Sunday, May 19, 2013

More on Sacroiliac (SI) Joint Dysfunction and Running

I've been getting a lot of questions about SI joint dysfunction lately. Before I post,  I just want to explain that I am not a doctor nor do I consider myself an expert in sacroiliac joint dysfunction. I am simply explaining what I know (scratch that, what I think I know) about my SI joint problems and what has worked for me. Also, I think its important for me to write that I have had this same injury for 12 years and was misdiagnosed most of the time. Keep in mind that what works for me may not work for you for a number of reasons. Read on for more.

What is the sacroiliac joint?

The sacroiliac (SI) joint sits between the sacrum (lower end of the spine) and the iliac bone . It is one of the largest joints in the body and the surface fits together like lego. A very small amount of motion should occur at the S.I. joint. The motion of this joint is typically so minimal that it might only slide a couple of milometers and it may only tilt and rotate a few 2-3 degrees. The primary function of this joint is shock absorbency and to provide enough motion and stability to protect the pelvis and spine from constant motion like running.

What is SI joint dysfunction

From what I have been told and from what I have read, SI joint problems develop when 1.) The joint doesn't move enough (hypomobility), or  2.) The joint moves too much (hypermobility). Keep in mind that there are actually two joints (one on either side) that are designed to move together as one.

Hypomobility (The joint doesn't move enough)
The joint locks up and doesn't have enough motion. This typically happens when the joint wears down due to age. 

Hypermobility (the joint moves too much)
If the ligaments surrounding the joint are weakened, maybe by pregnancy, a car accident, or another high impact injury (such as a bad fall from a steeple barrier, in my case). When the ligaments become weak, the SI joint moves too much and causes all sorts of problems, and pain. The locking sensation that can sometimes occur (for me between mile 4-8 of every race) is because the joint has over rotated. SI joint problems (for me) get worse as the race shortens and the pace gets faster (I.E. 10ks are a terrible race for SI joint problems)

Hypermobility can be quite tricky, especially in runners. Because there are essentially two SI joints, one side may actually move too much while the other may move just enough or not enough. This can make you feel off balance, like one side is tight (or needs to be pulled on or pulled out) and the other is loose. Its very annoying, believe me, I know.

What doesn't work for me
Chiroractic can work for people with hypomobility because it can return some motion into the joint. However, I have never had any relief from the chiropractor for my SI problems because while one side might move just right, the other side is hypermobile. Chiropractic care creates more motion in the joint, which in the beginning may be relieving if the area around the joint is inflamed, but over the course of a few weeks or months, might actually make your problems worse. My suggestion, make sure you understand just what your SI joint problems are before you consult a chiropractor.

Anti-inflammatory medicine, incline tables, acupuncture,  I've done all these things in excess. Thought they initially will give you some relief, over time your problems will return without strength exercises and a good physical therapist that understands your SI joint problems.

What works for me
A strength and exercise routine that is designed by a physical therapist. Simply massaging the joint never worked for me, however, the combination of physical therapy, massage, and exercises (at home, on my own, every day) have helped and continue to HELP my SI joint problems. Keep in mind that the flare-ups (locking episodes) will still happen if you are like me and genetics also plays a large role in your issues. Also, the more children you have, the more problems you will likely have with your SI joints. And before you start searching the internet for "strength exercises for SI joint dysfunction" you need to find out what kind of SI joint problems you are experiencing.

Ok, the really bad news
Sometimes the solution to the problem actually make the problem worse before it gets better. I have been working really hard on my strength all spring and sometimes over do. Thus I have dealt with major inflammation around the joint causing more "episodes". Also, if you get a good deep tissue massage, don't expect to do a workout a day later (or in some cases 2 days later). Taking two days between workouts and limiting yourself to one run a day will help when things are going really bad.

And, in closing:
If you think you are experiencing problems with the SI joint, see a doctor and get a referral to a physical therapist that has experience with sacroiliac joint dysfunction. If your therapist doesn't have much experience with dealing with SI joint dysfunction, see someone else or ask around your running friends. Someone you know has bound to have had some SI joint problems.

The end, for today.


L.A. Runner said...

Very informative post. In 2003, I actually dislocated my SI joint by fall off a curb in the dark while running. (Genius, I know.) HOLY CRAP- the pain was UNBEARABLE. I could barely walk, only tiny baby steps. I had extensive PT for 12 weeks.

Best wishes with this. Luckily, I rarely have flare-up. The PT warned me that when/if I have children my chances of issues will increase significantly.

Keep chipping away...

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