Over the years I have had the ‘joy’ of experiencing not one but two sacroiliac (SI) joint injuries. The first injury was to my right SI joint after crashing a tube on a sledding hill with my brother and brother-in-law. The second was bending and twisting while lifting a granite countertop injuring my left side. I decided to save a few bucks and move and install it myself. I have learned from experience what injuries can happen and tried a lot of treatments. The information that follows comes from science, years of clinical experience and my personal journey.
The trifecta of the pelvis
- Sacroiliac joint injury, pain and loss of motion.
- Muscle imbalances, trigger points and weaknes to the hip and trunk causing thigh or ITB pain and tension.
- Core muscle weakness and poor function causing re-injury.
Each pelvic injury, and even the low back, has three components that need to be evaluated and addressed to recover from an injury. The first is a joint or structural problem. This is usually the underlying cause and responsible for the other two. The next is a muscle imbalance, weakness and muscle trigger points of the trunk, hip and leg. Finally, the third is the core. With any back or pelvic injury your core gets inhibited.
Here is a video on how to quickly screen someone with back, hip and thigh pain. At the end of this post we share how to manipulate someone's back.
3 signs of a Sacroiliac Joint Problem
One leg is turned out more than the other
Different heel wear of the shoes
Pain to the tailbone or SI joint
You have determined that there is a sacroiliac joint injury. Here is a video that shows how this problem can affect the hip, cause ilitibial band tension and pain (outside thigh), as well as chronic knee pain. Calf muscle knots can come from a SI joint injury as well as ankle and foot recurrent injuries.
Joint Problem
Hip and Trunk Muscle Imbalance
Weak Core
Treatment of each area is needed for recovery. If you just address the muscle trigger points with dry needling and exercise given time the problem will resurface and in a lot of cases never fully get better. Treating the joints without addressing muscle function will also have limited success. Finally, without a functioning core re-injury is probable. (Even if you are doing core exercises.)
Searching the internet for foam roller thigh pictures gave a lot of examples of this popular exercise. This picture is from Runner’s World (I added the text) and a great example of what not to do with a foam roller. Other sites such as Men's Journal, Fitbit and many rehabilitation sites showed the same pictures, rolling directly onto the iliotibial band. Ouch!
Iliotibial band or ITB tension and pain, lateral thigh or outside thigh pain and tension, is a sign of a sacroiliac joint dysfunction and also that your core is weak. There is hip abduction weakness of your gluteus medius and minimus that cause the tensor fascia lata (TFL) to ‘over-engage’ and to compensate for the weak gluteal muscles. Because of this increased TFL activity there is more tension on the ITB creating inflammation to the anterior and posterior (front and back) borders of the ITB. This will cause adhesions to the connection of the ITB with the fascial sleeve of the thigh. This is why we feel pain and tension to the outside of our thigh.
Rolling your thigh does not help resolve your problem. Rolling right on your iliotibial band can cause injury and make it even harder to recover.
Can I stretch my ITB?
The iliotiibal band is incredibly tough, made up of very dense connective tissue. Our goal is restore its motion by relieving the adhesions that have formed to the connective tissue fascial sleeve of the thigh. We do this by working up from the knee, not down as this has no therapeutic value, and improve motion front to back of the ITB. Because of its structure and multi-joint attachment the ITB and TFL are really un-stretchable. It is best to go after the underlying cause rather than just focusing on a symptom.
By rolling your thigh did you ever reach the point of no longer needing this treatment?
Did you get better?
Treat the underlying cause, not just the symptoms.
Address the sacroiliac joint injury and loss of motion. Restore normal hip and trunk firing while reducing trigger points with dry needling. Finally, assess and treat the core to prevent re-injury. We like to ‘cheat’ and use diagnostic ultrasound for our core training. Check out the COR Strength Project for more on how to assess and train your core.
TIPS FOR TREATING BACK AND HIP PAIN
YOU CAN START DOING THESE THINGS
- The best thing to do is to get walking. Walking is a very gentle and functional way to get muscles working and to restore blood flow to tight areas.
- Try sleeping on a firmer surface if you have an unstable sacroiliac joint. You can also try an SI Belt to see if this makes you feel better.
- Sleeping on you side put a pillow between your legs. Relax the Back has a great wedge for this and I have heard comments that it is helpful. If you sleep on your back put a pillow under your knees.
Clinical Prediction Rule (CPR) For Low Back Pain
(OR Treat your back pain)
You thought CPR was something for your heart didn’t you? Well, it is but it also stands for a Clinical Prediction Rule. What this means is that when looking at good clinical studies on treating back pain there was a predictable rule that when followed had a high likelihood of success, both in the immediate as well as months later. What this means is if you see these things then do this thing. Here’s what to look for:
- Back pain no longer than 2 weeks or 13 days
- Pain that does not go below the knee
- A loss of hip inward or internal rotation
There were others as well but these three in clinical practice are the most valuable. If you have these three conditions then manipulate. Here is a video showing you a common manipulation that is very safe to do.
HOW TO MANIPULATE THE BACK
Check this video out
Remember if it is too painful then stop. Pain should be your guide. If you continue to have issues seek medical attention, through your Physical Therapist or chiropractor. There are family practice doctors that have a manipulation background as well. This information is to assist with ongoing care with a medical practitioner and is not designed to replace professional care. Lets take a lesson from our Canadian brethren to the north and be responsible for our actions.
If you have questions please reach out to our team at connect@cornerstonept.co. We are here to help.
Want to know more about dry needling? Check this link out.
