RehabilitatingSacroiliacJointDysfunctionwithPilates

HollyRumpfJune11,2017SynergyStudioAvon,CO2016

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Abstract

TheSacroiliacJointisastrong,typicallystable,jointthatislocatedinthe

pelvisbetweentheiliumandthesacrum.Itissurroundedbyseveralsupporting

musclesandligaments.Thejointisresponsibleforshockabsorptionand

transferringweightbetweenthespineandthelegs.SacroiliacJointDysfunction

referstopainintheSacroiliacJointthatoccursduetoabnormalmovementofthe

joint.Itcanbecausedbyanumberofreasons,butisgenerallytheresultof

instabilityinthepelvicarea.Treatmentcanincludenon-invasivemethodssuchas

heat/ice,rest,anti-inflammatorymedications,stretching,exercise,orinmore

seriouscasesphysicaltherapy,injections,andsurgery.Pilateshasshowntobe

particularlyeffectiveinalleviatingpaincausedbySacroiliacJointDysfunction

becauseofthefocusonbuildingstabilityandstrengthinthesurroundingmuscles,

correctingimbalancesandcompensatorypatterns,andstretchingmusclesthathave

becometootight.

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TableofContents

1.TitlePage

2.Abstract

3.TableofContents

4.AnatomicalDescriptionoftheSacroiliacJoint

5.SacroiliacJointDysfunction

6.CaseStudy

7.BASIPilatesConditioningProgram

10.Conclusion

12.Bibliography

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AnatomicalDescriptionoftheSacroiliacJoint

TheSacroiliacJoint(SIJoint)lieswithinthepelvisnexttothebottomofthe

spine,andisformedbetweenthesacrumandtheiliumbones.ThereisanSIJointon

eithersideofthesacrum,andthearticularbonysurfaceofthebonesinterlockto

providestabilityandminimizemovementofthejoint.Thejointissupportedby

severalsurroundingligamentsthatprovideadditionalstability.Musclesaroundthe

jointalsoeffectitsmobilityandmovement.Theyincludetheabdominalmuscles,

iliopsoas,erectorspinae,multifidus,glutealmuscles,piriformis,hamstrings,and

quadratuslumborum.AhealthySIJointshouldonlybecapableofsmallamountsof

motion(about2to18degrees)anditsfunctionsaretoprovideshockabsorption

duringweight-bearingactivities,andtokeepthehipsandpelvisstablewhile

effectivelytransferringloadbetweenthespineandthelegs(Vleemingetal,2012).

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SacroiliacJointDysfunction

SacroiliacJointDysfunction(SIJDysfunction)referstoimpropermovement

oftheSIJointduetoeitherhypermobility,inwhichthejointmovestoomuch,or

hypomobility,inwhichitmovestoolittle.ThetwosidesoftheSIJointgenerally

worktogetherduringmovement,sowhenonesidebecomestoostiffortoolax,the

sideswillnotmovetogetherandresultinpainorstiffnessinthearea.Aboutto10to

25%ofpatientswithlowbackpainarediagnosedwithSIJDysfunction(American

PhysicalTherapyAssociation,2017).Commonsymptomsincludelowbackpain,

upperlegpain,jointinflammation,sharporstabbingsensationsinthelowbackand

groinarea,numb/tinglingsensations,muscletightness/tenderness,andspasms.

Thesesymptomscanbemadeworsewithbending/twistingmovements,rolling

overinbed,standingupfromasittingposition,walking,andstandingorsittingfor

longperiodsoftime.SIJDysfunctioncanbecausedbyanumberofreasons,both

structuralandfunctional.Scoliosis,leglengthdiscrepancies,arthritis,ankylosing

spondylitis,pregnancy,prolongedvigorousexercise,muscularimbalance,andinjury

canallcontributetoSIJDysfunction.

Thegoaloftreatmentistocorrecttheunderlyingpathologyandalleviatethe

symptoms.Treatmentcanconsistofheat/ice,rest,anti-inflammatorymedications,

physicaltherapy,exercise,injections,andsurgery(Driver,2017).Pilatesis

particularlyeffectiveintreatingSIJDysfunctionbecauseofitsfocusonpelvic-

lumbarstabilizationandthedevelopmentofcorrectbodyalignmentandmuscle

recruitment.Strengtheningandstretchingmusclesaroundthejoint,particularlythe

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abdominals,pelvicfloor,andgluteals,helptoprovidesupportforthejointand

assistinmaintainingitsproperposition.

CaseStudy

IchosetowritethisstudyonmypersonalexperiencewithSIJDysfunction.I

amahealthyfemale,28yearsold,andhavebeenactivemywholelife.Iexperienced

anSIJointinjurytwoandahalfyearsagowhiledoingabackbendduringayoga

class.Ididnotfeelanythingatthetimeoftheinjury,butstartedtofeeladullachein

mylowbackthroughoutthedayafterwards.Thenextmorningmybackwasin

excruciatingpainandIcouldnotgetoutofbed.Followingmyinjury,Iexperienced

severechronicbackpainandmusclespasms,andwassolimitedinmydaily

functioningthatatIwasunabletowalkorrolloverinbedontheworstdays.

Iattributetheinjurytobeinghypermobileandoverlyflexible,whilenot

havingthecorestrengthtosupportmystructure.AccordingtoIsacowitz,“itisoften

theseimbalancesthatdirectlyorindirectlyleadtoinjury…forexample,a[person]

maybeveryflexible,yetlackthestrengthtosupporttheextremeROMthatthe

activitydemandsandherjointsareabletoachieve.Ajointthatishyper-mobileisby

naturenotasstableasatightjoint”(2013).

Iwentthroughseveralroundsofphysicaltherapy,massage,anti-

inflammatorymedications,andonesteroidinjection,thoughnoneofitmadea

difference.WithinthelastyearIfoundanewphysicaltherapistwhoutilizesmanual

therapytorealignmypelvis,andthroughacombinationofthatandPilatesthe

resultshavebeenextraordinary.

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BASIPilatesConditioningProgram

ThisistheprogramIcreatedformyselfinNovember2017,onceIhad

startedtoexperiencesignificantimprovementfromthemanualtherapy.Atthat

point,myphysicaltherapistsuggestedIfocusonmyPilatesworktobuildupmy

corestrengthandstabilityinordertomaintainthechangesthathewasmakingto

mybody.

Myprogramfocusedonworkingprimarilyinneutralspineinorderto

minimizeanymovementoftheSIJointandtoavoiddeepflexionandlowback

extension,astheywerecontraindicated.Ithoughtitwasimportanttobuildup

abdominalstrength,particularlythatofthetransversusabdominis(TA),asitis“the

mostimportantoftheabdominalmusclesintermsofstabilization”(Isacowitz,

2013).Otherareasoffocuswerestrengtheningmypelvicfloormusclesandgluteals,

whicharealsoimportantforstabilization,andstretchingmyhipflexorsandback

extensormuscleswhichhadbecometootight.Thisprogramwasdoneaminimum

ofthreetimesperweekfor6weeks.

Goalsweretogetmydeepstabilizingmusclestofireandtostrengthen

musclessurroundingmySIJointinordertoprovidesupportforthejointand

minimizemovement.Mybackextensormuscles,particularlytheQL,andhipflexors

hadbecomeoverlytightastheywerecompensatingfortheunderactivestabilizing

muscles,soIsoughttore-educatethosemovementpatternstorestorethe

relationshipbetweenmyagonistandantagonistmusclegroups.Ihopedthatonce

mybackmuscleswerenotbeingover-activated,itwouldhelptoreducespasmsand

lowbackfatigue.Theultimategoalwastorestorebalancebetweenallstabilizing

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andcoremusclesinordertosupportpropermovementinmySIJoint,andachievea

healthy,pain-freestateofbeing.

WarmUpontheMat

PelvicCurl,SpineTwistSupine,ChestLift,ChestLiftwithRotation

FootworkontheReformer-2redsprings,1green,1yellow

ParallelHeels,ParallelToes,V-PositionToes,OpenV-PositionHeels,OpenV-

PositionToes,CalfRaises,Prances,Prehensile,SingleLegHeels,SingleLegToes

- FocuswasonpelviclumbarstabilityandTAengagement.

AbdominalWorkontheReformer

ShortBoxSeries:RoundBack,FlatBack,Tilt

- Focuswasontheco-contractionofabdominalsandbackextensorstoget

thosemusclegroupsworkingtogethertoprovidesupportforthespine.

RoundBackandTiltprovidedanicestretchfortightlowbackandside

body.

**IskippedTwist,RoundAbout,andClimb-A-Treeinthebeginningasthe

rotationandROMcausedpain.OnceIgainedthestrengthtosupportmyselfI

graduallyaddedtheexercisesin.

HipWorkontheReformer–1redand1bluespring

Frog,CirclesDown,CirclesUp,Openings

- Focuswasonmaintainingneutralspineandpelviclumbarstabilization,

hipadductorandhipextensorcontrol.

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SpinalArticulationontheReformer–2redsprings

BottomLift,BottomLiftwithExtensions

- Focuswasonspinalarticulationandhipextensorstrength/control.

**OndayswhenmylowbackwasinpainIwouldmodifybykeepingmyhips

lowerduringBottomLiftwithExtensions,orwouldskipit.

StretchesontheReformer–1redspring

StandingLunge

-Focuswasonstretchinghipflexorsandhamstringstoalleviatelowback

tightness

FullBodyIntegration(F/I)ontheReformer–1blueand1yellowspring

ReverseKneeStretch

-Focuswasonrecruitingdeepabdominalmusclestoinitiatemovement

whilestabilizingmytrunk.Iusedlighterspringsinthebeginningsoasnotto

compensatewithothermusclegroups,andworkedmywayupto1red.

ArmWorkontheCadillac

ArmsStandingSeries:ChestExpansion,Hug-A-Tree,CirclesUp,CirclesDown,

Punches,Biceps

-Focuswasontrunkstabilizationwhileworkingarm,shoulder,andback

muscles.Ihadthetendencytogripmyglutessotrainedmyselftorecruitmy

TAformorestability.

LegWorkontheMat–2lbankleweight

GlutealsSideLyingSeries:SideLegLift,ForwardandLift,ForwardwithDrops

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-Focuswasonmaintainingpelviclumbarstabilityinneutralspinewhile

strengtheninghipabductors.

LateralFlexionontheWundaChair–Onespringon4

SideStretch

-Focuswasonstrengtheningobliquemusclesandkeepingmyhipsstacked

inneutralwhilestretchingmysidebody.

Conclusion

Throughconsistentpracticeovera6weekperiod,Inoticedaremarkable

differenceinmybody.Mypainleveldecreased,aswellasthefrequencyofmyback

spasms.InoticedIwasabletomaintaintheadjustmentsmyphysicaltherapistmade

forlongerperiodsoftime,andmovedfromseeinghimonceperweektoonceper

month.Iwasabletoaddinotheractivitiessuchashikingandcycling,whichIhad

completelystoppeddoingaftertheinjury.

IfoundtheBASIapproachtobeparticularlyeffectiveasBASIfocuseson

workingthebodyasawholeandrestoringbalance.Theblocksystemensureseach

areaofthebodyisexercisedineveryplaneofmotion.Iwasalsoabletomodifymy

workoutsdependingonhowmybodywasfeelingeachdaybyeitheradjusting

springtensionorselectingdifferentexerciseswithinthesameblocksothatIcould

workonvaryingobjectives.AsIbuiltupstabilityandstrength,Iwasableto

progresstomoreadvancedexercisesandaddinblockssuchasFullBody

IntegrationattheAdvanced/Masterlevel,andBackExtension.Icontinuetopractice

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Pilatesataminimumofthreetimesperweek,receivemanualtherapytreatments

onlyonanasneeded-basis,andamlivinggenerallypainfree.

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Bibliography

Driver,MDCatherineBurt."SacroiliacJointDysfunction:SIJointPainTreatment."MedicineNet.N.p.,n.d.Web.05May2017.Isacowitz,Rael.StudyGuide:ComprehensiveCourse.CostaMesa:BodyArtsandScienceInternational,2013."SacroiliacJointDysfunction."AmericanPhysicalTherapyAssociation.N.p.,05May2017.Web.07May2017.Vleeming,A.,M.D.Schuenke,A.T.Masi,J.E.Carreiro,L.Danneels,andF.H.Willard."Thesacroiliacjoint:anoverviewofitsanatomy,functionandpotentialclinicalimplications."JournalofAnatomy.BlackwellScienceInc,Dec.2012.Web.03May2017.