SI joint/PT/Prolotherapy/URRGGH!!

forgot to mention SI belt has helped with the pain but the pain still isn't gone . . . that includes running every other day with less pain but again still not gone . . . should I just be patient or jump to prolo right now. I'm not willing to consider exploratory surgery at this point . . .

If you really want to learn/consider how to self treat a SI joint problem, take a look at DonTigny's website:

http://www.thelowback.com/

The short story is that DonTigny is one of those PT's who has spent his whole career studying SI problems (he's got to be well into his 70's by now). His approach is very much biomechanically based. He sells a CD with all of the self treatment on it, but you'll find if you dig into all of the links on his website that you'll learn much of what you're asking about (including when to consider prolo).

I've always been surprised that his approach hasn't been more widely accepted, but one of the problems that we've dealt with in PT is getting past the "guru" style approaches of examination/treatment rather than into more science-based approaches.

I was hoping to hear how Prolo went for you. I am getting some good hands on PT now for the muscles on my left leg and hip, but what is hurting me now as I try to run is the SI joint. This is the same spot that started hurting 25 years ago when I started getting messed up. My running stride altered at that time to compensate. I think the PT is restoring my stride. I have been thinking of the prolo and was going to ask my doctor this week about it. It probably doesn't matter as I don't think insurance covers it. Would like to hear how it worked out for other runners.

I have tried the DonTigny stuff off and on for years but had little success, probably because of all the muscle imbalances. Does the CD offer much more? I also got a book this week that has a taping method for the SIjoint. It looked real simple, but I haven't tried it as I am working on the PT now: lots of massage, Graston, ART and who know what else twice a week.

I will try that link, but discouraging to hear someone else has tried for a long time with little success. Prolo at least offers the promise of a quick fix. I'm tired of endless possibilities that takes months to work, if ever. Nothing against any suggestions. Tomorrow I will thoroughly explore that link when I have more time. This just sounds like yet another diagnosis that they really aren't clear about. The frustrating thing is that the new PT seems to think, yep, no problem, I can fix you lickity split. That would be great if it were true. I want realistic answers at this point. Like statistically speaking what is the likelihood that PT will work for this injury?

Anyway, I will post again if I try prolo. I've heard some great things about it, including from some of my former PTs who have seen good results with some patients, and zero results with other patients (for other conditions not SI joint). The docs who give the injections say that it is really important who gives the shots b/c the location of the injections is critical. I'm considering caringmedical.com in Chicago, which will require travel for me but at this point I'm ready to do it. I'm just giving this last round of PT a chance at surgeon's insistence. Surgeon's have said prolo could cause problems, biggest concern for me is scar tissue created. But at this point I'm willing to risk it. My situation in terms of exercise ability couldn't be much worse and I've had it.

The pain isn't that bad but just never goes away and feels like I shouldn't run. How about SI belt stories? The SI belt has definitely helped, which gave me very high hopes in the beginning because at least I could run w/o very much pain (while wearing the belt), but again pain not gone so now I'm reconsidering.

Thanks again for the above link.

My neighbor had SI joint pain for years, and physical therapy did not help much. She did prolotherapy and it is like 95% better now. She is not a runner though. The insurance did not cover it.

My SI joint has been killing me since early in my pregnancy, I am really hoping it gets better after the baby comes :/

My own experience with all of this is that I acquired a SI problem back in my senior year of high school. I was preparing for spring track, doing a fair amount of early interval training in a pair of Nike internationalists (does anyone even remember those shoes? that was back in '83) and strained my left posterior tib. Long story short, the podiatrist that I was seeing dabbled in spinal manipulation and beat the hell of of my pelvis with a long-axis iliosacral manipulation. that toasted my training for the next 3 years (frequent bouts of sharp pelvic and thigh pain when trying to train, enough to stop me dead in my tracks) but it also led me to my career choice (PT). I really didn't get consistent relief of symptoms until my first year of PT school. One of my instructors listened to my story, took a quick look at my abysmal hip flexor flexibility and put me on a program of hip flexor stretching which was the start of my being able to train consistently again.

I'd look at the DonTigny stuff, like I noted before. It goes a long way to getting the basics down. I don't agree with a few things here and there (He's against hip flexor stretching, I think that it's essential, particularly for runners but I usually have the runners I treat do so as a lunge style dynamic stretch with a foot on a high step or counter and doing AIS style stretching which promotes posterior ilial rotation on the high leg side while gently stretching the hip flexor of the leg planted on the floor).

I think that SI problems are as much of a motor control issue as they are a ligamentous laxity issue, so training runners to work very regularly (multiple times a day) on making sure to brace their abdomen and tilt their pelvis back to neutral rather than the anteriorly tilted position that they usually favor is important - it's the difference between just doing abdominal /core training and really using that strength to keep your pelvis under your body. I see those faults in runners who can, for instance, hold a prone plank posture for 2 or more minutes easily but who also, when I take side view slow motion video of them outdoors, "cheat" by extending their stride less through their hip than they do through their lumbo-pelvic region. My experience with runners (21+ years as a PT, deep background in manual therapy, now in a practice where I specialize in treating runners) is that it's getting a lot of little things right that gets runners through these problems.

Besides what I talked about above, runners really need strong lumbopelvic control, excellent ability to squat with weight (most of the ones that I see can't perform single leg squats or squats with weight using proper technique to save themselves, nor can they single leg balance well) and a lot of extra work on hip abductors. In regards to running form, the only big thins usually are overstriding issues or low swing leg lift (longer lever through swing that places more load on the hamstrings). I usually encourage runners to make sure to not "sit in the bucket" when running but to make sure to try to lead with their pelvis a bit, which seems to limit the pain.

I think that many runners, surprisingly enough, get into trouble with their sitting posture (of all things) and really have to avoid any slumped sitting alignment because of the stretch it places on the SI ligaments. SItting with a pillow under the thighs to take load off of the ischii/pelvis)seems to help for short periods as long as they don't slouch through the low back. As far as SI belts, I think that they can help - I for one, though, can only wear one for about 3-4 hours before they cause me to ache and use them only for acute symptom control/calming.

I think prolo is an excellent idea if nothing else is getting you there, if you've really put in the hard work to correct the musculoskeletal strength /flexibility deficits. Here's a link for a prolo website if you have questions about it.

http://www.getprolo.com/

Probably more than you wanted to know, but I hope it helps.

Thank you Mr. Running PT!! Are you by chance anywhere near Orlando, Florida? I looked briefly at that website (more when I have more time tomorrow), but honestly for someone without a PT background, it just sounds so confusing. My former PT had me doing hip flexor stretches in lunge position, my new PT says I need to do them on table b/c I need back support?? And that's the only stretch I'm doing. I was doing tons of PT exercises but now I'm down to just 3 very simple: (1) exercise band holding both knees together, lying back, spreading legs out while not dropping either hip and stomach tight, then back, 3 sets of 10; (2) lying down, hips/back off table (lifted), arms at side, "tiny knee lifts" --repeat on timer for 2 minutes, focus again on not lifting one side or another, and (3) side adductor just lying on side, pillow b/t legs, leg up and down focusing on not moving back...then one stretch of hip flexors, just once daily on all of that stuff. Some of your terminology was over my head . . . it's just so hard to understand exactly what I should be doing but anyway I thank you for what you suggested. I will read the link again tomorrow and see if I can understand any of it!!

Realistically, doing all of these things, how long do you think until I should expect to be better? My pain is extremely mild, just concerning (used to be worse but never horrible terrible), I just feel like I shouldn't run b/c it causes the buttock pain (unless wearing the SI belt). Do you think I'm being too conservative?

FYI the SI belt is one from serola--their new kind--serola.net, she told me to wear anytime weight bearing for months. It has seemed to help a good bit and I would have to recommend to anyone with SI problems. I think this is a new design and it has been comfortable for me all day . . .again just don't know if it will solve the problem permanently and hasn't caused complete relief.

I wish I were a PT now!! Honestly I've considered changing careers just so I can understand this better (well that and I don't really love my chosen career but that's another story hahaha).

Also . . . when you see this type of injury IF the PT is effective, how long does it take people to get better and what percent get better?

I have improved with PT but it's just been so many months at this point...

THANK YOU!!

and, p.s.,

What do you think about the comments on the other thread about the PT profession by PTs saying that PT doesn't usually work??! That is really upsetting as a long-time patient at this point. Is that the prevalent view? I assume they have a mountain of studies on PT over many years proving it's efficacy or it wouldn't be an arm of the medical profession...but still would like to hear what you think about those comments.

Thanks again.

not all physical therapists are created equal. Very few understand all that goes into running. You need to find a competitive runner PT.

Easier said than done. I've talked to God only knows how many professionals at this point. I'm kind of ready to try prolo b/c PT just hasn't been working and I think anyway at least I've been told by even other PTs that I've seen some of the best PTs in our area . . . my current PT is a runner but not competitive. Ortho doc friend of mine said she is the best w/hips, his fave and he is picky. She gives simple instructions and seems sharp, only seen her 3 times so far. But if this doesn't work I think I'm going to try prolo first, then more PT later if that doesn't work. I do appreciate the advice, just that I've heard that from everyone and really made every effort, talked to lots of PTs, including 3 close friends, several ortho docs (2 friends) (I volunteer at a medical clinic), and lots of other professionals...frustrating. I think you are correct I just don't think that exists in my community or its like finding needle in haystack. :( Or maybe my current PT's methods will work; we shall see I guess. I'm hoping her techniques will work obviously.

I'd stick with what your current therapist is doing with you. Obviously, that PT has been able to examine you and knows much more about you than I could learn from a message-board thread. My experience is that you can get good symptoms control and get people back to running within a month and can build from there slowly over another month. It really takes a lot of work on your part. As much as possible, I try to get the runners I treat to cross train ASAP, and the most common way that I do so is to use incline-treadmill walking (15% incline, starting at ~3mph) which usually (depending on their conditioning) allows them to train at a level that will get their heart rate in the 140's- 150's. If they can get through a week of that, they can usually start a walk-run program (such at 2 min run, 4 min walk) along with the treadmill incline work and build up the run-walk to 30 minute periods (and once they achieve that, I have them transition to more running/less walking). The general rule of thumb with stability training in the advanced phases is to work through a combination of closed and open chain training, making sure that the runner maintains proper pelvic alignment - typical exercises include hip hiking on a step, step ups on a tall (12" or greater) step, single leg balance with leg-swinging and weighted squats or kettlebell swings.

The belt that you're using (Serola) is fine, they make a good product.

As far as the other thread regarding PT: I take all of that with a grain of salt. The kid writing it (the PT out with 4 years of practice experience) sounds a bit young to be making such grand pronouncements. Any career that you pursue is what you make it. All professions have their disgruntled members and also have their slackers and PT isn't immune. I find it to be quite challenging, have to work very hard to balance the time in the clinic with the time out of the clinic keeping up with the professional journals to stay as current as possible (particularly with treating runners, because there's a great deal going on in the literature now). My thinking is that most PT's aren't really that great until they get 10 years of experience; it takes that long to see enough patients and to absorb what you've learned to start applying it all. If his experience has been clinics that focus on loading their patients down with multiple modalities and such, then I find that sad as well, but each person (therapist) is responsible for what they do, and if he's been stuck working in such a situation, there's plenty of opportunities to work elsewhere. I guess what I'm getting at is that things aren't as dark (by a long stretch) as he makes out. If anything, what I've found is that PT has probably made too much of the weaknesses of their profession. Talk to other professionals in health care (medicine, podiatry, etc.) and you'll find that they deal with the same issues - PT has been more transparent about it than others (not just my opinion but what I've heard from physicians in regards to the line of evidence-based practice research that PT is carrying out). Want a dose of it? Go over to the message boards over at Podiatry-Arena and see how those guys stress over their profession, because they deal with the same things (and podiatry is on much slippier ground that PT is).

No, I'm not in the Orlando area; I used to practice in Sarasota, but moved to Greenville, SC a few years ago, in part because it's a great area to to work with distance runners, cyclist and triathletes(so I know what I'm talking about when it comes to changing jobs if one isn't happy with where they're at). The only reason that I have time to pontificate like this today is that I'm home because of the snow storm (the south really is clueless about snow removal). After I finish this, I've about 2 hours worth of Dartfish video from a running eval to process and a report/exercise program to write up for that runner who, surprisingly enough, has a problem very similar to yours.

Life is what you make of it!

Thanks. I appreciate the advice about the incline walking on TM, esp. since I have a TM at home, and it's raining today. haha. Snow storm sounds nasty, don't you miss Sarasota??

This is truly frustrating, most lower body activities cause pain, but I am following her advice. I don't really have lower back pain, just buttock pain, on both sides. MRI showed tendonopathy at tendon attachment at greater trochanteric region...PT says SI laxity causing that problem.

So I shall keep following her and hope this peppy optimistic lady runner PT will truly be the answer to my prayers. Thanks again for all of the feedback . . . sure wish I had a PT evaluating my case for 2 hours, but what can you do? Pretty soon I might just accept that running with pain is part of the deal...:)

Thanks again...

Just to jump in again. PT can indeed be all over the place. I did two months of Postural Restoration Therapy last year. Was very interesting, but ultimately did not help. I got new inserts for functional hallux limitis in the summer and thought that would fix things bumping my mileage to 50-85 miles per week. My hip got worse and worse- sort of like it was bracing to protect things. I stopped running in September because everytime I tried the hip would hurt (adductors and glutes). I got a cortizone shot felt great for 5 days but then it wore off. I was sent to a PT and he was horrible giving me basic hip exercises that I already knew how to do. Fortunately I found some videos online that showed some of the best examples of foam rolling (and reasons why with muscles illustrated) and stretching. I noted the PT was an hour away and asked of I could get a referral to her. I have been going twice a week (5th time will be today. She is an athlete (Ironman) and has just been doing massage, graston, and ART on my left side. I am slowly returning to running doin 1-3 miles on the treadmill. I ran outside for the first time Saturday and again on Sunday for 3 1/2 miles each time and my leg is doing so much better. I now feel it in the SI joint only although it is lessening and my legs and hips are still balancing. I don't know how long it will hold, but I had no afteraffects from either run. The hands-on removal of scar tissue is very helpful.

I realized upon reflection that what worked best for me was when the PRI PT did mobilizations on my foot last year I ran better. Same thing in the summer when the podiatrist did mobilizations on my feet and leg, my hip and running was so much better until it wore off. The toes control the hip. If something is wrong in your foot it can cause a reaction in your hip. Check that out too!

I jumped in again because of your mention of kettlebell swings. I wasn't even able to use my kettlebells since the last injury because of my hips not being level and how tight my left one was. Since the therapy I started back with them this past week, I have gone from 75 swings to 400 last night (sets of 100). For the first time it feels like I can swing properly and my hips feel much better after doing the swings. I only have a 35 pound kettlebell so I think I need to get a 50 pound one. I am amazed at how the swing seems to help now that I have getting the PT.

p.s. What does the SI belt actually do? Will the benefits continue . . . like let's just say I ramp up mileage that doesn't hurt with the belt . . . can I just keep wearing the belt and keep the pain away, let's say, forever? Or is there a time limit on the benefits that seem to magically come from this belt?

To the other (last) poster, PT is frustrating, sounds like you found someone good. Even with ART and gadson (which I've considered but not yet tried), the frustration seems to be finding someone truly good without having to try every practitioner in town. I have tried deep tissue massage from several ppl at this point, which had no effect for me (other than to be relaxing, which was nice but not my goal). :)

Only so much money in the bank for these treatments, you know? I don't mind spending a good bit, but I just keep paying and paying and so far not much luck. I have had considerable improvement over the past 3 weeks, but again not really exercising for two of them with the flu, and the pain isn't really gone and I'm just almost over it...but hopefully my depression from not running will stay in check and get me through this...good luck to you both . . .and thanks again for any and all tips!

err, uh, meant to graston . . . can't keep these modalities straight, what exactly is that anyway? Is that the thing where they use a metal device of some sort to give you a deep tissue something or other designed to create inflammation and promote healing?? There is a local chiro (not a PT) who offers ART and graston (sp?)...recommended by my last PT facility for athletes, but again just running out of funds to keep trying...paying out of pocket for endless PT.

correction, one chiro offers graston, several others offer ART, can't find anyone who offers both, and question if PT can't work, would those do much better? And which is better: ART or graston? Anyway thanks again...

I did 15 sessions of Art over the summer as I progressively got worse. He only worked on certain points of certain muscles (15 minute visits). The PT I go to works on everything (the whole picture) with my leg and hip. The graston was a small part, the ART was a small part, it seens it is a lot of tissue work most of the time (don't know what modality), but she works on everything starting with the foot, then the leg, then the hip (Lots of mobilizations).

yes Graston was with the metal blade. She only did this a bit on the achilles and hamstring area, two days later when she did it again it was pretty tender! I think it is to remove scar tissue.