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1854 Views 6 Replies Latest reply: Nov 27, 2012 6:12 PM by TonyaRN RSS
Lacasajo Legend 295 posts since
Jan 5, 2008
Currently Being Moderated

Sep 13, 2012 11:31 PM

SI Joint dysfunction treatment?

I clearly have SI joint dysfunction...been gradually getting worse for years.  I can get a chiropractor or good manual physiotherapist to get things back in shape, but it doesn't last for long any more and it takes little exercise to aggravate it again.  Has anyone tried prolotherapy for this?  Any success?  Any other successful treatments?  Anyone had surgery?  I don't want to be a couch potato!  I want to continue to be a triathlete!  Jo

  • NicholeJolene Rookie 1 posts since
    Sep 9, 2009
    Currently Being Moderated
    1. Sep 14, 2012 9:57 AM (in response to Lacasajo)
    SI Joint dysfunction treatment?

    My SI joint hates me.  I found it was happiest when I had a strong core from taking an ab class at my gym.  My trainer is really good at making sure we work all parts of our core.  But I am no triathlete so your core may already be strong.

  • JamesJohnsonLMT Legend 1,127 posts since
    Aug 23, 2009
    Currently Being Moderated
    2. Sep 20, 2012 5:09 PM (in response to Lacasajo)
    SI Joint dysfunction treatment?

    Good points from Nichole on your core. Not sure if prolo and/or PRP can toughen up the SI joint enough to make a difference, but in theory it could work. I'm sure practitioners will line up to tell you so. I wouldn't go with just anybody, though. Sloppy needle work could traumatize muscles or other tissues and give you problems you don't already have. Look for somebody with a decent track record if you decide to try it, and don't look for a bargain.

     

    As you know, pregnancy can be very hard on the SI joint and they often don't re-knit properly, especially in combination with exercise during, or too soon after, females having a much smaller joint that temporarily becomes hypermobile to accommodate the fetus (for those who don't know). Strong intra-pelvic muscles of course help, but stronger musculature also exerts greater force on joints. Is there a way to strengthen just the joint-stabilizing intra-pelvic muscles, without building a joint-shredding core? Not sure. However, prolo targets the supporting tissues like ligaments, too, which could be more productive.

     

    Last I heard, insurance carriers were not too cozy with prolo, being it is $hundreds a pop for several needed visits (PRP being out of reach for most non-professional athletes). However, if it was me and I had the bucks to spare, I'd give it a shot, so to speak.

  • JamesJohnsonLMT Legend 1,127 posts since
    Aug 23, 2009
    Currently Being Moderated
    3. Oct 21, 2012 10:03 AM (in response to Lacasajo)
    SI Joint dysfunction treatment?

    Jo,

     

    Thought I'd revisit this thread because I am not satisfied with my earlier post. I should have delved into the SI issue more deeply. I was reading an article by Eric Dalton recently that underscored what I had been taught years ago, but my recall wasn't working well this time. I am getting on in years, lol. Back to fundamentals!

     

    One of the primary contributors to SI joint pain is any difference in torsion on the joint caused by an effective leg-length discrepancy. Even if measured and found to be the same, differences in tone in the upper gluteals (G. Min, Med) can draw the hip bone back somewhat to change the effective leg length. As I recall, you had some hip issues over the years and there could well be differences in tone, whether part of the original problem or the aftermath.

     

    Some clues might be subtle compensatory curves in any/all of the Lumbar, Thoracic, Cervical spine, eg. a Left, Right, Left arrangement or apparent Scoliosis. A scuff pattern on the shoe of the long side, or a slight lateral displacement of the chin vs. the center sternum can be other clues.

     

    If that weren't enough, the arch of each foot is going to alter the effective leg-length in a training athlete. It's not an official part of leg measurement, but can add to the stress on the SI joint through the gait cycle. One tip off might be a history of achilles or rear-calf problems on the short side, and perhaps some foot pain.

     

    The main problem being the mechanical stress on the joint itself, and of course the stress of compensation by the intrapelvic and other core muscles with resulting pain syndromes. Lots of ligaments involved as well. For those new to the subject, a leg-length discrepancy or effective LLD will place enormous stress on at least one SI joint the way one tight cable on a suspension bridge will bear weight orders of magnitude above the others. Unlike the bridge analogy however, stress added to one side is not deducted from the other because of the dynamics of the gait cycle.

    https://landingpages-optify.s3.amazonaws.com/848167f0-1797-11e2-a268-0025900105d0-orig.jpg

    I'm not familiar enough with your case to know if this has been accounted for by the practitioners you have seen, but even if it has, effective LLD is notoriously hard to accurately measure. It can be inferred from the clues mentioned above, but the conventional LLD measurements don't always work.

     

    The simple method of ASIS to floor, or height and fore/aft measurement of the femur/tibia supine on an exam table with knees flexed can fail to reveal effective LLD because the aspects are isolated. Ditto for static x-rays, which measure from the perspective of the beam.

     

    Adding up to zero sum differences is not enough. The position of each joint at every phase of the entire gait cycle has to be taken into account, because angles throw a curve into the math. For example, a long Femur and short Tibia are fine for standing around, but it's a whole different ball game for an athlete, particularly a runner. Some of the newer sensor-based computerized gait analysis methods can probably define effective LLD more clearly, if the software is looking for the right parameters.

     

    Stronger core muscles of course will be more resistant to differences in stress caused by LLD or effective LLD, though it would be hard to deliver the same athletic performance per calorie expended when some are wasted on compensation. In the case of any LLD, you'd be better off with the added weight of a shoe lift.

     

    Bottom line, there is an underlying cause for every pathology, and your experience with temporary relief after treatment indicates a closer look for an ongoing cause. There must be a reason why therapeutic interventions don't take. Might not be cheap to get a definitive study done, but no doubt, every dollar spent will come back in time vs. ongoing treatment. Good luck, Jo. Wishing you many future triathlons and pain-free training.

  • TonyaRN Pro 70 posts since
    Apr 1, 2011
    Currently Being Moderated
    4. Nov 24, 2012 7:13 AM (in response to Lacasajo)
    SI Joint dysfunction treatment?

    Hey Jo... This is Tonya~  Been looking for you guys!!!  (Hip arthroscopy).  Where did our thread go??  Hope you are getting some relief .

  • JamesJohnsonLMT Legend 1,127 posts since
    Aug 23, 2009
    Currently Being Moderated
    5. Nov 24, 2012 9:59 AM (in response to TonyaRN)
    Re: SI Joint dysfunction treatment?

    Tonya,

    I saw it out on page 5 or 6 of search results (the original from coloradodora). At 599 entries, I don't know if it hit a digital limit or not, but I did not try to open it. Probably still works if there is no reply limit. There have been a few related HA posts since then, which I try to refer to the original, but I understand there are other forums out there on the topic that people may have moved the discussion to.

     

    There are occasional issues with the automatic editing function in this forum, which is why I always highlight, shift-delete and shift-insert before posting (block copy is disabled), problems with e-mail notification (linking back to the thread), plus occasional log-in issues, but arguably these threads also have more of an inside audience than some others I've seen. This can be good or bad (we're relatively free of spam/trolling here), but there is possibly a more lively discussion elsewhere. That doesn't mean more useful, though. This one has helped many.

     

    It would be nice to see how everyone is doing, but as forsurecan once wrote, people get better and move on. I think there are a lot of people out there that are still considering surgery, and could certainly use the advice. There have been a lot of success stories, with lots of lost time and living to make up for. Still, there are those who wait and hope, needing more encouragement than anything else. Good luck restarting the thread...

  • TonyaRN Pro 70 posts since
    Apr 1, 2011
    Currently Being Moderated
    6. Nov 27, 2012 6:12 PM (in response to JamesJohnsonLMT)
    SI Joint dysfunction treatment?

    James,  Thanks for the info.  I really hated to see the thread disappear.  The interactions really helped me get through one of the most difficult injury's of my life.  I am glad to see this one moving along! 

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