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.

 

The SI Joint Whisperer Tells All (Part 2)

The SI Joint Whisperer Tells All (Part 2)

Lucky you! In part 2 of this epic tale of SI joint mastery, Bizz shares with you her favourite exercises to rekindle an old friendship with your SI joint. For those of you who missed part one, she pretty much explains how most of us, especially as dancers, have jammed and stuck SI joints that can cause a multitude of pains, in the lower back, knee, etc. She explains that the root of these mysterious pains are often a jammed SI joint, something which often eludes us, and she further explains how showing it some love can go a long way.

And now onwards to part 2! Lots of great exercises in here, and be sure to check out Bizz’s website to see full video explanations of all the moves.

 

PART TWO

Rehab – How can I be BFFs with my SIJs?

Disclaimer: While I have lots of personal and professional experience helping people heal their SIJs, I am NOT, in fact, a doctor. If these exercises help you, that is wonderful, but if they do not or if your pain gets worse, PLEASE see a medical professional – ideally one who has experience working with dancers.

I’ve provided a number of options for each step because I’ve found that every SIJ joint issue has a personality of its own, and different bodies respond better to different therapies. I recommend giving all of them a try to find which ones whisper the sweet nothings that your SIJs need to hear. The best course of defence against future issues in the SIJs is to do a little work on them every day, from a minimum of 5 up to an ideal-world 20 minutes, either all at once or a few times a day, as needed. Once you become familiar with the exercises and with the difference between the way a functional and dysfunctional SIJ feels, you’ll know what your body needs and when, and you can address any weird twinges before they throw off your alignment and set off a zigzag effect throughout your body.

 

Step 1: Loosen Up

Since so much SIJ drama is caused by tension, the first order of business is loosening the f#$% up (something most over-achieving dancers prefer not to do) (note from Monika- HAHAHA! So true).

This is as much mental as it is physical – you need to get into your happy place so that you can let go of the anxiety that pain and injury cause. In extreme cases, I often recommend a glass of wine to promote relaxation (you gotta do what you gotta do!).

Bouncing: with your feet parallel and shoulder width apart, bend your knees slightly making sure they point over your second toes, and simply bounce gently up and down, letting go of tension throughout your body. You can let your head roll side to side as you bounce, and try bouncing on one leg at a time while you stack your joints over one another from your feet to your head.

 

Pelvic Tilt: laying on your back with your feet hip width apart on the floor and your knees bent, gently tilt your pelvis towards your head, rocking your tailbone up off the floor and slightly flattening the curve in your low back. This is a subtle movement that wakes up your deep muscles, so you need to keep it small. Your obliques, transverse abs and adductor magni can rock your pelvis, but only if you relax your glutes and try not to push with your legs.

 

Step 2: Align

The second most important thing you can do to improve your SIJ function is to embrace inward hip rotation.Turnout is not your enemy, but over-reliance on turnout muscles is, so do yourself a favour and learn to love parallel feet, hip width apart. In yoga, the opposite of turnout is called ‘inner spiral’. A balance of inner and outer spiral appropriate to the body’s position is the key to SIJ stability. A great way to learn to use inner spiral is to use an image I call the “pelvic smile.”

 

Pelvic Smile: When you activate your pelvic smile, you turn on your deep abdominals and activate your inner spiral while releasing your outer rotators. To do it, imagine that you are able to look at a cross-section of your body, as though you were cut in half just below your navel at the level of your ASISs (the bony points at the front of your pelvis). A top view from here would reveal the two halves of your pelvis connecting at the SIJs in something like a semi-circle.

If you make your index finger and thumb into a semi-circle on each hand and connect them at the tips of your thumbs, you can simulate this image. Without proper alignment, your hip bones can feel (and your hands will look) kind of like a ‘W’. We want to make them into a ‘U’ or smile shape. To accomplish this, there are three main actions:

First, you will imagine widening across the back of your pelvis, pulling your low belly muscles in towards your sacrum (pulling your thumbs out to make a rounder shape) Next you’ll use your deep abdominals to narrow your ASISs (hip points) towards each other in the front of your pelvis (pull your index fingertips towards the centre to make your fingers perpendicular to your thumbs). The third action deals with the body in space. When you are standing, the pelvic smile (fingers and thumbs) should be parallel with the ground, and when you lie on your back the ASISs will point up towards the ceiling. When on your stomach, the pelvic smile forms a bridge from one hip point to the other, with the sacrum at the apex. When you are moving through space, the pelvic smile should move with you, maintaining its position between your head and your feet.

Once I experienced the magic of pelvic smile, I couldn’t help but do it everywhere – in the shower, while washing dishes, grocery shopping…. it works wonder to get you in alignment, and you’ll find that after a little practice, you’ll develop a smirk on your face to go along with it, one that says “bet you can’t guess where I’m smiling right now ;)”.

Step 3: Warm Up

Developing a mental picture of your pelvis by using imagery (such as the pelvic smile) will help you to understand what does and doesn’t work for your body. If the pelvic smile doesn’t work for you, there are lots more options – ask around or check out Donna Krasnow’s dancer-saving Conditioning with Imagery.

Muscles, like people, have trust issues, and when dancers focus all their attention on the outer rotators, the inner ones will weaken and retreat, sulking in a corner and refusing to do their jobs. Being an especially touchy and stubborn kind of joint, the SIJ responds better to attempts at realignment once it’s been flattered with a little attention, so be sure to warm up before you try any of the release techniques.

You will find the exercises below described in my free workout video “The Pilates Quick Fix on youtube (or visit my website to order a DVD). Here is a quick list of the most important exercises to improve your relationship with your SIJs, so if you don’t have time for the 25 minute video, you can choose the exercises you need the most.

Abs: Imprint

Multifidus: Cat/cow

Glute medius and Adductor magnus: Hip release

QL & Latissimus dorsi: Back extensions

Ilio-psoas: Hip fold

 

Step 4: Release

Retraining involves three things: releasing tense and spasmed muscles, strengthening weak ones, and then stretching and massaging to lengthen the short ones. Because SIJ dysfunction affects so many parts of the body, it would be inefficient to try and strengthen the weak muscles without first putting things back into place.

Releasing is not the same as stretching. While stretching involves pulling on the ends of a relaxed muscle to make it longer, releasing places the body in a position that brings the ends of a tense or spasmed muscle closer together so that the muscle can relax. It’s important to release before you strengthen (and before you stretch), because it will help maintain your alignment as you retrain your body.

Some people hold more tension in their piriformis, while others focus theirs in the glute medius or QL. Releases are best held for 3 minutes, but the longer you stay, the more your muscles will remember what it feels like to loosen the f$%# up.

Outward rotation (releases glute max & piriformis)

Laying on your stomach with feet hip width apart, bend the knee of the affected side so the shin is perpendicular to the floor. Take the bent knee out to the side, about 30-45 degrees from the midline of the body, and place the knee on top of a pillow or cushion. Now allow the foot of the bent leg to drop towards the straight leg, passively rotating outwards. You need to relax the entire leg on the affected side, so you’ll want to prop the foot against something so you don’t have to use your hamstrings to keep the leg bent. I like to do this in a doorframe or near a table, but a chair or stack of heavy books would also make a decent foot-stopper. Once you’re there, focus on breathing deeply and relaxing the outer rotators on each exhale. I also like to reach back and use my hand to give the butt muscles a good jiggle to make sure they’re loosening up. This one is way easier if you get a friend to help, but it can be done on your own when necessary.

 

Inward rotation (releases glute med & IT band)

 

Laying on your side (with the affected side on top), make sure your body is in one straight line from head to toes. Bring your top knee forward, at an angle of about 45 degrees to the body and place the entire shin on a pillow or bolster. Roll forward slightly so that your weight rests on the cushion (you might like to cuddle a pillow to your chest as well). Make sure the foot and shin of the bent leg are at the same height as the knee. Once again, breathe deeply and go to your happy place, and add a little jiggle if necessary.

 

Seated fourth (releases glutes, piriformis and IT band)

This one is a great quick release you can do just about anywhere, no props required. Sit in fourth position with the affected leg behind you (bend the unaffected leg in front of you as though you were going to sit cross-legged, with the unaffected leg curled around behind you near your butt). Align your upper body with the thigh bone of the back leg, and lean away from the leg and rest on your hand or elbow. While relaxing the glutes and thigh muscles of the back leg, massage the piriformis and glute med. I often twist and wiggle around some in this position to find the ideal spot for release.

 

 

Bolster release (SI and QLs, etc)

For this release you’ll need a prop that is at least 8-12” in length and not much wider than your SI dimples. A foam roller will do but you can also use a tightly-rolled yoga mat or a bolster if you want something softer. The roll will line up with your spine, and you will lay on it with the bottom at your tailbone. If your prop isn’t as long as you spine, you’ll want to cushion your head and upper body above its end. Once in position on top of your roller, bring the soles of your feet together and your knees out to the side. Place your hands on your hip bones and rock them gently side to side while thinking soft and happy thoughts about your glutes. You may feel a clunk or a shift, or you may not feel anything move, but either way this is a VERY effective release for the SI joint once the muscles surrounding it have chilled out.

 

Step 5: Strengthen

Now comes the business of strengthening those tense, weak inward rotators so that they feel equal to the outers and start doing their jobs. Don’t skimp on this part – you have probably spent more hours ignoring your inner muscles than you care to admit, and this is your chance to make it up to them. Although joints can be replaced these days, you can’t just trade in the ones you’ve got for ones that trust you more, so you and your SIJs might as well start talking about your feelings and working through your issues now.

 

Pilates is a very effective way to strengthen your deep core muscles and facilitate neuromuscular repatterning. Make sure to use your pelvic smile! Instructions for the exercises below can be found in my Quick Fix video.

Abs: Tic tocs, Ab curl

Multifidus: Back extensions

Glute medius: Clam shell

Adductor magnus: Butterfly

QL & Latissimus dorsi: Swimming, Arm & leg reach

Ilio-psoas: Hip fold (*try it with a straight leg, too)

 

Step 5.1 Re-release

In the beginning stages of retraining, old habits could pop up during strengthening and cause a spasm in the outer muscles. If this happens, don’t stress, just go back to step 4 and re-release them before you stretch.

 

Step 6: Stretch/Massage

Stretching and massaging is about balancing the resting length of your muscles. You need to lengthen your outer rotators to balance them with your inner ones so your SIJs can rest easily between the two. Because the SIJ’s range of motion is small and controlled by deep ligaments, muscles and fascia, stretches won’t be able to get at all the structures that need attention. Massage (using props for those hard to reach places) will dig down into them, basically reverse-stretching them in the way you would roll out a pie crust.

Yoga is a great way to stretch while maintaining proper alignment and activation of your postural muscles. You will find instructions for most of these poses in my Hippy Hippy Shake videos (or see YogaJournal for step-by-step basics). And don’t forget to use your pelvic smile!

Downward dog

Chair pose (with twists)

High and low lunge (with twists)

Warrior 2

Side angle

Triangle

Pigeon

Fire log

Cobra

Bound angle

As for massage, a pair of hard rubber bouncy balls are ideal for getting into the deep structures around your SIJs (tennis ball size is good, but I find tennis balls themselves to be too soft and slippery). (Note from Monika- You can get a lacrosse ball for four bucks from Canadian Tire). Place them on either side of your spine and roll up and down against a wall for a nice deep massage. You want to avoid rolling over your spine, instead focus on the muscles and tendons. Make sure you get down into the glutes, and even turn sideways to get the entire glute medius and the IT band.

I’d love to hear how these exercises work for you, and I’d be happy to answer your questions on becoming BFFs with you SIJs, so feel free to drop me a line at bizzvarty@gmail.com. And as a nerdy bonus that doubles as a workout soundtrack, check out the classic Canadian tune “Let Your Backbone Slide” in which Maestro Fresh-Wes gives a shout-out to the SIJ just before the 3 minute mark. Holla!

BONUS #1:

BONUS #2: 

Check out the free 30 Day Core Challenge. It’s a great way to get back in touch with the fundamentals of “core” (do you know what they are?). All you need to do is make time every day for a few minutes of practice for 30 days. Simple 🙂

 

The SI Joint Whisperer Tells All (Part 1)

The SI Joint Whisperer Tells All (Part 1)

Today I am pleased to share with you a guest post by a fellow dancer, pilates and yoga instructor, performer, and self proclaimed SI joint whisperer, Bizz Varty. When she contacted me to write something for the blog I was thrilled, and I had no idea how much shit was going on down in my SI joint until she pointed out to me how common it is for that pesky guy down there to be jammed and angry.

Without further adieu, here’s part one of Bizz’s epic tale of the mysterious little bugger that is the sacro-iliac.

The SI Joint Whisperer Tells All (and encourages you to loosen the f#$% up!)

By Bizz Varty

Part 1

The sacro-iliac is quite possibly the most mysterious and misunderstood joint among dancers. As a dancer and a yoga teacher, when I hang around with my dancer friends, I spend a lot of time releasing stuck, jammed and pinched sacrums (they call me the SI joint whisperer). As delightfully satisfying as a recently-released SI joint can feel, (note from Monika- BEST. FEELING. EVER.) I have realized that constantly putting it back where it came from is like using a cup to catch water from a leaking bucket just so you can pour it back into the bucket – that is, rather inefficient. This realization plus my own lengthy history of pain in the posterior hip and spine have led me on a search for long-term solutions in the form of alignment, conditioning and neuromuscular re-patterning.

An injury back in high school began my long journey to understanding my SI joint. I was dancing every night as well as playing soccer, and woke one morning with a pain in my back/hip, a pain that eventually moved into my knee.

For weeks I felt I’d ‘lost my bounce’, because jumping sent a ricochet of pain all the way from my toes to my neck along my right side. Being young and stubborn, I did not seek medical attention or even apply an ice pack. Instead, I just tried to dance it off. Though the intense pain eventually went away, my right hip and knee were never the same. Fifth position and attitude derriere caused pinches and twinges in my back and I constantly had an incredibly tight IT band.

But I continued to dance anyway (See Monika’s article “The Problem with Dancers Today” for more on this).

For three years I was held hostage by the twinges, aches and pains that seemed to move around to a different part my body every week. Then, in my second year at York, a ballet teacher suggested that maybe one of my legs was longer than the other. Intrigued, I went to a physiotherapist who said that they were, in fact, the same length, but my SI joint was stuck on the right side.

That first SI adjustment changed my life – for a few weeks anyway. Not knowing that this was something I would eventually become very passionate (ok, maybe a little obsessed) about, my early efforts to maintain this new and wonderful SI joint balance were half-assed at best. Going to physio each week became more like going for an SI release every week. That is, until my PT got fed up and showed me how to release it myself. Then, she began teaching me how to activate my deep core muscles, which blew my stubborn dancer’s mind.

In the 6 or 7 years since, the amount of attention I’ve paid to the problem has varied in relation to the wide assortment of injuries and misalignments I encountered. I would try to dance (or swim, do yoga or even walk) with my SIJ locked. Then, I would have to spend several days dealing with the after-effects only to have it happen again the very next week.

I learned the hard way that the best offense is a good defence, and began addressing my SIJ with daily re-patterning work about a year ago.The improvement has been magical.

Certain activities (especially if done when tired or distracted) will still throw my SIJ off, but now that I know the symptoms (non-specific pain in my knee and IT band) and the solutions (I live for pelvic smile and seated fourth release!) I no longer suffer daily from the repercussions of poor patterning.

My method may not be the simplest, but I find it very effective, as do many of my students. Stabilizing your SIJ, especially if you are a dancer who expects your body to maintain a large range of motion, should be a daily practice. Tight muscles will pull the SI out of alignment, and the body’s compensatory efforts will keep it stuck there.

If you have SI joint issues, chances are good that they are supported by years of well-intentioned but inefficient movement patterns. (Note from Monika- I agree… the road to dance injury is paved with the best of intentions).

I don’t say that to discourage you, I say it to help you understand that you can’t half-ass this if you want it to work. Trust me on this one, I’ve lived through the drama and made it to the other side. A happy SI joint will improve your movement in a million little ways that you can’t even imagine until you’ve experienced it. It takes some time and effort to find what works for you, and to figure out how your body tells you that it needs attention, but it is SO worth it!

Anatomy: What is the SI joint and how does it work?

The Sacro-Iliac joint is in fact two joints – one on each side of your sacrum where it meets the back of your pelvis – specifically, the inner edges of the ilium. You can find these spots by looking for the dimples at the back of your pelvis (just above the crease between your cheeks). The bump you will feel near each dimple is your PSIS or Posterior Superior Iliac Spine – anatomy-speak for “the bony bump at top of the back of your Ilium.” The SIJs are weight bearing joints that provide shock absorption for your spine and distribute the weight of your upper body onto your pelvis and into your legs and feet.

There is some misinformation out there that states that the SI joints do not move, but in a healthy body this isn’t true. To be fair, the SIJs are not designed for a large range of motion as they are stabilized by many deep ligaments. Especially in the type of loose-jointed (which is to say, long-ligamented) bodies that dancers tend to have the bones do move in relation to one another, and when they do they cause widespread (though usually subtle) shifts in overall alignment. Rather than a ball and socket joint like the hip and shoulder, or a hinge joint like the elbow and knee, the SIJ is a gliding joint, more like those found in the spine, where two relatively flat articular surfaces slide against one another. (You can find out lots more nerdy pelvic anatomy stuff on Wikipedia if you’re interested!).

So, if your loose ligaments aren’t holding the SI joints stable, what is? That would be your deep core muscles, namely the transverse abdominus, multifidus, piriformis and ilio-psoas. But there are a number (some say as many as 35) of other muscles that have a connection with the SIJs including the gluteus maximus and minimus, erector spinae, latissimus dorsi, quadratus lumborum (QL), hamstrings, quadriceps and tensor fascia latae as well as the IT band. You would think with so many supporters the SIJs would be good and stable, however all of these muscles also have other jobs to do when the body is in motion, and when those other jobs take priority over SIJ stability, it can throw all kinds of things out of whack.

Side note: SI joint dysfunction is sometimes called “piriformis symdrome” because the piriformis in one of the primary culprits for malfunction, especially in dancers who overwork their turnout. While piriformis syndrome may well be caused or aggravated by SIJ dysfunction, it is a distinct problem that affects only a small portion of the general population. In less than 20% of bodies, the sciatic nerve runs through the middle of the piriformis muscles (instead of underneath it) and when the piriformis is overly tense it pinches the nerve, causing a radiating pain down the back of the leg. The only way to determine if you fall into that 20% is by cutting your butt open to take a look so you may never know for sure, but if you have a shooting nerve pain that starts in your buttocks, you can bet that your sciatic nerve is being irritated by your piriformis.

 

Symptoms – What do unstable SIJs feel like?

SI joint instability is a bit of a misnomer. What I see in many dancers are SI joints that have become locked into place by tight, weak muscles. In an effort to protect what is an especially loose joint in dancers, the body tenses up resulting in a joint that is in fact too stiff for its own good.

As I said before, the SI joints should move, not a lot, but just enough to transfer information from the pelvis and legs to the spine and back again. When this doesn’t happen, because the joint has locked into place in the interest of self-preservation, pain can sometimes be felt at the back of the hip near the dimples. But the body is crafty, and in a dancer’s loose body, the spine, pelvis and hips can shift subtly to work around the blockage. In cases like this, pain might not be felt at the SI joint at all. Rather, the over-stability there will cause instability in other locations – typically in the front of the hip, the low back and the knee, but sometimes all the way down to the toes and up into the neck. (For me, I don’t feel anything in my SIJ until after I notice a pain in my knee).

Usually the piriformis, and often the QL and glutes will be very tense, (Note from Monika- Yep. So. Tense.) and could even be in spasm. To make it more complex, a problem with the right SI joint could very well cause pain in the left side of the body, as the brain will just reassign whichever nearby muscle is strongest to cover for the weak ones that are busy tensing up to create more “stability” – essentially, to use the technical term, an “anatomical cluster-f#$%.”

Try this at home: If you suspect your SI joint is locked, you can get a friend to try and help you determine on which side. Standing tall with the feet parallel, have your friend stand behind you and place their hands on the SI joints, just above the dimples. Raise one knee to hip height slowly, then lower. Repeat on the other side. If your friend feels the SI joint lift upwards when you raise your knee (instead of staying still or moving down slightly) the SI joint may be locked on that side.

Causes – What makes dancers so vulnerable to SIJ cluster-f#$%s?

Most people are stronger in the outer hip and weaker in the inner thighs as a result of sitting for long hours and standing with poor posture. Dancers tend to be looser-jointed than the average population, as the dance world has a way of discouraging those less flexible folks. Add to that the dancer’s affinity for overusing the outer rotators to create more turnout as well as a penchant for general over-exertion and you’ve got a recipe for SI disaster. The SI joint was simply not designed with turnout in mind, as most mammals move most efficiently in the saggital plane. But that’s not to say that dancers and their SI joints can’t be friends. In fact, you too could very well become BFFs with your SI if you regularly practice the exercises which will be outlined in part 2.

(Note from Monika- I will post part 2 tomorrow, which is full of fun stuff to show your SIJ some love)

BONUS:

BONUS: 

Check out the free 30 Day Core Challenge. It’s a great way to get back in touch with the fundamentals of “core” (do you know what they are?), which, as you now know, is an important component in SIJ happiness. All you need to do is make time every day for a few minutes of practice for 30 days. Simple 🙂

Here’s a little about Bizz:

Bizz (Elizabeth) Varty has a passion for dance, music and mind-body fitness. While completing her Honours BFA in Dance at York University she discovered her love for dance science and kinesiology. She also studied Arts Management at Humber College and is certified as both a pilates and yoga teacher.

Bizz has studied dance for more than 20 years. She has choreographed and performed across the province including her 2009 work, the Janis Joplin-inspired piece Honey, I Know How You Feel for the BAZAAR dance festival at Toronto’s Opera House. Along with Beth Lifeso, she is co-director of Cocktail Dress Productions, who have performed at Massey Hall and The Rivoli in Toronto.

Her interest in fitness began at a young age and she has been practicing Yoga and Pilates for 15 years. Her teaching style combines the precision and efficiency of pilates and the philosophy and flow of yoga with the creative expression of her dance background. Bizz’s attention to anatomical detail and her fun, engaging instruction have earned the respect of students of all ages and backgrounds. For more info and free videos, visit www.basicfitness.wordpress.com.