You have lower back pain. You are looking to determine what condition do you have and how do you help yourself. Sacroiliac joint dysfunction should be one on the list for you and your Spine Specialist to rule out or in. We will end with a few stabilization exercises for your sacroiliac joint pain.
Here is what you will get from this short article. Many articles will go over the “what” and “how”. We will give you the down and dirty secrets that you need to know about your sacroiliac joint dysfunction.
- What is sacroiliac joint dysfunction?
- How do you know if you have a sacroiliac joint dysfunction?
- What are two things that your medical doctor, chiropractor, or physical therapist might not know or share to you?
- Five commonly prescribed exercises and what to do if they do not work?
Your pelvis consists of three bones: 2 ilium and 1 sacrum. There is a meniscus-like disc called the pubic symphysis. The pubic symphysis consists of cartilage that has more type 1 collagen called fibrocartilage.
1. What is sacroiliac joint dysfunction?
Your sacroiliac joint is the transition between your lumbar spine and your long thigh bones called femur. Your sacrum acts more like your spine. The two ilium acts more like your hips (coxa-femoral joint). Your pubic symphysis helps to absorb this back-and-forth reciprocating force from your legs that happen as your walk, run, or sprint.
The primary function of your sacroiliac joint is to help transmit and coordinate the kinetic chain force from your legs to your upper body and vice versa. The elaborative explanation is the sacroiliac joint’s role is to take and spread the shock that comes with your leg hitting the ground to your trunk, neck, and opposite arm.
Our swing of the arm causes your opposite arm to whip the other direction. Just like the use of a whip, the snapback whip of your arms brings the kinetic force back down the trunk, sacroiliac joint and opposite leg to swing forward. We hope you realize that the kinetic chain force of walking has a rythmic flow from right to left to right and up to down to up.
In short, your sacroiliac joint dysfunction happens when you lose the ability to move the kinetic force from your legs to your arms. The same occurs from a top-down movement of kinetic force.
There are TWO types of sacroiliac dysfunctions: Moving too much (hypermobility) or moving too little (hypomobility). The motion at the sacroiliac is controlled by two types of tissues: active or passive tissues.
Active tissues include all the surrounding muscles that expand over the sacroiliac joint. Passive tissues include all the surrounding connective tissues that are not controlled by the brain, per se. The list includes ligaments and capsules.
Phew! The first question was a longer explanation than you may hope for but that was the most condensed version!
Our philosophy is that everyone can get better and stay active. If you can get all of your body parts to work the way it is designed, you can do amazing things. This is possible in the face of arthritis, age, or whatever you may have been told. YES YOU CAN!
There is no clinical test that is reliable in diagnosing you with sacroiliac joint dysfunction. Research emphasizes practitioners to use a collection of tests that targets the pelvis (which includes the sacroiliac joint) to determine if you have a sacroiliac joint dysfunction.
2. How do you know if you have sacroiliac joint dysfunction?
There is one very accurate test that can help you know if you DO NOT have sacroiliac joint dysfunction. The test is called Fortin finger test. If your pain is very specific to the junction where your ilium and sacrum connects, you have a POSITIVE Fortin finger test. If your pain is not in the region of your sacroiliac joint region, you have a high chance that you do not have sacroiliac joint dysfunction.
You maybe like the many people we see with lower back pain and have pain around or at the sacroiliac joint region. Unfortunately, this makes things still clear as mud.
Your Spine doctor may inject directly to your sacroiliac joint to determine if your pain goes away immediately or not. If you get relief, then the assumption is that you have sacroiliac joint dysfunction.
There are still clinical debates and best practices when it comes to the subject of sacroiliac joint dysfunction! New (and frequently old) clinicians tend to favor going to educational courses revolving around this subject, as it is a source of clinical frustruation in the management of sacroiliac dysfunction.
3. What are two things that your medical doctor, chiropractor, or physical therapist might not know or share to you?
The two things that you need to know about your sacroiliac joint dysfunction are: there is no such thing as treating the sacroiliac joint only AND you cannot manage one ilium without the other ilium.
The main reasons for this dilemma is due to the clinical idea that we have to determine whether it is a local tissue source of problem: sacroiliac joint, hip joint, or lumbar spine joint, lower back muscle, or lower back ligament.
The first question that goes through many people’s head when we hurt our lower back is “What did I just injure?” We understand that our minds want us to believe that it is simple to look for that one thing.
The body works together. Walking requires all muscles to work in coordination with each other. The sacroiliac joint role is to move forces around so the body works well together.
The dilemma is being perpetuated with the question of “chicken-or-egg”. Is the lumbar spine muscle, facet, or disc injury causing the sacroiliac joint dysfunction OR the other way around?
In our opinion, and based on helping 1000’s of lower back pain recover and get back to their activities, we rarely see a patient with only sacroiliac joint dysfunction without lower spine dysfunction.
If you believe in the idea of kinetic chain movement and the idea that your whole body needs to work together to move, you need to address the lumbopelvic-hip unit.-Dr Danh Ngo
We have a slogan that goes by the statement of “Never chase the pain. Find the source and treat the source.” If you limp or alter your gait due to pain, both legs are not moving optimally. If you cannot run because your lower back and pelvis are hurting on one side, you have to address the mechanics and functionality to both left and right sides.
If you have a left leg that is over-compensating (working too much), then the other side is working too little.
Orthopedic Physical Therapist Specialists are mechanics of the human body. We focus on addressing any mechanical limitations and use a precise form of exercise prescription to ensure you know how to manage kinetic chain forces well. The categories of human movement include mobility, stability, strength, coordination, endurance, reactive control, and power/explosiveness.
You can have a sacroiliac joint dysfunction if your lifestyle requires a mixture of a certain human movement capability but you are not training in that certain mixture.
Lastly, the idea of left and right needs to work well together means that a Sacroiliac Joint Fusion will always lead to over-compensation to the other side. The compensation may happen at the sacroiliac joint, hip, knee, or lumbar spine. The weakest joint(s) will be the next place to scream dysfunction or pain. We never recommend getting a sacroiliac joint fusion.
4. Five commonly prescribed exercises and what to do if they do not work?
The 5 exercises program is design to help if you have either a hyper or hypomobility sacroiliac dysfunction. We focus on making sure you address the mechanical component of most sacroiliac joint dysfunction with a self treatment reset. The next phase will be to ensure both joints are stable and well supported by your muscle-brain connection. Lastly, we end with coordination and staggered stance strengthening for your short stronger sacroiliac joint protocol.
If you are interested in 10 additional exercises (video and written instructions), fill out the short form below. The 10 additional exercises will include regressive and progressive exercises to the 5 exercises listed in this article. It will include soft tissue or mobility exercises to support the 5 exercises in this article.
A. Sacroiliac joint reset.
Lay down and bring one leg up. Try to pick up the side that does not hurt up first. Place a stick on the top of that leg and the back of the bottom back thigh. Gently push your thighs in the direction of the stick for a count of 10 seconds.
Your legs should be moving in opposite directions. If that does not aggravate your symptoms, you can ramp up the intensity of your push.
Perform 5 reps for 10 seconds contraction.
End by placing your fists between the ends of your inner thigh. Push your thighs together slowly and increase intensity. You may hear a “pop” to your front bone and that is typical, but not necessary for success.
Get up and walk or go up and down a few steps. If you feel like there is still discomfort, you can try another set of 5 reps.
If that does not relieve some discomfort, repeat with the opposite leg pushing pattern. 1-2 sets maybe necessary.
Lay on your back on a flat and firm surface. Raise your hips and chest up towards the ceiling. Make sure your elbows, wrist, and hands are flat on the table and tuck closely towards your trunk.
Flex and contract your gluteals or buttock region so you can emphasize supporting your Sacroiliac with the strongest muscles that surrounds the back side of your Sacroiliac joint region.
You should feel your glutes working only. If you do not feel your glutes working, you may need to regress to progress.
Hold for 30-60 seconds. Repeat for 5 reps. Do daily for 4 weeks.
C. Active Straight Leg Lift.
Lay on your back on a flat and firm surface. While keeping both legs and knees firm. Raise your legs up to a vertical position. If you cannot reach this height, remain focus on keeping a straight leg. You will get there with time and practice.
If you happen to feel your groin or front thighs tensing instead of your abdominals, brace your abdominals muscles. Practice timing your leg raise with a prolong exhalation.
You should feel your abdominals working only and never tension to your groin or front thighs. If you do not feel your abdominals, you may need to regress to progress.
Repeat for 10 reps and 2 sets.
D. Table assisted elbow to elbow tap.
Place your hands on a firmly secured that is about the height of your thighs. Keep your spine firm and straight. Tense up the back of both thighs.
Alternately, touch your elbows with one hand. Switch. Perform 20 reps. Make sure you try not to rock side to side or twist. This is important for your Sacroiliac Joint stability.
If you notice that you keep swaying or rocking, you may benefit from out additional 10 exercises comprehensive approach.
Perform 2 sets. Do daily for 4 weeks.
E. 1/2 kneel.
Kneel down and support your knees with a sofa cushion or a few thick blankets. Bring one leg forward. Make sure both feet are aligned straight. This is important, but work your way towards this ideal if you have discomfort. Raise both arms up high if you have good balance. Practice safely and use your best judgment.
If you are not swaying and you are practicing with good judgement, close your eyes. Practice improving your single leg balance.
Spend 2-3 minutes working each leg. Do daily for 4 weeks. This is one of the most important exercise out of the five.
If you notice that you keep swaying or rocking, you may benefit from out additional 10 exercises comprehensive approach.
Enjoy and practice daily with our suggested protocol.
If you desire a more elaborate 10 Sacroiliac joint dysfunction exercises and self care (includes video and written instructions), please fill out the form below. If you are in need of immediate Specialist Sacroiliac Joint solution AND live in the surrounding city of Long Beach, California, get a FREE consult with Dr Danh Ngo.
He is in the 1% of Physical Therapist with TWO SPECIALTY: Orthopedic and Sports Medicine. Click on the Blue button for your special chat and time with Dr Danh Ngo.
Danh Ngo PT, DPT, OCS, SCS
Spine and Sports Medicine Expert
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