Skip to main content

Author: Sam Visnic

Is A Short-Leg Contributing To Your Sacroiliac Joint Pain?

Is A Short-Leg Contributing To Your Sacroiliac Joint Pain?

Written by Sam Visnic on . Posted in Mobility, SI Joint.

A very important factor to rule out in chronic SI joint pain is that of a leg length discrepancy.

When the legs are not equal length, it can make the sacral base un-level, thus contributing to stress and strain at the sacroiliac joints and lower lumbar spine.

There are 2 different types of leg length issues that you should know about:

Leg Length Discrepancy Erik Dalton

1. Anatomical Leg Length Discrepancy

This refers to when one leg is actually shorter than the other.  This can be a result of injury to the joints/bones, or what you were just born with. The truth is that this type of leg length issue is very rare!

RMT-Weight-Shift

2. Functional Leg Length Discrepancy

This type is usually caused by muscle and joint imbalances, which upon correction, the leg length is restored.  This is the MOST common type of leg length issue seen.

How To Test For The Two Types Of Leg Length Discrepancies

In this video, John Gibbons explains a simple test that can be used to assess leg length variation.

If a true anatomical leg length discrepancy is suspected, a full length X-ray may need to be performed to confirm.

How To Fix Functional Leg Length Discrepancy

Since functional leg length findings are associated to muscle and joint issues, they must be addressed by resolving these imbalances.

For instance, excess anterior pelvic tilt is a VERY common finding in SI joint-based imbalances and leg length discrepancy.

In the video above, I talk about the most common causes for excess anterior pelvic tilt, which include short/tight hip flexor and lower back muscles, and long/weak hip extensors and abdominals.

5 Special Tests To Uncover SI Joint Dysfunction

5 Special Tests To Uncover SI Joint Dysfunction

Written by Sam Visnic on . Posted in Mobility, SI Joint.

As you can imagine, much controversy surrounds manual testing for dysfunction of small joints that move as little as 2 mm. Many clinicians believe the following manual tests produce non reliable evidence of SI joint involvement in pain, but presently there are few other options.

Medically, the customary procedure for SI joint diagnosis is joint blocks via injection, but these as well have difficulty standing up to criticisms. Clearly more research needs to be devoted to the accurate diagnosis of SI joint pain.

The above, however, does not necessarily mean these tests are not clinically useful. They can provide valuable information, particularly when they are able to reproduce symptoms, and of course be used to follow up and assess changes after therapeutic interventions. Since these tests are relatively safe and easy to perform, they can be used to gather clues.

The following tests are the most customary ones, and I will not delve into more complex testing in this post, as that is better suited to a clinician’s textbook, but you should also be sure to check out my other blog post: Is A Short Leg Contributing To Your Sacroiliac Joint Pain

#1 Gaeslen’s Sign

#2 FABER Test

#3 ASIS Distraction

#4 Side-Lying Sacral Compression

#5 Femoral Shear Test

In Summary:

It is suggested by some therapists that at least 3 out of the 5 tests above must be positive to indicate SI joint involvement, and that if all 5 tests are negative, move on to testing other areas as possible pain generators.

Physical therapist Stuart Fife, reports dismal numbers with regard to reliability and accuracy of manual testing methods, and Richard DonTigny asserts that often the correction validates the diagnosis.

Based on this information, it appears that all tests may give clues, and instead of any one given test, multiple tests should be performed to accurately test for SI joint involvement in pain, and which corrective measures should be carried out for resolution.

Sacroiliac Joint Belts – Do They Work?

Written by Sam Visnic on . Posted in Mobility, SI Joint.

Sacroiliac joint belts can be a helpful tool in the process of pain relief and restoration of function.  Belts have been found in studies to reduce laxity of the sacroiliac joints and improve stability.
The SI belt essentially serves a sort of artificial locking function to compress the surfaces of the joints together, which increases friction and reduces shearing forces.

Do These Belts REALLY Work?

In short, YES!  In the video I state that the biggest issue is whether you actually HAVE pain coming from the sacroiliac joints or not. Attaining an accurate diagnosis of pain from the SI joints isn’t that easy, simply because there isn’t an established “gold-standard” test.

Some people get significant and immediate reduction in pain once the sacroiliac joint belt is properly used, while others only have a minor reduction in pain, but often times there is some improvement in mobility or strength in the pelvic muscles. These are positive signs that you may benefit from the belt.

Is there a simple test to find out if the belt COULD work for YOU?

Yep! In the video above, I show a test that can be performed while lying on your back. Since the belt’s job is to compress the pelvis, we can mimic this action with a set of hands. Definitely ask someone to do this for you, which will be a much better test than attempting it on yourself.

Lay with your legs straight out. Lift your leg up from the floor in a controlled speed while assessing how it feels, both in terms of muscle strength, coordination, and pain levels. Test the other side as well.
Next, ask someone to gently compress your pelvic bones inward, toward your midline, and hold while you repeat lifting your legs. If there is improvement, then you will likely benefit from wearing the si belt.

Does it matter if you put the belt on standing vs. sitting vs. lying down?

Yes. I recommend only putting on sacroiliac joint belts while lying on your back, AFTER doing your corrective mobilizations.  This way it functions as an SI brace to “lock in your work”.

SI Belt – How To Wear

There are a few things to know when wearing an SI belt.  The video I created for Youtube has received tens of thousands of views and the comments clearly show that most people were not applying the belt correctly.

If you follow the steps I outline, you’ll get the most out of the belt and get results if indeed the belt is what you really need.

How tight does the belt need to be?

Its important to understand that the emphasis should be placed on the position of the belt, NOT how tight it is. One study in particular showed that a belt with a tension of 100 N did not significantly differ from one at 50 N in terms of reducing sacroiliac motion.

More is NOT better in this case!

Which belt is the best?

Sacroiliac joint belts all do the same thing so its really a matter of comfort, since most people who benefit from it will wear it often. Nothing is worse than having to deal with a poorly designed belt that is constantly riding upward when you sit or move.

I personally like Serola. Now, I don’t have SI joint pain, so I can’t comment, but many of my clients like this belt.

Does relying on an SI belt make your own muscles weak?

No. Using a sacroiliac joint belt is not the same type of thing as a lumbar spine brace. SI joint instability is a ligamentous/joint problem. Since there are no muscles that directly move those joints, wearing the belt will not weaken anything. You can wear it 24/7 if you want.

That said, it does NOT mean you shouldn’t address the muscles that support the pelvis. In fact, this is the CRITICAL element. Without adequate muscle balance, strength, endurance, and coordination of the core muscles, you are very likely to have ongoing setbacks in your corrective process.

How long should you wear a sacroiliac belt?

There are two aspects of this question.  First, you “can” wear a SI joint stabilization belt pretty much throughout the day.

The factors that should be considered include the stress on skin (chafing), and altering your ability to move freely due to any misplacement of the belt.  If you wear it properly and not too tight, you should be able to wear it comfortably for longer stretches of time.

The second aspect is how long over time should you commit to using a SI joint belt?  This is going to depend on the primary reasoning for wearing it (damage to sacroiliac ligaments, short term pregnancy or post pregnancy, etc).

Generally speaking, the goal ultimately is to not needing the belt and relying on your on musculoskeletal stability improved functioning.  So, you should work closely with your therapist for a plan for easing away from it.

This could take as little as a week, to months, again, all depending on the initial reasoning why you’re wearing it.

SI joint pain belts are really a relatively short-term crutch.  They aren’t the “main show”!

How To Know If Your SI Joints Are Causing Your Pain

How To Know If Your SI Joints Are Causing Your Pain

Written by Sam Visnic on . Posted in Mobility, SI Joint.

Not too long ago, the sacroiliac joints (SIJ) were considered a primary source of lower back pain, and in particular, sciatica, however, once it was found there was no “canal that held the nerves against the joint”, the emphasis was shifted to disc herniations.

While the debate rages on, much like with spinal discs, can the sacroiliac joints be a cause of lower back pain? Well, as of recently, research is showing much more about how the SI joints can be a part of the overall pain picture.

Lets start by getting acquainted with the SI joints and how they may be cause of pain, and of course, how to address it.

What ARE The Sacroiliac Joints?

The SI joints are a part of what is referred to as the “pelvic girdle”. The main function of the pelvic girdle is to link the upper body and the lower body for movement. The pelvic girdle is made up of 3 bones and 3 joints (2 of which are the SI joints).

The bony plate at the bottom of the spine is called the sacrum, and the 2 large hip bones that are found on the left and right sides of the sacrum are called the ilia (ilium is singular). The joints at which the hip bones attach to the sacrum are the sacro-iliac joints. In the front of the pelvis, the 2 ilia are joined together by what we call the pubic joint.

The pubic joint is connected by very strong ligaments, and have opposing surfaces that keep it quite limited with regard to range of motion, but can be effected by the influence of the muscles that attach in the area, as well as hormonal changes.

The sacroiliac joints are unique in that cartilage on the sacral side is hyaline cartilage and the cartilage on the ilial side is fibrocartilage. The SI joints are L-shaped with regards to their contour, and its interesting to note that the shape of these joints vary quite dramatically from person to person, and according to Philip Greenman, DO, from side to side in the SAME person!

These joints appear to have the greatest amount of motion from age 25 to 45 (Greenman), which is very interesting, especially considering this is the age range in which back pain appears the highest, and additionally, when disc pathology is greatest.

Additionally, as both genders age, gradual changes such as fibrous adhesions and even ossification often occur, which obliterate these joints. (Grays Anatomy, Pg. 675, 1995).

2 Types of SI Joint Stability: Form and Force Closure

Generally, it is agreed there are two major stabilization systems for the SI joints, called force and form closure.

Form closure refers to the stability of the SI joints via the shape of the surfaces of the ilia on the sacrum. These surfaces are a combination of concave and convex. Force closure refers to the functioning of “slings” of muscles as well as the ligamentous support.

One such sling involves the glute maximus and opposite side latissmus dorsi as they merge into a super thick diamond-shaped area of connective tissue in the lower back called the thoraco-lumbar fascia.

How Do The SI Joints Cause Pain?

Frequently, SI joint dysfunction is overlooked and misdiagnosed, mostly due to the multiple effects that are seen as a result that make the overall situation appear to be multi-factorial and complicated. SI joint expert, physical therapist Richard DonTigny, has identified the following:

1. The glute medius is inhibited when held in anterior rotation 
2. The ilial orgin of the gluteus maximus is separated from its sacral origin 
3. The iliolumbar ligaments are loosened as the ilia approximate the vertebra 
4. The long posterior ligaments will be stretched and may avulse from the PSIS 
5. The ilial origin of the piriformis is separated from its sacral origin 6. If the sciatic nerve exits through the piriformis it may become painful 

Yes, this is quite the complicated list! At first when the SI joint dysfunction appears, these may not all be present, but as the problem becomes chronic, some or all of them may appear and make it very difficult for the average doctor or therapist to see through to the root cause of the pain.

Depending on who the pain sufferer is seeing, and their specialty, normally accounts for what they will focus on correcting. This usually leads to failure, because only the symptoms are being addressed. At the root cause of course, is the mechanical dysfunction of the small SI joints!

Sacroiliac Joint Pain

How Does Sacroiliac Joint Pain Usually Show Up?

As you can see from the image, the most obvious and common area of pain related to SI joint problems is right next to the small bones that can be felt just to the sides of the lower spinal vertebrae called the posterior superior iliac spines. (PSIS for short).

Although the picture shows a relatively small region of common pain, pain patterns associated to SI joint dysfunction are highly variable due to the complex nature of nerve innervation to the joint.

The SI joints do not commonly refer pain to the lumbar spine, but that does not mean they are not frequently involved with problems in the lumbar region. It is important to keep in mind the relationship of sacroiliac joint dysfunction to disc pathology.

Disc pathology may be exacerbated by side bending and/or rotation, therefore, when the SI joints are not balanced, they will contribute to stress on vulnerable discs. It is also possible that SI joint dysfunction may actually be a factor in causing disc bulging.

Should You Exercise After Massage Work

Should You Exercise After Massage Work

Written by Sam Visnic on . Posted in Massage Therapy, Movement and Exercise.

When is comes to the question of whether or not you can exercise after massage work, we need to consider the context and goals.

For example, is the ultimate goal for relaxation?

If simple relaxation is the goal of massage work, then it wouldn’t be recommended to exercise afterward.  Relaxation is associated with increased parasympathetic nervous system activity, and exercise is generally associated with sympathetic nervous system activity.  Thus, these are antagonistic concepts.

If pain relief and/or increased range of motion is the goal, then specific types of exercise or movement would be helpful after the massage work.

Let me give you an example.  Let’s say your neck is limited in rotation to the right due to some muscular tension and it’s been causing discomfort.  After the massage session, neck rotation is improved due to less muscle tension.

The results can be maintained by simply doing repeated neck rotations in both directions throughout the rest of the day in order to “train” the new available range of motion and get it to stick.

When you consider exercise after massage therapy, we are either talking about something very specific, like the example about neck rotation, or general exercise for the whole body.

It’s important to know the goal in order to determine the best way to approach working out after massage work.

 

 

Breathing: The Overlooked Key to Resolving Muscular Imbalances?

Breathing: The Overlooked Key to Resolving Muscular Imbalances?

Written by Sam Visnic on . Posted in Mobility, Movement and Exercise.

It’s quite ironic to think that one of the most fundamental elements to overall health is often neglected in the context of muscle therapy.

While most people know and understand on a very basic level that breathing properly is important, there is an obvious lack of adequate information available to cover the actual details of the topic along with concrete guidelines that are simple to follow – particularly in relation to restoring a healthy posture and correcting movement based imbalances.

Let’s change that right now.

In this article, I will cover the essentials of breathing and clear up common misconceptions associated with it.

WHAT IS THE IMPORTANCE OF BREATHING?

 If breathing is not normalized, no other movement can be. – Dr. Karel Lewit

I love the above quote because it so accurately describes precisely why breathing is so important. Your breath is closely tied into your nervous system, and hence any changes to it will directly impact other essential body parts and functions, including your musculoskeletal systems.

In other words, breathing affects your movement patterns.

Judith Delaney mentions in her book Clinical Application of Neuromuscular Techniques  that “breathing dysfunction is at least an associated factor in most chronically fatigued and anxious people and almost everyone subject to panic attacks and phobic behavior, many of whom also display multiple muscular-skeletal symptoms.”

While these symptoms could be explained as a coincidence, the abundant overlap between all relevant components deems it highly unlikely; especially considering the intimate relationship between your breath and the central nervous system.

HOW DOES BREATHING AFFECT YOUR POSTURE?

A simple way to understand this relationship between breathing and posture is to perform a simple self-test.

Stand up with a straight posture, take a deep breath and then exhale. Next, try the same thing while slouching your back. Notice the difference?

Chances are that you’ll feel most comfortable in the position where breathing feels unrestricted and easy. It may surprise you however, to find out that this is not the ideal position for most people. In fact, that is one of the major reasons why it can be so difficult to correct a faulty posture without addressing the muscles associated with respiration.

You just cannot go where you really don’t breathe well. The respiratory muscles aren’t only responsible for your breathing; they also take part in stabilizing your spine.

Let’s take an example, like standing on your toes. This basic movement causes breathing muscles such as the diaphragm, deep abdominal muscles, and the pelvic floor muscles to contract, which is a direct demonstration of how they are partly responsible for spinal stability itself.

Trigger points in your pelvic floor muscles can cause what’s referred to as an excessive anterior pelvic tilt. This common postural condition can lead to significant changes in your overall weight-bearing – when your pelvis tips too far forward, it puts most of the weight on the toes, leading to detrimental shifts in your posture as your body tries to compensate for the faulty position.

Another common area of distress is the neck. In cases of less-than-ideal breathing, neck muscles can become fatigued and subject to trigger points that lead to upper body pain; including headaches and even jaw muscle fatigue or TMJ disorders.

BREATHING AND YOUR ORGANS

Normal movement of our internal organs is referred to as motility. A slouching posture coupled with a sub-optimal breathing pattern has the potential to negatively affect this process, which will limit your ability to control your health, activate certain muscles, as well as limit your range of motion.

WIDESPREAD EFFECTS

A subtle change in the PH of your body can cause dramatic changes in all of your bodily systems; including pain perception and even emotional stability.

The body is an intricate machine that requires perfect balance among all elements to run smoothly, and even a subtle change in one of them can throw the whole system off balance.

It’s easy to forget that breathing is a basic chemical process; namely the constant exchange of oxygen and carbon dioxide that keeps you alive. If this exchange is disrupted in any way, it leads to a subtle change in PH that can cause dramatic changes in all your bodily systems; including those that control pain perception and emotional stability. In other words, a poor breathing pattern and changes to the PH can provoke increased nerve sensitivity and thus make you less pain tolerant.

All things considered it’s quite logical that incorrect breathing is at least one of the responsible components in certain cases of chronic pain conditions, such as fibromyalgia, where widespread aches and fatigue are every day occurrences.

 TRUE OR FALSE? “Is belly breathing ideal?”

Belly Breathing and Muscular Imbalances

FALSE!

Contrary to what many people think and have heard, belly breathing by itself is NOT ideal.

To clear up this very common misconception, let’s break down the…

PRIMARY ISSUES WITH BREATHING

  • Chest Breathing
  • Paradoxical Breathing
  • Belly Breathing

A natural physical reaction to stress is to tense our neck and shoulders while moving our breath up high in the chest region, causing the shoulders to rise and fall during the breathing cycle.

This overcompensation of the chest movement causes what we call stress-based breathing, because it is a direct result of stress induced movement patterns that prevent the diaphragm from moving down and hinders the abdomen from expanding, thus forcing the air to enter the chest region.

One of the problems with stress-based breathing is that it affects the volumes of air entering the body, forcing you to breathe more frequently in a shorter amount of time to fill your lungs with enough oxygen.

As discussed in the previous section, this will lead to an imbalance in PH due to the ratio of oxygen and carbon-dioxide being skewed in the process.

A severe example of this scenario is when a person begins to hyperventilate, which is a fairly strong stress response that affects both physical and cognitive aspects of the body, quickly leading to a state of panic unless the situation is controlled.

Paradoxical breathing occurs when the OPPOSITE motion occurs relative to normal breathing.  In this scenario, as one breathes in, the abdomen moves inward, and during exhale, it moves outward. This is the LEAST ideal type of breathing pattern.

Diaphragm Breathing and Muscular Imbalances

If you look at the diagram above, you can see that the arrow goes down during the inhalation process, which is the direction that the diaphragm muscle is going.

You’ll also notice that this area begins to flatten out, because the diaphragm muscle activates during inhalation as to allow air to fill the lungs. If it does not move down, the upper chest has to rise in order to accommodate the influx of oxygen.

During exhalation, the diaphragm goes up and forms a dome as the abdominal muscles contract, which is ideal.

SO WHAT IS OPTIMAL BREATHING?

Optimal breathing basically comes down to having a good balance between the inhalation and exhalation musculature, as well as between the abdomen and diaphragm. The other essential element is correct belly breathing, which involves adequate lateral expansion that moves the ribs as needed to allow enough air flow.

The four images below depict different contractions of the abdominal muscles.

Breathing and Muscular Imbalances

1:  This picture shows the action of drawing in the transverse abdominus; the deepest abdominal muscle and the one responsible for sucking the stomach up and in. This movement is not ideal during inhalation as this part of the breathing cycle requires the diaphragm to go down.

2:  This image shows a fairly rigid contraction of the larger abdominal muscles. If you tighten your abs super hard and then try to breathe, you’ll notice that it’s very difficult. In other words, you won’t be able to expand your abdomen enough to allow proper air flow, forcing you to move the breath up to the chest region in order to fulfill your oxygen requirement. (Note that this doesn’t mean you can’t train your core muscles, just that you need to strike a balance between the superficial and deep abdominal muscles.)

3:  This photo shows a more ideal position, as it involves a normal amount of tension in the abdominal muscles – not too tense, but not too relaxed either.

4:  The final image shows the abdominals in a very relaxed position, which is clear from the forward tilt in the pelvis. This over-relaxation of the abdomen is often seen in people with bloating due to digestive issues, causing them to belly breathe constantly as a result, or a great degree of muscular imbalance in the pelvic region.

CONTRIBUTING FACTORS TO BREATHING IMBALANCES

  • Emotional Stress – phobias, anxiety, and other emotional disorders can be exacerbated by incorrect breathing patterns, but they can also be root factors that contribute to respiratory imbalances in the first place.
  • Nutritional Issues – things like digestive problems, inflammation-provoking dietary habits and food allergies can absolutely contribute to disrupting the breathing cycle.
  • Environmental Allergies – any kind of allergy can be a cause of breathing stress.
  • Underlying Pathology – whether present in the lungs, the immune system, or the nervous system, an underlying pathology can be a contributor to respiratory stress and thus breathing pattern imbalances that can be difficult to correct.

INTEGRATION IS KEY

The key to solving imbalances is integration. Reducing stressors as those mentioned above is extremely helpful to speed up this process and reduces the reliance on any one approach. Attacking the problem from several different sides of the spectrum is the best way to ensure success with improving your breathing, and in extension, restore posture and movement based imbalances.

A good plan includes several different approaches, such as:

  • Restoring flexibility to the muscles of the upper body
  • Restoring mobility to the spine and rib cage
  • Restoring function and relieving chronic tension in the diaphragm, pelvic floor, and deep abdominal wall
  • Education on proper breathing and daily exercises
  • Education on emotional stress and noticing when it’s time to engage in relaxation methods
  • Dietary intervention

RECAP

Let’s take a moment and go over the key points of this article.

  • Faulty breathing includes chest breathing, paradoxical breathing and belly breathing alone.
  • Optimal breathing involves belly breathing with lateral expansion and a balance between the abdominals and the diaphragm as well as inhalation and exhalation.
  • Integration is key, which means you need to address any possible causes such as postural imbalances, underlying health concerns, allergies etc.to solve the problem with breathing related issues.