Sacroiliac rehabilitation question:

[mshelb]

Does anyone have anything to share regarding mobilization of the SI joint and restoring proper joint function? I’m “cleaning the slate,” doing just WW and BB right now, but I’m having difficulty figuring out which exercises to use and which ones to avoid. Complicating it all - I have hypo-mobility in my hip flexors and hyper-mobility in the lumbar region. I need to balance that out because it is wreaking havoc on my lumbar discs.

I'm considering putting it all in a daily practice log here, but I'm not sure what I'd accomplish with that.

Ideas? Recommendations?

[Jarlo Ilano]

Mike,

Real hard to say without seeing what in particular is not moving at your S-I joints.

Easiest thing to say without being too wrong is to work on making your hips as loose as possible.

Free hips lessen the forces that can irritate your hypermobile lumbar spine. And sometimes freeing the hips and the associated muscles helps loosen the S-I too.

Bodyflow (and Grappler's toolbox I assume) has a bunch of good exercises for this.

[mshelb]

Thanks Jarlo –
I understand about the internet diagnosis. My feeling about it is that the joint itself is a little battered. It was injured for years and stuck for an unknown portion of that time.

Right now it doesn’t really move far out of position from what I can tell, but I can feel it, it’s not moving right, and then I can usually get it to go back in with a pop/clunk. Then the motion is normal, and my back feels normal.

Maybe my question is better framed like this: I’m thinking that repetitive, normal motion of the joint -without it locking out of position- would help over time to strengthen it and grease the groove of normal motion, at which point I could add more mobility exercises. Walking being my solution here. Right now, gentle introduction of mobility exercises near my hips and back seem to be causing trouble. I get the lower-back pinching sensation and reduced range of motion with my right leg until I fumble around and get it to go back in. Then later I have a sore back. It seems counter productive.

My question: Is there a big hole in my thinking there – going with the assumption that my perceptions are correct? Walking to restore the joint is an application of what Coach teaches in the joint strength programs, yes? Or am I likely to end up frustrated in three months with only very worn shoes to show for it?

My doctor is great in many respects – he figured out my problem and got rid of my back pain. But he looks at me like I’m crazy when I ask questions like “will walking help me to heal.” He responds with vague terms like “return to exercise” and “normal activity levels.” I did the full rehab routine with his Physical Therapist, and my core activation is very good since I started doing be breathed. But my back and SI would not stand up to “return to exercise.”

[Scott Sonnon]

Mike,

The problem with walking is the load-bearing dance it creates, and it may inhibit your ability to recover full ROM. Others in similar conditions have found success with Warrior Wellness on the floor, and off the edge of a bed - pronated and supinated to free your ROM from structural (anti-grav) tension.

[Scott Sonnon]

Mike,

The problem with walking is the load-bearing dance it creates, and it may inhibit your ability to recover full ROM. Others in similar conditions have found success with Warrior Wellness on the floor, and off the edge of a bed - pronated and supinated to free your ROM from structural (anti-grav) tension.

[mshelb]

I hadn't considered that. Exercises from the floor sound manageable. I will get started on that tonight.

In the progress category, my knees are much improved, my back is releasing and my shoulders are more mobile/grind less each day. Unfortuantely, my progress is amplifying my frustration - if that makes any sense.

Thanks again Coach Sonnon.

[Scott Sonnon]

Mike,

Please be patient and compassionate with yourself. Not doing so can set up patterns of internal bracing which runs counter to release.

[KEVIN TEAGLE]

Mike,

For what it's worth please listen to Coach Sonnon when it comes to going easy so as to not set up internal bracing from fear. As you gain success on the floor and confidence you may want to consider shin box exercises which can be found in the
Body Flow book that Coach Sonnon wrote. We use them with our Geriatric (old people) who have similar issues. We always do both sides and sometimes allow pillows under the knees until there is confidence. There is no shame and there is no hurry to go slow. Go VERY EASY when attempting them and celebrate greatly even your smallest improvements. This celebration makes a bigger difference than most realize. My patients who celebrate the small stuff get to the big stuff, my patients who ignore the joy of minor improvement often frustrate themselves right out of health.

For what it's worth.

Dr. Kevin Teagle

[Scott Sonnon]

The pillows are a superb training wheel for the Shinbox! I never thought of such an elegant solution to applying Incremental Progression there. Thanks for sharing such a great suggestion! :D

[mshelb]

Please be patient and compassionate with yourself.
Words to live by. I will keep this advice in mind as I go about it all.

[mshelb]

And thanks Kevin for your input, too. I like the shinbox. I will be sure to use it carefully. I did read Body Flow: Freedom from Fear Reactivity, and the patience and incremental progression ideas are not lost on me.
I was feeling as though I'd jumped too far ahead and didn't know where to start.

I will celebrate my little increments. They're all I've got. :)

[Coach Gostnell]

celebrate greatly even your smallest improvements. This celebration makes a bigger difference than most realize. My patients who celebrate the small stuff get to the big stuff, my patients who ignore the joy of minor improvement often frustrate themselves right out of health.

That there is why - or one reason why - Dr. T is such a cool guy 8) to know & work with.

Celebrate! Celebrate! Dance to the Music! Even if it's a slow dance at first. :D :D :D

[KEVIN TEAGLE]

Oohh yeah, I like slow dancing.

[mshelb]

Thought it might be worth posting an update here. Patience is paying.

I’ve used what Coach Sonnon and Dr. Teagle recommended here, and I took some of my own advice as well. I researched until I figured out how to keep my SI properly aligned. I found a resource with dozens of medical research papers on SI dysfunction and treatment. This is a dangerous thing to do in some respects, I know, but the solution I’ve discovered is nothing drastic and it’s working. I have an easy stretch-like move that I do several times a day and now my hip never moves far out of place. There is less mechanical noise from the joint too, because I don’t have to pop it back in. This has all added up to just feeling good physically.

WW is feeling better every day and I think I’ll be able to figure out when I can add those back exercises. Spinal rocks are still my favorite part of my routine - it’s where I find and celebrate my little, incremental successes. Thanks everyone for your help. I'll share more when I get there.

[Scott Sonnon]

Great, Mike!

[KEVIN TEAGLE]

Awesome Mike, I love it when people get better, it makes me giddy.

Kevin Teagle

[mshelb]

It's time for another update. I'm not completely out of the woods yet, but I have made a lot of progress and I can see the path.

To start, I took a step back on my WW practice to make sure everything I was doing was _helping_. The shinbox switch suggestion by Dr. Teagle made a lot of sense after consistent practice. I think I'm getting a lot of neuro-muscular re-education out of that one. I also made some more discoveries on how to put my SI back in place and even a good way of confirming when it is out.

I was making slow progress but felt like I needed some further help. I went looking for a massage therapist and stumbled upon the chiropractor down the street. A good, good person. I have a renewed, profound respect for the chiropractic profession. Dr. Teagle, your wisdom and obvious competence gave me the confidence to try again. My previous experience years ago left me a little shy of adjustments - the doctor was gifted and intelligent but must have treated me for someone else's injury because he -twice- left me unable to turn my head for weeks at a time.

Anyway, my new Chiropractor told me my full recovery is his personal mission. He fixes whatever I've tweaked and I leave relaxed and comfortable three times a week. They use a few modalities for stimulating the healing process too, and things are moving by leaps and bounds. I'm growing my daily practice with new movements and celebrating my incremental successes, but my recovery is out in front of me. I can't keep up - that's an incredible feeling. I did some lumbar figure 8s last night with no discomfort and the feeling afterward was near euphoria. That and the clubs - I don't feel tweaked after playing with the clubs now. I can train without running into that wall.

Going way back to my original post here - my hip flexors are releasing too. My lumbar spine has a noticeably re-integrated structure to it - it flexes instead of folding there now. The integrating structure lecture (DVD) helped a lot with understanding where I was going with that. My back feels stronger (structurally) than it has in 5-6 years.

In conclusion - yes, I've got a fair distance to go yet to reach my new potential, but I can see the way to it now. Thank you, thank you for your help.

[Jarlo Ilano]

Good stuff Mike. Let us know if we contribute anything more for you.

[Scott Sonnon]

Well done, Mike. Keep us updated on your continued progress.

[KEVIN TEAGLE]

Ahhh sigh of relief,

It is good to see some Chiro's out there being sensitive to the patient. It is good to see that you stepped out Mike. Well done on being sensitive to yourself. Keep that wisdom about you, especially when you start feeling invincible.

There are many wonderful professions that can help you continue, keep your eyes open for the ones who listen and are willing to change their own treatment plan to fit you and not they're expertise.

I still have a deep belief that you can teach your own system to get rid of the injury. I applaud you on your progress and I look forward to hearing more.

Dr. Teagle

[mshelb]

Thanks Jarlo and Coach Sonnon for the encouragement.

Dr. Teagle – thanks for checking in with me again. My chiropractor said nearly the same thing about listening to the patient and not trying to be the expert, and he only said he could make me better after he was convinced I would do my part. He won over the skeptic in me right there.

My confidence has grown a lot with respect to dealing with this and I can see how you're right about being able to teach yourself to heal from it. I’m not sure I would have seen it a short while ago - I was feeling more than a bit lost.

So I'm using my visits as an opportunity to work with a coach – a second opinion to help me understand what I'm dealing with. Well, that and he fixes my mistakes, but I'm trying to learn from it as much as I can. I discussed it with him yesterday and he said my displacements (my word there, not sure what you'd call it) are getting smaller and smaller, with an increasing workout load. I'm definitely progressing.

It’s funny, I’ve learned so much over the course of dealing with this that I can’t imagine where I’d be if I hadn’t hurt myself and gone through this process. I have no regrets despite the pain and inactivity over the past two years.

[Scott Sonnon]

Mike,

It's the healthiest, and IMO most important discovery... these situations are challenging blessings.

[kcsportsdoc]

You know, I've been following this thread from afar and it has been wonderful to read. Not just for the improvements (and not merely the physical improvements) but because it's really a primer on self-care, and working IN CONCERT with a health care professional.

Very inspiring stuff. Kudos from me to everyone involved: Jeanne, Dr. T, Jarlo, Coach Sonnon and, most importantly, Mike.

It just goes to show you what can happen when you combine a healing attitude, intelligent planning, compassion and dedication.

Way to go and way to keep going everybody.

Best,

Kevin

[mshelb]

This is dragging out longer than I had hoped.

Thanks Dr. Cooper for your words of encouragement; it means a lot to me. I’ve learned a lot from reading your advice to others. And yes, this definitely has been a blessing as well as a challenge for me. We’ve all learned a lot from your challenges Coach Sonnon. You have a gift for sharing with that.

Right after my last post here I made a small (only took 5 minutes) but consequential mistake: I tried to go linear. It was just two sets, I was at the gym and the floor wasn’t available for flow, I didn’t use much weight, I was careful…umm, yeah, it didn’t work out like I’d planned. So that set me back about a month. But I learned from it too, and once again I am pain free.

Significantly, my sacroiliac is completely stable – for three weeks now I haven’t had a fixation that wouldn’t go back in with a simple hip-side-sit (WW beginner). I’ve even scrapped my list of SI-don’t-dos. I’m working on my L5-S1 now as there is still some dysfunction in that joint. But it was better before and now that my SI is right, I have no reason to believe that I can’t get this to heal.

I’m still working with the Chiropractor and asking an annoying number of questions - using that feedback to adjust my daily practice. He’s amused that I can now predict what he needs to adjust - WW practice tells me what that is of course. And I have the ok to start exercising again, so I’m feeling good and having fun. Just won’t be buying that Bruiser as soon as I’d like to.

Thanks again everyone. I’ll keep posting until I get there.

[JasonE]

I am now working on my own SI joint too. Over the last few weeks I've been pretty busy and got lax in my WW practice. Add long hours of sitting with poor posture in my work cubicle to that, and bingo: an old injury has become aggravated.

I haven't needed to see my chiropractor for treatment in 18 months, but I decided it was time when occasional WW was only slowing the gradual conversion of stiffness into pain. This morning I did a little WW to lube things before seeing my chiro and he confirmed my suspicions regarding the SI joint and its cause. A side effect that I hadn't noticed yet is that residual tension had radiated through my hips, causing excess tightness in my soas and quadriceps muscles, resulting in a short left leg.

After about 15 minutes of masterful work, my SI joint and hips were adjusted, and suddenly my pain-free ROM was much improved. It will take a few days or a week to resolve the remaining excess tension in the multifidous and other muscle groups, but I'm just fine with that. :D

Today I started a new habit of using more of my breaks at work to walk around outside and do WW and Body-Flow. Once this resolves, I plan to start working the back arches I've been neglecting in favor of other things. I'm fortunate this issue is resolving fairly quickly.

Sometimes its good to be reminded of the importance of consistency in practice.

[mshelb]

Jason,
It’s good to have your company and you have my sympathy. You sound like you really know what you’re doing with it all though. To me, a good adjustment when I need it is like getting a new set of wheels. I think I know how you felt walking out of there. :D

Midday practice is a new goal of mine too, and specifically because of the cube-slide effect. I'm planning to use the stairwell because no one else ever does and it’s really hot out there lately.

I'm learning to listen to my body tell me (literally) when things are out of line, through WW. A pop on a particular movement in a particular spot corresponds to a specific adjustment. OK, well, I’m not that good yet, but I’m learning. As I have erased the tension through my back and hips, I can often feel the tension of a misalignment because there is less background noise. Even better, I’m starting to figure out what exercises put things back where they belong and quiet that occasional chatter. This stuff is pretty cool.

I hear you on the back arches. They require a lot of respect as well as discipline from me. Doing them wrong seems to hurt as much as doing them right helps. I've been playing with your snaking exercises too – they're ingenious!

Best of luck to you in your recovery.

[JasonE]

Mike -

I am going back to WW Basic, then sophisticating the movements into Infinities and Cloverleafs as the tension releases. My CBs are getting a bit of rest until this resolves, so I am stepping up my Body-Flow, particularly Knee Switches and alternating Cossacks.

[mshelb]

Jason,
Thanks for sharing your plan – it’s valuable for me to hear a second approach and compare. I’m still doing WW basic too. I tried moving up of course, but it didn’t work nearly as well – I just wasn’t ready. I’ll know when it’s time to move things along.

Spinal rocks and shinbox switches are still my favorites for bodyflow. My SI was stuck for so long that my body forgot how to move with it. I’ve come a long way, but my strength and articulation continue to improve with the combination. I’ll try adding the knee and Cossack switches and see how that feels.

Let me know when things have improved for you. Thanks again.

[Jarlo Ilano]

I'm learning to listen to my body tell me (literally) when things are out of line, through Warrior Wellness™. A pop on a particular movement in a particular spot corresponds to a specific adjustment. OK, well, I’m not that good yet, but I’m learning. As I have erased the tension through my back and hips, I can often feel the tension of a misalignment because there is less background noise. Even better, I’m starting to figure out what exercises put things back where they belong and quiet that occasional chatter. This stuff is pretty cool.


Mike,

That's really good! I like what you said about "background noise". I was playing with some ideas in my head that I wanted to ask the chiropractors on this forum about (the two Kevins :D ).

That is that I notice when there is more myofascial tension around a particular joint, it is more prone to "pop". For example, when I sprained my wrist a while ago, it would click and pop as I would move it, and I could feel the tension around the wrist build up until it made a sound. No specific manipulation or anything, just moving in circles it would make the noise. Then as the wrist got better it was no longer so likely to even click.

The same with my low back at times, I will get to a flat foot squat to remove tension and it would build up until the release and a pop (less audible, more internal) would occur.

My conjecture is that the myofascial tension surrounding the joint makes it more likely to "pull" on the joint capsule and have it more at a point of distension, so that even regular range of motion activities can cause the joint capsule to be at the point where it causes cavitation of the synovial fluid. Whereas normally, this would require going to the endrange (or even beyond) of your joints' motion.

So, the sound isn't the goal, but relieving the tension around the joint is...

But it is kind of circular, because the joint cavitation has effects that accompany it, such as neuro-reflexive inhibition of the muscles around the joint....

Well, just rambling. Thanks for sharing your story, it reminded me a little of what I was thinking about!

[Chuck Kechter]

Jarlo,

If your theory is correct, there's an article in there!

Good stuff!

[Scott Sonnon]

Jarlo,

Regardless, it's a very insightful theory and should be included in the magazine!

[mshelb]

I know this is a really old thread, and it might seem strange to dust it off and plunk down a 900-word post, but I’ve wanted to update this thread for a long while - to close it with a "Ha! Finished!" sort of statement.

But looking back through it, I can find two places where I already claimed victory and then admitted that I still had issues to address. This recovery really is a journey and not a destination, so I’ve decided to check in and claim another significant victory.

Here goes: starting at the beginning - the sacroiliac issue is toast. I fixed that and it’s not coming back. But after I fixed that, the degenerated disc that resulted from the several years of sacroiliac dysfunction then became a very relevant issue. It was less painful than the SI, so I underestimated what was involved at first. I quickly found that it was very limiting and more difficult to heal because it involved a worn, shrunken disc and the accompanying damaged facet joints that took a while to get where they were and were likely to take a similar amount of time to bounce back. I don’t plan to get the after MRI image to document my recovery. This is about pain-free movement, and I can track the problem just fine with the symptoms that were very evident when I started this process: tense, painful lumbar “displacements” as I call them; described by my chiropractor as the vertebrae rotating or sliding slightly out of place. This would leave me feeling tweaked and tension-wracked every time I over-stepped myself for most of the 13 months since I last posted here. Fortunately my chiropractor fixed this for me each time it happened and also provided regular feedback on my progress - what moved how, how far and if the movement was less, the same or worse. I also kept up with my personal rehab journal and my near-daily practice.

My plan for recovery started with a list of movements that I couldn’t do, a list of ones that I could do, and a list of movements that I called my indicators. These indicator movements gave me painless feedback on the state of things with clunks, pops, grinds or slight twinges. Next, I planned my movements for recovery using the advice I’d received here along with some of the elements of CST. These included: don’t go above rpd-4; beware of movements that feel good but cause pain and tension 2 days later; work to shrink the list of don’ts; grow the list of do’s; track progress with the indicator movements; and also be patient, take small steps, and keep track of every little success. If I hadn’t tracked every little success, my progress would have been so slow I would have been crushed with frustration. This was important because it allowed me to clearly see the forward progress.

My process didn’t always clearly reflect THP, but it was a learning experience and everything I did was focused on building stability and pain free movement in my lumbar spine. I practiced, waited, and revised the plan every time I reviewed my progress and found a flaw.

It was rough at first; my rules got rid of everything but two-thirds of Warrior Wellness beginner, spinal rocks and walking. I hit lots of setbacks along the way, but patience and perseverance eventually paid off. In April I discovered that I could do backward bends and full lumbar circles with no delayed ill effect. This was huge for me - back bends had seemed unattainable. Next, I added a short jog a few times a week, and even started playing light basketball. I began using my 15s again without difficulty or pain and I even got a 25 pound Clubbell®. My lumbar displacements got smaller and things started improving faster. I dropped the running when I added Flow Fit and that has made a big difference too. Next, I attended the CST workshop in Maryland in June and I held up just fine despite being quite concerned about it initially. (Congratulations to Coach Tran and Coach Billew–the elevation is well deserved). Now my daily practice is improving quickly, and I’m going to start sophisticating movements.

Like always, I do have caveats on my progress. I’ve got to be careful here; I’m not done yet and I still have movements that I avoid because they cause me problems. Back bends are possible, but deviation from the established, safe motor pattern is painful and mildly traumatic. So I’ve got some recovery left yet with the lumbar spine, but my displacements are small now and often move back themselves after a short time. Now the original problem - the sacrotuberous ligament sprain/tear that started my whole downward spiral eight years ago is evident again and limiting me – my right hip has a rotational no-go range that is quite painful and I'm addressing that. But even with these limitations, this is a big, big victory for me. I’m active now – working out, playing ball, moving really well, and exploring movements with the Clubbell®s, all while making forward progress with my health. This is so much fun - a huge quality of life improvement for me.

CST and everything that I learned here has been irreplaceable in walking that path back to health. Thanks again to everyone who was part of that for me. I look forward to posting more progress again soon.

[Jarlo Ilano]

Holy Crap! That's just great Mike!

Always nice to hear of people's progress, and yours is nothing short of inspiring!

[Kathryn Woodall]

Mike,
Your story is completely wonderful and I appreciate that you shared it with us! Fantastic work and truly another victory!

[Coach Simon]

[QUOTE=Coach Ilano]



So, the sound isn't the goal, but relieving the tension around the joint is...

QUOTE]

Yes, temporarily "resetting" the tensegrity, fascially and neurally. Repeated movement in all degrees of freedom probably rewrites the motor engrams to be more balanced and appropriately responding, therefore avoiding the sticking (hypomobility, inappropriate firing patterns and buildup of gas or CO2).

[Jarlo Ilano]

So, the sound isn't the goal, but relieving the tension around the joint is...


Yes, temporarily "resetting" the tensegrity, fascially and neurally. Repeated movement in all degrees of freedom probably rewrites the motor engrams to be more balanced and appropriately responding, therefore avoiding the sticking (hypomobility, inappropriate firing patterns and buildup of gas or CO2).

A Chiropractor and a Physical Therapist in agreement?:eek: ;)

Great day in the morning!:D

[Coach Simon]

Great day in the morning!:D

:)

[mshelb]

Coach Ilano, Kathryn -
Thanks for the words of encouragement. I've learned valuable little bits of advice from reading your posts on other threads. Every little bit counts.

I'll share more when I get there.

[Woody]

Mike, I read your posts with great interest as I have suffered SI problems for years. It seems as though you did a lot of SI rehab before posting this thread. Can you direct me to those resources? Are there other threads on this website? I searched but was unable to find anything. I've had a chronic SI problem that began to bother my L5. Seems like I need to follow in your steps. I can detail my challenges and efforts but didn't want to hijack your thread.

[mshelb]

Woody-
I wrote a lot more about the process of my SI recovery in another thread here: http://www.rmaxinternational.com/forum/showthread.php?p=48136#post48136 . This is a good summary of what I know and might help you some.

The other aspects of my SI rehabilitation that I didn't dig into here included the research that went into understanding the specific nature of my condition, the joint mechanics and anything else that could help me. Also worth noting (if you are new here) are the concepts of tensegrity/integrated structure. There are articles in CST Magazine, threads on the forum, and a lecture by coach Sonnon on DVD that go into that concept. It changed the way I thought about it all and was critical for me to understand how to move forward. It also helped me know when I'd found a good doctor, which is the final and likely most important part of my SI rehabilitation.

The first successful treatment I used was with a Physical Rehabilitation Medicine doctor (a Physiatrist). He practiced a somewhat controversial technique called prolotherapy. I did 8 sessions of prolotherapy, and I still believe that this helped me. (I was in really bad shape to start - all I could do was hobble/waddle. I could even think about running a step). Prolotherapy was really expensive and not covered by insurance. It doesn’t work for everyone, so my doctor told me and so I have read. It might not be the right thing for you.

The thread starts right about at the end of that treatment (Spring 2005) where I was improved to the point of relative comfort in everyday life, but still unable to train. At this point I could run, but I hurt afterward and I felt tweaked most days, with no ability to transfer strength to my upper body.

My next stroke of luck was finding a good chiropractor who recommended that I see him several times a week (for a ridiculously low fee) and he kept things lined up enough so that I healed the rest of the way over the next several months. He used another somewhat controversial modality (treatment) that I thought helped me too. I’d share that over a personal message, but I don’t want to turn this thread into a debate over these techniques. Limit one red flag per post for me here.

The thread covers the rest of the journey. Regarding the doctors and chiropractors, I strongly recommend that you shop until you are happy with who you’re seeing. Be willing to hurt feelings by moving on if it’s not right. Look for someone who treats the system rather than just the symptoms. Read that article by Dr. Cooper on working with your doctor, too.

Keep in mind that this was my path for my injury – yours will be different. My SI injury was a bit unique – it originated out of a severely sprained and mis-diagnosed sacrotuberous ligament sprain (originally diagnosed as a hamstring tear). That alone will make my experience significantly different than the average SI sprain.

But I think there is a lot to be learned from sharing, so ask questions, share your challenges/efforts and hijack this thread as best you can. I’m interested to hear about your experience. I imagine I’ll learn a good bit from you, too. Besides, there are some excellent medical professionals watching this forum here, and that can only help.

Best wishes on your recovery.

[Joseph David]

Mike,

Thank you for sharing your journey. Many lessons for all to be had from your experiences. Best to you in your continued personal triumph.