Chronic pain in right SI joint


#1

Mukunda,

I just started working with a client with chronic pain in her right SI joint. She occassionally sees a PT who “puts her back together” from the sits bones through the lumbar spine. After this adjustment, she has some temporary relief from most of the pain, but she is unable to keep the SI in place. When she came to see me, she had just returned from a plane trip and a “bad back” week. I gave her the SI exercise and the JFS for ankles, knees, hips. A week later, she was still having a “bad back” week with much pain. After practicing the exercises, which she did 4 times during the week, she felt less pain. The next day, however, she did not feel well at all. Should she continue with the exercises? Should she expect pain as her body adjusts to a change in muscle strength, flexibility, etc?

What should be my approach with her? I have been working with her on relaxation to decrease vata. Toward the end of relaxation she was aware that she felt no pain. As she had that awareness, pain came back. Also, I had her do samma vritti ujjai pranayama. While concentrating on her breath, she had no pain. Her homework for this week is to work with relaxation and breath.

Where should I go from here? So that your recommendation can be more specific, she has very limited ROM in internal and external hip rotation in the supine test position. She has excessive ROM in external hip rotation in the prone test. Hip flexion on the right side as approaches 70 degrees causes pain in right SI. In abduction on the right side, she feels “stuck” as she approaches 45 degrees.

Peace,
Kathy


#2

First you need to be sure the s/i exercise works to correct the motion. Second is to have clear MT findings so that you know what are weakest muscles that destabilize the s/i and what secondary movers are weak in the region. Third, the exercises you give to change these need to be progressive so that both of you can assess her getting stronger. That is giving a progress of something she can only do 6X then make sure her stamina increases while being comfortable to twice the start. Usually this should be within 4-6 weeks. You do not mention results of MT. That is the place to start.
Your ROM tests will only tell you what is tight. That is not where to work with an unstable s/i. Begin only with toning and make sure she is not doing any activity that increases her ROM. An excessive ROM of external rotation needs to be tightened so that she is back to normal. You do not give me MT results, So check your MT and see if internal rotation is weak. Grade the progression of MT exercises so that you can both see progress. Start with simple but challenging such as sunbird with rotations then progress to JFS #5. And doing hip rotation tone while at work or walking.

     Be sure she informs you of all physical activity and then assess those activities to be sure they are not contradictory to your program.  If the PT has given exercises see that they are clear and that she is not overwhelmed.  If PT only does manipulation then you or she needs to tell PT that stability and tone is not the result of her work.  So question is if PT is not helpful but temporary why continue it?  Get more communication from her, she should avoid anything that isn't helpful.  Temporary help is not helpful.  This condition requires being tough so that what ever is helpful is done even if it is  just one or 3 exercises.  Vata requires lots of pranayama, relaxation, yoga nidra, resting when they are tired, and inquires into sleep, sex life, bowel motions, fear, etc.  it is a whole person conseling that is needed to be of optimal help.  

namaste. m