Part of some SIJ problems

[Aussie-m]

I found that if you have SIJ problems you could have a misaligned pubis symphysis, if the pubis symphysis is out by 1 mm your SIJ will out by 3 mm , so if the PT has not checked this during your SIJ treatment/diagnoses they have not done their job in full , something to be aware off , and to maybe get it adjusted , you need your pelvis to be balanced to get proper pain relief and function . This is only part of the solution ,but a part over looked by a lot of PT’s , so did you get your pubic symphysis checked or adjusted when your PT said you have SIJ problems ????
Something to check
I also posted this topic in physical therapy for the people with SIJ problems and therapists to take note .
cheers

[HerMajesty]

Absolutely true; SIJD is actually a misnomer better described as pelvic joint dysfunction because the pelvis has to be checked not just in relation to the SIJ but also to the pubic symphysis and hips. My SIJD was 100% corrected, but the issues certainly did involve the pubic symphysis and several other factors. After my SJD was treated, I took an interest in the field of Manual Therapy and worked for 1.5 years with the PT who did my correction. During that time I saw a few patients whose problems originated 100% in the pubic symphysis alone. The most dramatic presentation is when the pubic symphyseal fibrocartilage gets wedged in a forward position, which if extreme enough will "lock up" all normal movement within the SIJ. Conversely, pubic symphysis diastasis (separation of the pubic symphysis, often related to childbirth), will alway make the SIJ hypermobile.

[Aussie-m]

I put this out there to see what type of response that would occur, i am so glad that you have expanded on this HerMajesty , i will add that childbirth and TRAUMA are usually the cause , but i will say you were very lucky to find a therapist who could balance your pelvis , i found it difficult to find therapists who included this and doing a number diagnosing procedures , to find the cause , i found that they do a simple bend-over PSIS test and say you have a SIJ problem then give you a general set of exercises to fix it , but it does not address the cause of the problem .It is a complex mechanism the pelvis . I will say to everyone take note when diagnosed with a SIJ problem see if the therapist can find the cause by using a number of diagnosing techniques . May be HerMajesty can expand on diagnosing techniques to be aware off,so we all can be better educated when dealing with PT's.
Thanks for your input HerMajesty
cheers

[HerMajesty]

May be HerMajesty can expand on diagnosing techniques to be aware off,so we all can be better educated when dealing with PT's.

In addition to palpation to determine symmetry, PT Manual Therapists use spring testing, putting manual force through the joints in various directions, to determine the functional movement of the joint (hypermobile, normal, or hypomobile). If there is another method aside from spring testing to accurately assess joint function, I am not aware of it.
The PT who corrected my SIJD is Jerry Hesch, who teaches his own method of joint assessment and treatment (Hesch Method). He does an enhanced version of the traditional Manual Therapy spring test which he calls "Springing With Awareness", and teaches it to other PT's in continuing ed seminars. It's harder to describe this method of assessment than it is to watch it in action: If you search Jerry Hesch or Hesch Method on youtube, he has videos posted of patient assessments.
If a patient sees a practitioner who works on the SIJ, and does not receive a hands-on assessment similar to what is seen in the videos, then the practitioner should be asked to explain exactly how they are discerning the pattern of pelvic joint dysfunction. There might be other methods; but if so then the practitioner should have an answer that makes sense. Unless the pattern of dysfunction can be clearly identified, the "treatment" will have to be nonspecific/ generic excercise, as you already pointed out.

[rea]

I have been going to an orthopedic for diagnosis of SIJD besides what the chiropractor told me. They did an injection in my left SIJ and I had great pain relief. The physician assistant told me I had degeneration more in my left SIJ than right which fits my symptoms. When I got my report along with a copy of the xrays, the tech said there was no problem. Bull.... went back for a follow up and they offered surgery. Asked about my hip misalignment and she said it wasn't that much of an uplift. Am I wise not to jump into this surgery? I couldn't get her to write me a script for PT either.

[HerMajesty]

rea,
What kind of surgery were you offered?
Something like SIJ fusion has a poor track record in most cases and would be ridiculous to attempt without conservative treatment like PT first. But it really depends on the surgery, it might be for some pathology for which PT could cause further injury (?) A guess since if PT might work, orthopedic surgery is rarely encouraged before giving it a try.

[rea]

That is what I gathered from reading on here. I asked about PT. Nothing was offered. It was SIJ fusion with the titanium pins. I go back Jan. 10th to see the doctor instead of the physicain assistant. I'm going to try for PT again or make an appointment with a chiropractor that said he would go slow with my therapy. If it wasn't for going to Arizona to see Hibner I'd take the money and go to Nevada to see Jerry Heush. Would pain management refer me for physical therapy?

[HerMajesty]

My Pain Management referred me to PT, but I had a POS plan. In an HMO it might have to be your PCP. They should be able to give you that info easily if you call your insurance plan customer service #. SIJ fusion is rarely beneficial and I personally have never heard of anybody getting it done without a trial of PT first, although I am sure it happens. I think you're very smart not to jump into that surgery.

[Aussie-m]

Hi there , if you can get the problem diagnosed properly then get the problem treated , i found that some therapists only treat the symptoms not the cause . The problem is to find a good therapist to diagnose you correctly then a treatment plan usually you will need a multidisciplinary practitioner or may be a couple of very talented ones .

[rea]

Hi Aussie,

Thank you for your advice on the SI. I was seeing the chiro for over 4 months. Line me up and by the time I got home I was messed up again. Kept "locking up" So I went to see an osteopathic doctor that does proletherapy. One of the first things he did after checking out my hips was work on my pubic symphsis. He did manipulation before and after the prolotherapy injections. While I'm still in horrible pain, I can tell a difference. Found out that my Pain Mangagement does proletherapy also but I'm sticking with the "manipulator". I know this is going to take time but having someone hands-on is what I needed. I have read and am aware about proletherapy but I have to try everything before deciding on surgery. It hit me hard that my life will never be the same but just having something change (working right again) helps.