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Physio Detective Blog

SIJ Movement and Beliefs – Challenging your beliefs about “old theories”

OK, so most patients tell me that their SIJs are too loose, that their ligaments are overworked and lax and that their joint subluxes all the time.

As a clinician, I believe everything that my patients tell me is happening to them but I don't always believe the beliefs about *why* it is happening to them. That is fair enough. I believe that they are going through their pain/dysfunction, I believe they are genuine about it (there is the occasional person that exaggerates things but they also ask questions like "so, will you have to tell the insurance company about that?", "will this affect my payout?", etc...), and I believe that they want to get better.

So, how do I (and any clinician worth their salt) determine what is actually going?

For statements about their ligaments and joint subluxations, you have to test them!

Now the beauty of seeing a patient in person is that I can tell how they got their beliefs, whether it was from Google or the clinician or if they are just using their own words to describe what they are feeling.

If you believe your joints are too loose, then test yourself lying flat on the floor...preferably concrete or tiles (you will see why in a minute).

1. Have someone test you. A therapist preferably
2. Have that someone put wedges or coins or small pieces of 3mm wood or whatever you want under your ASIS on the "anteriorly rotated side" until they believe you are "lined up straight". Note the height off the floor that you "need" to make yourself "level"
3. If that amount is more than 8mm (and most people will need more than that), you either have an SIJ that moves outside a normal range of motion (possible) or there is another explanation for it (also possible). A recent review (2008 - full text article here http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565072/) found 7 studies that looked at how much the SIJ moved and found the MOST amount of movement being 8mm.
4. OK, let's assume a few things now...I DO NOT ADVOCATE THIS...this is just an interesting thought experiment...
a. assume that X-Rays are safe and don't contain ionizing radiation
b. assume that your doctor will agree to this
c. assume you are happy to accept the results
5. The experiment would then be to take an X-Ray at a set distance with you on the bed lying prone. Have your "therapist" (whoever is with you) check that the results are the same as before. You would then take the X-Rays. Then, without moving (or as little as possible), add the amount needed under the ASIS and retake the X-Ray. (The reason why you had to test on the concrete floor is that the X-Ray beds I have seen are flat and hard - if there is a small cushion/mattress on it, have them take it off...if this were a proper experiment, ethical (it is unethical to XRay you like I am suggesting without the whole experiment undergoing ethical review etc)

If you have a hypermobile SIJ, you will see the changes on XRays...a movement of 8mm or more can be seen...but i bet in most people, not much changes at the joint level.

My thoughts have been changed over the years by thinking about such things and testing the clinically and trying to take the opposite position to where I stood in my beliefs. I have kept the beliefs that have withstood intellectual and scientific (research) challenge and I have changed the beliefs that have proven to be inaccurate (positional testing is the main one, the amount of SIJ motion available is the other).

Having said that, I believe that the SIJ moves and it moves in a small but significant amount. I test for it. However, I have found that other tests and research has led me to believe what i was seeing before as "positional faults" are more likely to be muscle activation patterns etc...

What do you think? Are you ready to challenge your beliefs?

Please remember that my beliefs have changed about the reasons *why* i feel what i feel. I still feel them, I just interpret them differently. I can still feel and see the old "positional faults" but if I can "fix" them without all the old techniques I used and without manipulation, then it has to beg the question "was it really stuck in the first place?"

All "systems" and "paradigms" we use in all areas of life are simply a means to describe what we see and feel and live with and experience. I refer back to science because it seeks to explain why we feel these things.

I hope you found this an interesting post...

4 Responses

  1. Hunter

    So I realize this is a old post, but thought this might be the most fitting post for my question.

    I have been reading about the benefits of Yoga, and especially paired with Cross-fit.

    Question is, with an SI Joint that has been found to be hypermoble on one side, could Yoga be counter productive?

    Yoga has a lot of asymmetrical positions, as well as positions that seem to push the boundaries of mobility of certain (or all) joints.

    Thoughts?

    Thank, Hunter

    1. Hi Hunter. No problem.

      Quite a number of beliefs in your comment that need questionning – not because they are wrong but because it helps everyone to question everything.

      1. Hiw did they diagnose it was hypermobile on one side? It it controllable? It is a torn ligament? Will it ever get better?

      2. Yoga benefits with crossfit – i think it is good but what type of person are you – hypermobile type or hypomobile type? How is your balance and control? Do you find doing yoga harder or easier than an overhead squat?

      3. Yoga does have asymmetrical positions – is this a bad thing?

      4. Pushing the limits of flexibility – is tjis a goodnor bad thing?

      Personally, I need more information and to assess you to answer your question fairly…therefore, you are going to get the tried and true favourite response – it is hard to say if it is good or bad for you. You should get assessed before conmencing any physical activity program. Yoga might be good for you or it might make you worse.

      Sorry for being general – i hope you understand why.

      1. Hunter

        Antony, Thanks for the reply!

        1) Iliac crest on right posterior side bulges out more, especially when sitting and leaning forward. Not sure on the specifics of diagnosis, had mri done (showed no problem), it was my PT who noticed it during functional movement test of some type. PT thinks I should have no problems as long as I stay active and continue to work on stabilization. It was explained to me as a “lax” ligament in SI that was causing sciatica, hip pain, r knee, right ankle, etc. Also, I believe it was explained to me that due to hyper on right side, my left SI has compensated and become hypo. Will it get better? Maybe I have some research to do on ligaments, thought ligaments stay “lax” once injured.

        2) Apparently told I was Hyper on right, Hypo on the left. Balance and control I believe are good. Don’t due a lot of overhead due to shoulder issues(jiu-jitsu over the years really messed me up).

        3) Guess this is where my being hyper on right, hypo on left might come into play.

        4)Good question, what if it involves hypermobile joint? This also will lead me back to doing some further research on whether or not injured “lax” ligaments can be fixed (w/o surgery).

        I totally under stand the generality of the response. Guess to get to a question thats not about me personally. Assuming someone had a hypermobile joint. Would you discourage pushing limits of flexibility in those areas. I know some of my questions beg other questions first, so thanks for any response. I guess I have a lot more to learn about SIJD, and what type I have specifically.

        ps, one of your posts on FB SIJD forum was the reason I decided to start facing the pain, and that getting active again (with guidance from my PT) will help me from getting worse down the road. Thanks for all the time you spend helping strangers from the other side of the world!

        Hunter

        1. Thanks Hunter. I would keep things within limits and work with the PT to determine how much you can do. I dont usually “push” things, i seek to improve the range and control over all joints.

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