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SI Joint Pain

Discussion in 'Injury Recovery and Prevention' started by Zillagreybeard, May 29, 2020.
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Zillagreybeard
Zillagreybeard
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  • May 29, 2020
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SI Joint Pain

Rehab pros tend to overcomplicate biomechanics and oversimplify the injury/disease process. The SI joint is extremely susceptible to this complication/simplification contradiction.
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“Your X and Y are all out alignment causing your Z to poke on the A which impinges on the B. But if I release this muscle 2 x week for 8 weeks, you’ll be good bro.”
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🤪I hate to be a buzzkill, but here are some facts we know about the SI joint.
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✅There is little clinical value in assessing and diagnosing precise movement aberrations at the SIJ.
✅Studies have consistently shown poor reliability of palpation in this area. If you can’t “feel” the movement here and don’t feel confident in your findings, you’re not alone my friend.
✅Motion at the SIJ is extremely limited. It’s barely a joint. One study found 8, 2.2, and 4 degrees of motion in the z, x, and y axes respectively. That ain’t much. Other studies have reported less.
✅Tests, clinical observations, and manual techniques for the assessment and treatment of SIJ dysfunction have been shown to be unreliable and invalid.
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🤷🏽‍♂️OK- so assessment kind of sucks for this area, but what do we do for treatment?? My patient is still in pain. I’M STILL IN PAIN!
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🏡Your assessment and treatment should be based on history, examination, positions of provocation and relief, and exercises that can facilitate pain reduction or work in antagonistic ways of the pain triggers. This should sound familiar: it’s how most of PT works.
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🔥For example, if walking and standing hurt more than sitting or slouching, we probably know that extension is more of a pain trigger than flexion and we can use that to guide one aspect of our exercise prescription.
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🐶If single leg exercises hurt (which is common), but bilateral patterns don’t, then…. (don’t make me spoon feed you this!)
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🤘🏽Try a few different patterns, see what works, stick to the basics as much as you can, and follow sound principles of exercise progression. Build over time until the rehab looks more and more like training. Every case is individual, trust the process and measure your progress in weeks not days.

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