelvis. During these reformer sequences you might need to prop the sacrum or around the sacrum to get her comfortable. Casey is filming a Pilates Show about propping the sacrum and back of the pelvis with blankets. Look out for that. Maybe in a couple of weeks. Also the Smartspine protocol for this client would be very helpful. Marie Jose has just released a 2 and a half hour video on this on our site. Please check it out. One important thing to stay away from with this type of client is one leg balance work. It will further irritate the SI joint. You also want to pay close attention to how they are side bending. Make sure they are not just translating as they are trying to side bend. With that dysfunctional strategy they are avoiding the opening of the SI joint. Keep us posted on how your work with this client is going . Love Jen
On: September 27, 2015 09:30 AM
Thank you so much Jen for the help and insight. I cannot tell you how much I appreciate it. She is an amazing athlete and I really want to help her. The discrepancy in leg lengthen is quite pronounced. She told me that a doctor once prescribed her a "lift" for the shorter leg in the form of a special orthotic but she hasn't used it for years. When I did footwork on the reformer with her she clearly cannot keep her pelvis stable because in order to fully extend the legs she has to hike one side of the pelvis. I feel like this will be an issue with any and all leg work we do that is not unilateral in nature. For footwork should I prop one of her legs in order to allow both to fully extend and keep the pelvis level and stable? Being the type of athlete that she is she wants to power through the work and I have had to really press the important of details and fine tuning. It will be a learning curve for her but she seeming to be willing because of the pain.
On: September 29, 2015 14:12 PM
Hi Lauren, I think you are right on target. Try propping (maybe with a small hand towel or washcloth) under the heavier side of her pelvis. Also try building up the floor under her shorter leg/foot. You can do this at the foot bar or use the Foot extender plate hooked on the foot bar so her foot can have a full floor at an angle ( more options and challenge than just the Jump board). I will film a Pilates show and go over how to prop the pelvis and how to build the floor under the foot. Be on the look out for it. Keep up the excellent work and keep giving us progress reports on this client. Love Jen
On: October 01, 2015 06:19 AM
Thanks so much Jen. I will keep you posted on our progress. Lauren
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