Injury of the Month- 6 Things to do When Your SI Joint Feels Funky

Injury of the Month- 6 Things to do When Your SI Joint Feels Funky

A little while back, Bizz Varty wrote an awesome two-part article for me on the topic of the sacroiliac joint- That fun little joint where your sacrum and ilium meet.

Though it’s a topic that’s already been given some deserved attention, I feel as if it’s time to touch on it again (though I’m no SI joint whisperer, like Bizz claims to be). And if you’re reading this, Bizz, I’m still waiting for my magical SIJ adjustment ;).

There are a couple of reasons that I’m dedicating another post to the SIJ:

1)      Bizz’s original SI joint article continues to be one of the most popular ones on my site. I’ve even had some readers email me out of the blue asking what they can do about their SI joint issues after having read Bizz’s SIJ saga. Clearly, this is something people want to know more about, and who am I to deny the people what they want??

2)       I recently took an online seminar, presented by Rick Kaselj, and learned a bunch of cool stuff about SIJ pain, and exercises to eliminate said pain. I’ll be quoting a lot fun facts I learned from his presentation. Rick is a super smart guy, an I can honestly say I wouldn’t know half of what I know today if it weren’t for him and the great information he makes available to industry professionals like myself.

3)      My SIJ has been bothering me for about a month now, and I know exactly why, and I’m going to share it with you, and what I’m doing to help it.

4)      All the dancers I’ve worked with recently seem to have at least one funky SIJ. And it’s usually their right one.

So here we go! Here’s to hoping I can live up to Bizz’s glory. I’ve got some big shoes to fill. She did a really good job outlining the anatomy stuff in her article, so I’m not going to re-hash it all. And if you haven’t read it yet, CLICK HERE and then HERE. Seriously, it’s about time.

As I mentioned, I have been dealing with a bit of a cranky SI joint lately. I have a couple of educated guesses as to why:

1)      I have been training harder and heavier than usual.

2)      I have been sitting at my computer more than usual.

3)      I have been paying less attention to my pelvic alignment.

4)      I have stopped doing nearly all extra core training.

5)      I’m probably more stressed than I realize.

6)      I am a woman.

In case you didn’t know, women are more susceptible to SIJ pain than men. This is because of that thing called child birth. Remember that thing? The ligaments that stabilize the SIJ are more lax in women so that we can do that child birth thing one day. Less stability= more susceptibility to getting hurt.

Women also naturally have a higher degree of anterior pelvic tilt than men, which puts more stress on the SI joint. This is why paying close attention to alignment and doing an appropriate amount of core training is essential for us ladies, and especially dancer ladies.

Why is SI joint pain and dysfunction such a big deal?

Well, it hurts, so that sucks. But our SIJ’s have a pretty important role- To transfer force from the upper extremities to the lower extremities. And the reverse. Force transfer is important for any kind of athlete. Also if you like having fun, playing sports, or tipping cows.

What does SI joint pain/dysfunction usually feel like?

SIJ pain is usually lumped in the broad category of “lower back pain”, and can be characterized by a radiating pain around the lower back and bum area.

Bizz mentions a couple of cool assessments you can do on yourself to determine whether or not your low back pain is coming from the SIJ, so I won’t get too into that. Also, if you have lower back pain, your first move should be to see a professional about it to determine a proper rehabilitation program. That said, one assessment I generally do when working with someone is a little Thai Yoga Massage move called the “hip hop”.

 

This is Albert (Krishna), one of my Thai Massage teachers, teaching at the Sivananda Yoga Center here in Toronto.

Those Thai were trying really hard to mainstream when they named that one… But anyway, this particular Thai Massage stretch not only feels awesome (because it wiggles the SIJ around), but based on how much movement I can get in the person’s  SI joint, I can tell how jammed and unstable it is, and which side is more affected than the other.

In dancers, I’ve noticed that the right side is generally less stable, with less movement and more pain. In my experience, dancers also tend to have more external rotation in their right hip. This is because in dance classes we end up practicing things more on the right side than the left, and so we develop more turnout on the right side, which causes the right piriformis to get super tight, pull on the SIJ, and cause pain.

This leads me to…

What Causes SI Joint Pain?

In Rick’s seminar (who, by the way, knows way too much about every injury), he listed that the SIJ is most commonly injured by:

1)      Trauma

2)      Pregnancy/child birth

3)      Overuse

4)      Repetitive movement

5)      Leg length discrepancy

For dancers, and other super active people, the most probable causes are muscle imbalances created by overuse and repetitive movement. I would also add prolonged poor positioning, or shifty alignment, to that list, but this can be lumped under repetitive movement.

The most common muscles associated with SIJ pain are glute med and max, piriformis, quadratus lumborum and biceps femoris. These muscles stabilize the SIJ. When stability is compromised due to an increase of stress on the joint, they tighten up to try to add more stability.

What Can You do About Your SI Joint Pain?

First, stop doing the things that make it hurt, go see a specialist, and get some rest. And then you can start doing some of these things:

1)      Find neutral spine. Find it and start walking around in it all day every day. I cannot stress how important alignment is if you like not being in pain all the time! Being in the proper alignment will take stress off the SI joint and strengthen the muscles which stabilize it. Start now. Find neutral spine and use it as often as you can. How?

I like to find neutral spine by using a little trick I stole from Dr. Stuart McGIll: Bend forward about 45 degrees and put your fingers on your low back erectors. They should feel hard and activated*. Begin to bring your back into an upright position, but stop when you feel your lower back muscles first relax. This is neutral for YOUR spine. Now hold onto that position with your pelvis and bring your ribcage back over it if you feel like you’re leaning way forward.

Sam is so awesome for always being my “exercise model”.

I tend to always be in too much anterior pelvic tilt (sway back posture), so being in a neutral pelvic alignment is important for me if I want to be pain-free and happy. Which I do. This trick worked wonders for me and taught me how to properly engage my core, glutes and hammies.

 After you’ve mastered finding neutral spine (read, have become obsessive compulsive about using it all freakin’ time), strengthen it! Learn to deadlift with perfect form, and start deadlifing everything from now on.

There is no more “pick up from the ground”. There is only deadlift.

2)      Get some core stability. Specifically, learn to activate the transverse abdominus and the deep pelvic floor muscles. Not only do you need strength and endurance in your core, but a little fine motor control don’t hurt either. Your core muscles stabilize your SIJ. More stability is good!

Stable joint=no pain

Unstable joint= pain

Mike Robertson, from Indiana Fitness and Sports Training,  wrote an article called Core Training For Smart Folks, which you should now go check out. If you’re smart…

3)      Learn proper hip extension. Get a friend to check  out your hip extension skillz by doing a simple single leg hip bridge. If you notice that there is significant arching in your lower back, and your chest is rising to your chin, and your bum is still squishy, then you are doing hip extension from all the wrong places.

4)      Self Massage. Most of us can’t afford to get weekly massage therapy. Luckily, you can still get a good amount of benefit from self massage You may need to do some self-massage on your problem areas 3 times a day at first, and then reduce the frequency until you’re just maintaining whenever you feel a flare up.

I forget who I heard it from first, but I like the saying, “Doing self massage between massage appointments is like brushing your teeth between seeing the dentist.”

My favourite items to self-massage with**:

Lacrosse ball:

Great for hitting the piriformis, glute med and max, lower back, and QL area. If that’s too intense, use a tennis ball, or a less dense rubber ball from the dollar store.

Foam roller:

Use it for the above if using a lacrosse ball is too intense. Also for your IT bands and upper back. I’ve never tried it, but I hear you make your own roller out of various other hard objects wrapped in other various softer coverings. Try wrapping an unopened soda bottle, one of those Nalgene bottles, filled with water and frozen, or some PVC piping wrapped with bubble wrap or that non-stick rubbery stuff you put under tablecloths.***

5)      Static and dynamic stretches. Perform dynamic stretches for the culprit muscle(s) before you do any kind of moving for the day, and static stretches after you’re done your day’s work.

Dancers be careful with your hamstring stretching! Many people have tight hamstrings as a result of SI joint pain, but dancers actually have pretty darn flexible hamstrings, and seem to be obsessed with stretching them. In my experience, dancers can benefit a lot more from strengthening the hamstrings than stretching them more, as they are one of the more common dance injuries. One that is close to my heart, so to speak.

6)      Improve thoracic mobility. If you only move from one point in your spine (probably the lower part), then all the stress will accumulate at that point. If you can learn to move from multiple points on your spine, the stress will be more evenly distributed.

And that’s all she wrote.

For more on exercises and strategies for developing strength and changing the way you move, check out my resource, Dance Stronger. 

*Yes I realize I just used the words ‘hard’ and ‘erectors’, almost in the same sentence. Sue me.

**Sue me, again…

*** If anyone tries to make their own foam roller, I want to see a picture of it! Success or fail.

 

What Does “Pull-Up” Really Mean, Anyway?

For the dancer and the strength training enthusiast, the term “pull-up” has entirely different definitions.

Also, “pull-up” means something vastly different  to the cross-fitter than it does to the strength training camp.

And for those who think that kipping doesn’t have to stop at pull-ups, why not “kip” everything!!?

But as much as kipping squats makes me laugh, let me get back to the point at hand.

What the hell does it mean to “pull-up” in dance class?? Has your ballet teacher ever yelled at you to “pull up”? Yeah, mine too.

Pulling up is something that I could never figure out. I knew it had something to do with engaging my core muscles, and trying to get taller, but I just couldn’t find an image that worked for me. Not until I started heavy squatting anyway… And then it became abundantly clear.

Now I always tout that deadlifts are the ultimate exercise for dancers to to teach them how to engage their glutes, and find neutral spine and a lot of other really great things. Actually I dedicated an entire post to the deadlift a while back.

However it wasn’t until recently that I realized what the squat brought to the table in terms of teaching the dancer an “old trick” in a new setting. This re-learning of dance concepts through weightlifting is something I think is essential if you have reached a plateau in your technique, and need something to bring you to the next level.

Enter, Le Squat.

Heavy squats taught me to “pull-up”

Like I said before, I knew that pulling up had something to do with my abdominals and lengthening my spine, but in a dance class, you can sneak your way through  without necessarily pulling up the whole time. Sure, you won’t do exceptionally well- You’ll probably fall off your balance more often than not, and you won’t be terribly pleased with yourself. But you’ll make it out alive. It’s not like you’ll get crushed under a heavy iron bar that weighs more than you.

When you put a loaded, heavy-ass barbell on your back, engaging your abdominals is non negotiable- If you don’t “pull-up” as you go down, you WILL get hurt.

This is one of the reasons that the squat is a great learning experience for a dancer. As you are performing the eccentric (descending) portion of the squat, you will learn very quickly, by necessity, what it means to pull up through your abdominals. You need to  “go up as you go down”- Brace the abdominals, and try to put more space between your individual vertebrae to try to resist the weight of the barbell crunching your spine. On the way up, you need to hold onto that feeling, but with even more power, because now you’re also fighting gravity. Ohhh that gravity.

Here’s a video of me squatting yesterday  (and by the way, 150lbs 4 times is a personal best for me. Just sayin’, I’m pretty pleased). If you have a keen eye, you can kind of see how as I descend before each rep, I “pull-up”, just like I would need to in ballet class if I were doing a plie, for example. A really, really heavy plie…

Also a pretty sweet song in the background. One of my favorite Chili Peppers tunes, from in my opinion, one if their better albums.

But anyway.

There ya have it. Deadlifting is awesome for dancers, but so are squats.

If you’d like to learn more about deadlifting and squat technique, and how to prepare your body for it, check out my resource, Dance Stronger.