SI Joint Part 3: Treatment of SI Joint Pain

   |   By    |   Categories: low back pain   SI Joint Pain  
[ssba]
0 Flares Twitter 0 Facebook 0 Google+ 0 StumbleUpon 0 0 Flares ×

Treatment of SI joint pain (SIJP) includes chiropractic manipulation (good for the SI joint that isn’t moving enough), myofascial release, heat, postural education, SI belts (good short term strategy for the SI joint that is moving too much), electrical stimulation, stretching, therapeutic exercises, SI joint injections including prolotherapy, Platelet Rich Plasma, stem cells and SI joint fusion.

At Back to Function, we use a combination of chiropractic manipulation, myofascial release, stretching, electrical stimulation, SI belts and therapeutic exercises to get rid of SI joint pain. Not only is our treatment protocol unique, but we are one of the few providers in California certified to use Postural Restoration techniques.

At Back to Function, we choose exercises based on the specific postural pattern and side of the SI joint pain. For the PEC pattern, the primary goal is to restore the ability of the patient to flex their spine and expand their posterior mediastinum. This will allow them to touch their toes (without pathologically overstretching their hamstrings) and to fully squat comfortably while breathing. Once the sagittal plane motion and ability that was compromised by the PEC pattern is restored, the patient is managed for the underlying Left AIC pattern depending on the side of SI joint pain (for more information on the PEC & Left AIC patterns see Part 2: Assessment of SI Joint Instability).

Examples of PEC Exercises to Correct Sagittal Plane Posture

Modified All 4 Belly Lift

Standing Un-Resisted Wall Reach

Squatting Bar Reach

Right SI Joint Pain/Dysfunction Related to a Left AIC Pattern

Right SI joint pain is thought to occur because of too much motion across the posterior right SI joint due to the distraction across the joint caused by right sacrum rotation. Based on the left AIC pattern, the right hip is often positioned in internal rotation and adduction. To achieve optimal lumbar-pelvic-femoral position, the goal would be to achieve right hip external rotation with concomitant left hip internal rotation. The right gluteus maximus can correct right hip external rotation in the transverse plane which can contribute to repositioning the sacrum from a position of orientation of right rotation towards neutral.

Exercises with the patient in a side lying or supine position are done initially until motor control with the correct muscles is achieved. Then exercises can be advanced to sitting and then to a more functional standing position.

 

Left Sidelying Right Glute Max

Left Side Lying Right Glute Max with Hip Extension and Abduction

Standing Wall Supported Left Knee Flexion with Resisted Right Glute Max

Left SI Joint Pain/Dysfunction Related to a Left AIC Pattern

Left SI joint pain is thought to be caused by too much motion in the SI joint due to compensation for the inability to get left hip internal rotation due to the left AIC pattern. This causes compression at the left SI joint and can contribute to SI joint instability. Exercises need to focus on training the left hip to internally rotate via the left acetabulum moving over the left femur with facilitation of the left gluteus medius and adductor magnus.

Right Side Lying Left Adductor Pull Back

Left Side Lying Knee to Knee

Left Side Lying IO/TA with Left Adductors and Right Glute Max

 

This article demonstrates a few exercises related to SI joint pain that can be caused by postural asymmetry. For a detailed evaluation of your SI joint pain, please contact us at 310-534-1900 or by email at info@backtofunction.com.

References:
  • Boyle, Kyndall. Conservative Management for Patients with Sacroiliac Joint Dysfunction. www.intechopen.com
Dr. Chad Moreau
About Dr. Chad Moreau

Dr. Chad Moreau is the President of Back to Function, a sports chiropractic office dedicated to providing elite quality care for athletes and athletic-minded clients. He is also the Chiropractic Consultant for the Los Angeles Kings (NHL) and the Team Chiropractor for the Los Angeles Dodgers. He can be contacted at drchad@backtofunction.com.

Leave a Reply

Your email address will not be published. Required fields are marked *

©2020 Back to Function. All rights reserved.