Talking to the Pro's
Once back in Portland in early September, I learned several new technics for supporting my ailing SI joint from bodyworkers. Those ideas, combined with other points I’d learned earlier this year, triggered some of my own self-care theories to test in the coming months. Read on for what more I’ve learned.

Bend & Twist
Sitting is all it takes to stress SI joints and bending is often worse because it can put even more strain on the joints. Not surprisingly, bending forward and then twisting, or vice versa, is also a loser for irritable SI joints. I now fully understand that bending a little to get into a lower kitchen cabinet and then twisting a little is all it takes to dislodge my vulnerable SI joint. “Thou shalt not….” is my new rule to myself regarding this maneuver. 

I’d been minimizing sitting and bending forward for 8 months and now it was time to be even more refined, which was to bend or twist, not both at the same time, or preferably, turn then bend. I now move my feet first to get into the position that I would achieve by twisting, then squat or kneel on the floor to access a low shelf. I return to standing, without twisting, then move my feet back to where they need to be. Tedious and robotic feeling, but it keeps me out of pain.

When pulling on a heavy door or a tight cabinet latch like in our trailer, I first carefully align myself with the ballistic forces I’m about to create. Instead of being off to the side of the handle as I often am, I make sure to square myself with it before I make the jerking motion. Being off-center with the strong forces can create the ‘bend & twist’ dynamic in my torso that I want to avoid.

Lift the left foot off the floor to keep the knees together to reset the left SI joint.
When dealing with a persistent injury pattern like my SI joint dysfunction pain, “micro-trauma” is a concept that eventually comes to mind. Micro-trauma is a repetitive use injury with the degree of injury being very small but the number of repetitions being very high. The opportunity to bend and twist arises dozens of times in an average day for me so it is likely to be a source of micro-trauma and therefore worth interrupting to aid in healing my SI joint.

Lumbar (Low Back) Pain

 If the bulky back muscle paralleling my spine in the left, low back area, the Quadratus lumborum (QL), is sore, it likely means that my left SI joint is currently so unstable that the back muscles are splinting or contracting to protect the weakened joint. 

Those big postural muscles won’t calm down until the misalignment of SI joint is corrected. Though icing my back muscles may sooth them enough to enable sleep, it’s not enough to fix the problem: I instead need to improve my joint alignment as soon as possible.  And I’m convinced: stretching the QL doesn’t provide any relief when the SI joint is the source of the problem.

DIY SI Joint Adjustment
I now can sometimes reset my misaligned SI joint by using 1 of 2 maneuvers performed on the floor, on my back, with my knees bent and my feet on the floor. With 1 exercise, the knees are kept at the same level and the legs are held together while both legs drop towards the floor on the right side, allowing the left foot to lift off of the floor so as to keep both knees together. The effectiveness of the move requires keeping the top, left knee level with the top of the right knee. 

Holding the rotated position with the legs to the right will open the left SI joint and close the right. After holding the position for minutes, some will hear a “Pop” when and if the joint releases, though I don’t. The goal is to open the joint, allowing it to move beyond its stuck place and encouraging it to properly seat when the legs rotate to the right side, which closes the left SI joint.

Another variation is to have the feet and knees widely spaced rather than held together and then drop both knees towards the same side. This is sometimes called “windshield wipers” because of the wide sweeping track of the legs. This position also opens the SI joint on the side of the raised hip and closes the joint nearest to the floor, so I hold it for a couple of minutes when the left side of my pelvis is high.

”Windshield Wipers” may reset a misaligned SI joint.
If I’m sensing my left SI joint is misaligned, I prefer to begin with the first of these to adjustment technics. The pain level in my left lumbar area increases after 1-2 minutes in the held position, at which point I stay with it a few minutes more. I then slowly swing my knees to the left side and hold a minute, then slowly go back and forth between the 2 sides several more times. I then spend a few minutes doing the windshield wiper exercise. I never feel any profound change while performing these fixes but I usually am more comfortable when I return to standing.

DIY Pubic Bone Adjustment 
I often benefit from re-setting my pubic bone as well when my SI joint is misaligned. On the floor, on my back, with my knees bent and my calves on a chair seat, I firmly press the medium width surfaces of a yoga block between my knees for a minute or so. The position is similar to Fallen Chair Pose (below). 

Immediate Intervention
One of my new strategies for the fall of 2015 was to reset my SI joint and/or pubic bone the instant I sensed that either had slipped out of alignment. When a professional resets my SI, it often slips out of position within 24 hours. That happened several times in the 3 weeks we were home in September, so I became clearer than ever before about recognizing the moment the misalignment occurred and whether it was little slip or a bigger, immobilizing “clunk.” 

To improve my odds of success in keeping my SI joint in alignment, I purchased a cheap, lightly padded, diaper changing pad and sewed an 8” ripstop nylon extension on to it. Only weighing a few ounces and being water resistant, I intended to carry it on the outside of my pack when hiking so I could whip it out and flop on to the ground the moment I sensed a glitch in the joint and attempt to reset it. I hoped that reducing the amount of time that the joint was misaligned would support the deeper healing that needed to occur in the soft tissues of the joint.

Resting in ”Fallen Chair Pose” invites jangled pelvic & back muscles to calm.
Inviting Healing To Happen
What I call “Fallen Chair Pose,” which is resting on your back on the floor with your lower legs supported by a chair seat, was also recommended to me by a massage therapist for my irritated SI joint. Done with your hip and knee joints bent to 90 degrees, this is a “Good for what ails you” pose when your back or hips are painful. I have intermittently used this for resting position for decades when I have felt like I’d strained my back, with good results.

The key with this position is to get comfy, to feel like the legs are well supported, then chill-out. We are talking 5-10 or more minutes to convince the strained or over-worked muscles that they can take a rest. Once the muscles relax, then your body has a chance to heal itself by letting the muscles renegotiate so the ones that are supposed to be working work and the muscles that shouldn’t be engaged will simmer down. 

If your legs feel uneasy in this resting position, try loosely binding them with a yoga strap or a belt around your thighs above the knees. Have the strap slack enough that the knees flop away from each other but are limited in their range of movement. Often muscles will more readily relax if the body is well supported..

Endless Asymmetries
I learned a new exercise this fall that revealed side-to-side differences in my hips though it wasn’t presented as an SI joint pain remedy. But I assume that “outing” all asymmetries in my pelvis must be a good thing for my SI’s, so I added it to my repertoire.

This exercise is performed on the floor in the starting position for bridge pose. Wrap a yoga belt or other strap around your thighs just above the knees with the knees 4-6 inches away from each other. Place the medium width of a yoga block between your ankles. Simultaneously press your ankles into the block and press your legs away from each other and against the strap. Keep the upper body and abs relaxed during this exercise. Hold each rep for about 1 second while using about 50% of your available strength. Perform 3 sets of 20 reps each.

I like to work this exercise 2 ways: one is with my low back relaxed and moving towards the floor and the second way is with a definite arch in my low back. I feel slightly different sensations in the pelvic muscles with these 2 variations.  I also benefit from doing some reps emphasizing the pushing actions more on the left side and then a few making the right side work harder.

”Push Together/Pull Apart” addresses pelvic muscle imbalances in me.
More Field Studies
Empowered by a new round of information about SI joints and having a clearer understanding of the cause of some of the uncomfortable and painful sensations in my pelvis and low back, I embarked on our fall hiking trip with a new optimism. Clearly I needed to develop a strategy for coaxing my highly irritable SI joint into supporting me in the life I wanted to live. I’d listened, learned, and finessed my structurally imperfect knees into letting me play hard for 40 years while keeping them safe (though not always pain-free) and now I was intent on learning how to do the same with my SI joint.

Along with attempting to immediately realign my SI joint on and off the trails, I intended to develop a routine to address related muscle issues. A glute stretch, some reps of bridge or another symmetrical pelvic exercise, and a 10 minute rest in fallen chair pose would form the initial foundation of my SI joint self-care practice.

Reframing My Thinking:  Chronic vs Acute
While obtaining new advice from several different professionals in the fall of 2015 about treating and managing my painful SI joint, I recognized the need to sort my problem-solving strategies into 2 categories: chronic and acute. Doing so was the obvious way to reconcile conflicting advice I had received, all of which had made sense despite being contradictory.

My Portland LMT had shown me the 2 technics above for opening and hopefully, re-aligning, my SI joint when it went out of its proper position. I had the impression that it would only be effective in less severe situations. However, that welcome self-care advice was in complete contradiction with the advice from the Palm Springs chiropractor I’d seen in December and January—he had urged me to stop all twisting and forward bending movements because they were opening the injured joint.

It made sense to eliminate the extreme forces on my painful SI joint when it was in an acute stage and it made sense to open the joint when it was more healthy but misaligned in hopes that it would reset itself. Clearly it was time to select my care strategies in the moment based on the acuteness of the current misalignment and the current severity of the inflammation. We often think of our self-care activities in terms of “project mode” and “maintenance mode” and now I needed to refine the application of my SI joint pain interventions in the same way.

A New Perspective

Signs of Progress
Even though I’d had significant SI pain all summer, I had sensed that the joint was slowly healing and I hoped that the inflammation in the soft tissues was receding. 

The most reassuring sign of improvement during the summer was that the big Quadratus lumborum  (QL) muscle paralleling the spine on my left side was no longer chronically sore like it had been for over a year. The QL will contract to the point of chronic spasm to stabilize the pelvis when something is amiss and I assumed that that was what I had been experiencing. With the seemingly spontaneous release in my QL, it was time to explore other more subtle changes that might keep my SI joints healthy on a day-to-day basis. Since I was generally improving, I might actually be able tell what was helping and what wasn’t.

Subtle Irritant?
Along with limiting movements in which I both bent forward and twisted, I began looking more critically to assess if my right-handedness contributed to my left SI joint irritation. As I understand it, twisting my pelvis to the right tends to open my left SI joint. Since I preferentially reach with my dominant, right hand, I found that I often twisted a bit when reaching to retrieve items. Perhaps this habitual movement pattern was causing a repetitive use injury or micro-trauma to the joint. It was a guess, but like minimizing simultaneously forward bending and twisting, I embarked upon reaching with my left hand more often instead of my right in hopes that it would reduce the strain on my left SI joint. 

Subtle Benefits?
A week into our fall road trip, my SI joint was suddenly more resilient. It had been in, and painfully out, of alignment multiple times during our 3 week stay at home. During that time, 4 different practitioners had worked on my body and each had weighed-in on my SI. I’d also begun sleeping with a proper knee pillow, started doing the new exercises mentioned above for my SI, and had been more attentive to minimizing the stress on the joint during bending, twisting, and reaching activities. My best guess was that all or most all of the lifestyle changes were helping to some degree.

Timing Is Everything?
We left town on October 1 and had several driving days, which aren’t good for SI joints, and then began hiking hard. We hiked 65 miles in 10 days and did a 40 mile bike ride within that interval as well. Amazingly, my SI awareness was nothing more than a whisper the entire time.

I was immediately stunned by the new stability of my SI joint during this latest active spell and especially because the joint was more comfortable during and after a hike than in the preceding several hours on a particular day. The obvious conclusion (though not necessarily correct) was that when my SI joint was doing well that it benefited from more activity rather than less. I surmised that the rhythmic, repetitive motion of walking might help confused and irritated muscles reorganize their actions IF the joint wasn’t overly irritated or inflamed. It seemed like it could be a good example of the importance of tailoring my activities to the wellness state of my SI: I knew that hiking when my SI was misaligned triggered pain and Quadratus lumborum spasm and hiking when it was aligned seemed to actually sooth the muscle groups in my legs and pelvis.

Accelerating Healing
It’s always seemed like a contradiction, but I often feel like I can only sort out how to get well when I’m not very sick. When my body is overly injured, it’s hard to tell what helps because everything seems to hurt it or nothing makes it feel better. And the opposite is true as well: once my body starts mending, I can better determine what it needs. I try to learn everything I can during the healing phase to inform myself should the injury recur.

Curiously, about 2 1/2 weeks into our road trip to hiking venues in the US intermountain west, my SI suddenly improved further. The change correlated with deeply massaging my upper quads by rolling that upper, lateral thigh area over a softball on the floor. I stumbled upon this sweet-spot after my hardworking quads were recovered  enough that I could massage out most of the knots in the belly of the muscles in the mid-thigh area using a Trigger Point foam roller and a rolling pin. Only then, when they weren’t particularly knotted, could I work even more deeply on the upper most portions of the quad muscles near the hip by rolling over a softball.

It was a painful process but when I returned to standing the first morning after the intense tissue work, I could tell that the softball trigger point release on my left quads had made my left SI joint more comfortable. The next morning, there was far less pain in “rolling out” the upper quads and the ever-present dull ache of my SI joint was all but gone. And the 3rd morning, the discomfort with the intense self-massage was even less and my SI joint was even more at ease during the day.

Finally getting access to and relief in this patch of chronically tight muscles felt like a turning point and I eagerly worked the same area on my right side as well. 

"Peeling The Onion"
When dealing with longstanding physical or emotional pain, the healing process is often like peeling an onion: it has to be done in layers and both timing and sequencing matter. By the end of October, I felt like that was my process with my psoas, that I’d peeled off the layers of armoring in the quads and could actually work with this deeper muscle. The softball work on my upper quads likely gave me new access to my cranky psoas on both sides.

My latest psoas stretch: Elevating the hips to stretch the left psoas (not suitable for everyone).
The psoas is a massive muscle that attaches on the upper thigh, crosses the pelvis at the front of the hip, then dives deep and attaches to the spine in the back. I’d long suspected that psoas tightness or a psoas-related imbalance was important in my SI issues and so had been including stretches for them in my daily wellness routine.

My sense had been that my stretches and the work of my massage therapists had only kept the psoas involvement from getting worse, but that whatever was agitating them wasn’t being fully addressed. Then something changed: one morning I could suddenly go deeper into my quads. The next day, I could dig into the superficial aspects of my psoas with a softball. Whatever had been stuck, probably for years, was finally shifting though I haven’t a clue as to what allowed me to work more deeply. It was exciting times in my SI joint pain journey for sure.

After 3 days of deep roller and softball work on my upper quads and psoas, I felt a dramatic sensation change when in Bridge Pose, especially around my pesky, right psoas. When at the top of the movement, I could feel an almost stabbingly deep—though welcome--pull in my pelvis on both sides. It felt like I had more range of motion in the pose and a very strong, symmetrical pull.

The immediate message was that I was  probably experiencing a major breakthrough in unraveling the psoas component of my SI problems. The big-picture lesson was to keep plugging away on all fronts because there is no way to know when or where the next break-through will be—that’s the way it is with peeling the onion.

The frustrating lesson from striving to permanently quiet my SI joint dysfunction is that the details of what is working for me in dealing with muscle imbalances won’t necessarily help the next person. I suspect that the root of many SI problems is muscle imbalances, but which parts of what muscles is probably different for each person. It’s a game of hide-and-seek in which we each must find the tugging culprits, one-by-one.

I was quickly convinced that deep tissue self-massage by painstakingly rolling over the softball was going to be a part of my daily SI wellness routine. Keeping the upper quads, the psoas, and glutes in the buttocks soft and resilient seemed important for my overall SI joint health, just like decreasing the density of my lower quads with the softball was important for my knee comfort.

Getting There
Slowly but surely, I feel like I am clawing my way out of this “pain hole” caused by my SI joint misalignment vulnerability. The lifestyle changes that I made on the advice of the Palm Springs chiropractor last winter are key to both coping with the acute and chronic phases, including minimizing sitting, standing symmetrically, and sleeping with a knee pillow.

Making other small lifestyle changes, like not simultaneously bending and twisting, ‘squaring myself up’ before jerking on resistant doors, and keeping my pelvis square when reaching and standing, seem to be helping. I also have continued a decades-old practice of modifying chairs and seats to open up the hip angle a tad rather than being in a bucket seat configuration.

I am certain that maintaining my daily self-care routine of stretches; strengthening exercises like bridge; and muscle/fascia tightness release work with the foam roller and softball, are also key to the long term health of my SI joint. My ‘morning mat work’ has always had a heavy emphasis on coaxing my troublesome knees into being high-performers and now my SI joint needs are stealing the morning show. Both my knees and SI joint will likely always have special place in my ongoing attention to my wellness. I’ve long felt that discipline is the key to aging gracefully and they will continue to get my best.