SI JOINT UPDATE (June 2015) BREAKTHROUGH
I experienced a major breakthrough in diminishing the chronic discomfort in my body when I saw a chiropractor for the first time when in Palm Springs the winter of 2014/15. His treatment, his recommendations, and the progress of my sacral-illiac joint (SI) health were noted in “Recent Fitness Focus Journals, #10 Injured SI Joints.”
Once back home in May, the bodyworkers I saw both agreed: they didn’t think my SI joint had been in as perilous of a condition as the chiro. At its worst, my SI had only caused me significant discomfort, not the “can’t get out of bed pain,” which made it unlikely I actually had a tear. All agreed that backing off from the deep yoga poses I love for 6 months to a year was wise and I may abandon most of them forever. My ultimate goal is to be healthy and comfortable in my body and I’m not attached to any particular modality to get there.
The chiropractor’s information connected the dots for me: over the following months I began understanding how some of my eccentricities were actually the product of attempting to diminish pain that I hadn’t recognized as coming from my SI problems, like my fussiness when sitting in certain positions.UNLIKELY CULPRITS
Car & Plane Seats
I’ve always been a “fussy sitter” whether in a car, on a bus, or in a plane. Not accommodating my sitting preferences leads to restlessness and irritability and now I know why: most standard seating stresses my SI joints and hence, makes me generally uncomfortable.
The fashionable and ubiquitous bucket seats are the worst, especially on a long journey. One issue is the backward tilt of the seat bottom. I’ve always attempted to at least level the seat, if not make it nose-down in front, with blankets, pillows, or whatever I had available. I don’t like the pressure on the backs of my thighs at the front edge of the seat bottom but now I also understand that the pinched angle of bucket seats is the source of my global irritation. By elevating the back end of the seat bottom, I’m opening the angle between my thighs and torso to 90 degrees or more and the more open the angle, the less pull on my SIs.
The high sides on the edges of bucket seat bottoms are also irritating to my SI’s if the remaining sitting space is narrow. I’m OK if all of my thigh flesh contacts the flat area of the seat but if my outer thigh tissue hangs up on the side ridge, I’m at risk of a subtle tugging on my SIs. Building up the seat bottom to eliminate about half the depth of the seat bottom to the top of the side ridges usually solves the problem.
If I have any padding leftover after modifying the seat bottom, I also craft back support for more comfort. Being shoved forward into a hunched position by many seat backs also closes the hip angle, resulting in another persistent tug on my SIs.
There is plenty of room for my feet but the space is misaligned with the seat.
Vehicle Foot Space
Since owning a monster truck that amazingly does not allow the passenger to sit with both feet in line with his or her hips, I now understand how my grumpiness when riding in it emanates from my SIs. The passenger seat itself isn’t centered with the foot well, which displaces my left foot towards the right, putting a small but constant strain on my very vulnerable left side.
We were always baffled as to why such a huge truck crowded the passenger’s left foot and were horribly disappointed to see that many of the full-sized SUVs we were considering did the same. I’m sure the salesmen were baffled by our careful assessment of the passenger seat ergonomics when car shopping recently.
Bill’s meticulous online research had narrowed the field of SUVs to 5 that would meet our towing and off road needs and then declared that we would buy the vehicle that was the most SI-friendly. Of course, having me do all the driving would also have solved the problem but Bill wasn’t keen on being catawampus either once he understood the systematic problem. Luckily, 2 of the 5 finalists allowed the passenger to have proper hip-foot alignment and the final vehicle selection was made on the basis of the driver’s ability to see out the back and side windows.
Airline economy class window seats also can be problematic for SIs, especially if there is little or no gap between the seat and the fuselage. The curve in the main cabin area fuselage at the floor can crowd the nearby foot so it does't align with the hip.MORE SI REMEDIESSI Belts
Shortly after seeing the chiropractor in Palm Springs this winter about my painful SI joint, I bought an SI belt. He didn’t think I’d benefit from one, but for $20 I thought it was worth a try and it was, for both of us.
SI belts & sacral blocks.
The concept is simple and several things will do the job, which is to hold the joints together with pressure from the outside. Before buying the belt, I was particularly uncomfortable one evening and I grabbed a 4” wide exercise band and wrapped it firmly around my hips. The relief was almost instantaneous. It did require the least stretchy black band in the set of 5 to provide enough support, but it provided welcome compression and convinced me to buy an SI belt.
Purchased SI belts are usually a wide fabric belt with a short elasticized segment and a Velcro buckle to secure it. They start at about $20 online; I haven’t seen them for sale in stores.
I wore my SI belt pretty much all day for the first month that I had it and wore it less and less as my joints healed. Now I only use the belt for hiking and running.
The belts are designed to be worn under clothing but I wear mine over my pants. That way it is quick and easy to adjust should it shift or if I failed to get the tension right. Wearing it on the outside also makes it easy to remove at lunchtime during hikes to let the sweat underneath it dry.
Perhaps the biggest surprise was that Bill also benefits from wearing an SI belt. It was at the end of an especially long hike and Bill’s typical “end of the hike back weariness” had set in. He was however, unexpectedly deeply exhausted. I whipped off my SI belt and suggested he give it a try because there wasn’t anything else that would possibly help at that point. Bingo! He felt the immediate relief and he picked up his pace. Bill promptly bought his own belt but only uses it on the descent phase of a hike.
Months later a bodyworker back home confirmed the previously unimagined: that Bill also had SI issues. His joints weren’t as vulnerable as mine, but they were indeed mobile (not everyone’s are) and he was prone to misalignment issues. The bodyworker also warned against becoming too dependent on the belt lest one shortchange themselves by not doing enough strengthening work to support the joints. The SI belt is a useful intervention when the pain level is high or when engaging in stressful activities but is not a substitute for stabilization exercises.
How I'm positioning the sacral blocks.
Our SI belts were added to our growing closet of remedies. A few years ago we realized that we were usually better off looking for remedies rather than cures to our ailments. As one ages, the balance tips and fewer and fewer problems actually have cures and cures seem to always run the risk of side-effects. We think of remedies as generally being mechanical and external rather than surgical or ingested. Our minimalist shoes are an example of a remedy as well as the splints Bill uses to calm the arthritis in his hands.Sacral Pelvic Blocks
When ordering a second SI belt for myself, I actually bit on amazon.com’s “You might also like” suggestion, which was for sacral pelvic blocks. The chiro had used them to treat me in Palm Springs but their use seemed too mysterious for me to treat myself with them. At $30—half the cost of an appointment with the chiro and with rave reviews—I decided to give them a try.
I took my new blocks to 2 bodywork appointments and the 2 opinions as how best to use them gave me confidence to experiment. I used them daily for about 10 minutes at a time for the month that we were at home and they helped keep my SIs in alignment. Too big to carry on our bikes over the summer, I’ll experiment with substitutes and look forward to using the real thing again during our travels to the SW in the fall.
This is a dandy stretch for the adductors of the inner thigh.
My primary bodyworker back home was impressed with the SI joint health improvements triggered by my visits to the Palm Springs chiropractor and noted that now his supportive work centered around releasing the glutes, adductors, psoas, and ITBs. I learned new stretches for 2 of these 4 muscles while at home to support my SI joint health.
I love my new adductor stretch and so far, it seems to be a great substitute for my recently discovered use of a softball as a trigger point roller to release the tension in my adductors. The new stretch is quicker and easier to do than the trigger point work and seems more effective.
Give the stretch a try by lying on your back with your buttocks to the wall. The easiest way to get into position is to sit on the floor sideways to the wall, then rotate you legs up as you bring your back to the floor. Rest both straight legs against the wall and let your right leg slide down the wall towards the floor while keeping the left leg vertical. Both legs should be straight and against the wall. Let the right leg drift towards the floor, but not rest on it, until you get sufficient stretch sensation on the inner thigh. Actively press the left leg against the wall and simultaneously perform Kegel exercises with your pelvic floor muscles. The left leg can drift to the left if the right leg is near the floor and you aren’t getting enough stretch. Bend your knees a bit to make a gentle exit from the position. Repeat on the other side, letting the left leg drift towards the floor to receive the inner thigh stretch.
Upper Psoas Stretch
My favorite psoas stretch had been missing the upper portions of the thick, long psoas muscle, a major hip flexor, which has been contributing to my SI woes. The refinement I needed involved doing the usual lunge but with the forward foot moved from the floor on to a chair, table or kitchen counter, depending on your flexibility.
To stretch the left upper psoas, put the right foot on a piece of sturdy furniture with the left foot back 3-4’ from the object. The left leg is straight, the right knee is bent. Bend back from the hips but emphasize being vertical over doing a deep back bend. If you are flexible, getting a deep stretch takes some fiddling with the position of both feet and the extent of back bending. I like to perform this stretch with support for my hands on both sides, like a chair back on one side and a wall to touch on the other as it can be tippy and it is most effective if it is held for 1-2 minutes.