SI Joint: Sacral Torsion & the Hesch Method June 2020
Different Solutions for Different Problems
There has been a 4 year-long dormant period in the deepening of my understanding of sacral-iliac joint dysfunction (SIJD) and I am reveling in new clarity, an “ah-ha” moment. Like most complicated subjects, they are simpler once you understand them.
Only now do I know to think of SIJD as having one of 2 major sources. The dysfunction source with which I was previously familiar was when there is a tiny misalignment between the 2 bones at the joint on a relatively vertical axis when in standing. The misalignment occurs between the sacrum (triangular posterior pelvic bone in your midline) and one of the 2 ilium (the big bones on each side of the sacrum). Visualize a broken ceramic plate when the 2 pieces line-up just right, the jagged edges snap perfectly into place, almost seamlessly. That’s what your SIJ looks like when it is normal. Sufferers from misalignment at this junction often achieve relief from their pain by wearing an SI belt low on their hips, which provides the support for this delicate joint that the overstretched ligaments can no longer provide.
The other major source of dysfunction, the one that is new to me, is called sacral torsion. In sacral torsion, the SI joint itself likely isn’t disturbed but there likely is muscle tension putting torque on the SIJ in this condition. This condition is largely a muscle and/or nervous system triggered-problem that twists the sacrum and the ilium in out of the vertical plane.
The detailed studies haven’t been done to precisely know what occurs in SIJD and there may be overlap in these 2 misalignment conditions. Nonetheless, it is helpful to think of them as 2 different issues: bones shifting out of position relative to each other and likely lacking robust stabilization by the ligaments vs muscles or nerves that are triggered to cause a rotation of the 2 bones.
In my experience, the treatment and healing timeline of these 2 sources of SIJD are markedly different. When my SIJ bones were out of alignment, it took about 18 months for the overstretched ligaments crossing the joint to heal sufficiently for me to be comfortable and resilient. In contrast, sacral torsion can be resolved in about 2 minutes and “stick.”
My Treatment Experience with the Hesch Method
My Symptoms
In 2020, I was suspicious that I had an underlying structural alignment issue because of a recurrent cycle of muscle pain in my right buttock that triggered a cascade of spasms in the: Gluteus minimus, Gluteus maximus, TFL, inner thigh adductor, lateral hamstring, abdominal obliques (which caused back pain), and occasionally the psoas.
It was a painful cycle that had been brewing for years and had been particularly active for over 18 months; sometimes it would reduce me to slowing limping off of a hiking trail. I had been aggressively self-treating it with do-it-yourself myofascial release but I could not break the cycle of pain. Professional massage had been very effective in maintaining my high level of physical activity but it ceased to be available to me in the coronavirus pandemic, putting me into crisis.
The Hesch Method
Victoria, a new online, SIJD pen pal, took the opportunity to be treated by Jerry Hesch of Aurora, Colorado, when he was seeing clients in Ohio in early June. Two days after learning of her “miracle cure” in a 2 minute treatment of a 10 year-old cycle of SIJ pain, I sent an email inquiry to Jerry. Her ‘fix’ was unbelievably fast, but the theory behind the treatment was compelling to me.
Jerry replied overnight and by 10:45 the next morning, my husband and I were off to Golden, CO with our trailer. We had been outside of Grand Junction, CO for 2 months because the prevalence of coronavirus infections there was 1/4 - 1/3 the prevalence at home in the Pacific NW. Unfortunately, the Denver area was a hot spot for the virus, with the infection rate in Aurora being 10 times great than where we were in Fruita.
We had been employing our very best obsessive-compulsive skills for 3 months to avoid contact with the coronavirus and going for several one-on-one treatments of more than 15 minutes was against all of our best practices but my level of pain and dysfunction made assuming the infection risk seem like an acceptable trade-off. Of course, if we developed COVID-19, our opinion would change. Jerry didn’t share my level of concern about the risk of infection but he did oblige my request to wear a mask.
The Hesch Method of treating joints, especially the SIJ, was developed by Jerry Hesch, a physical therapist with advanced training. He has distilled a huge body of knowledge and experience down to very gentle, simple manipulations that he employs for 2 to 4 minutes at a time. It’s almost like energetic practices in its subtlety and a bit like chiropractic in his use of positioning. There is no pain, no ballistic movements; it’s very quiet and passive for the patient. It appears that his maximal treatment plan is 3 visits of 2 hours each on consecutive days.
Treatment Areas
My upper 2 vertebrae, C1 (atlas) and C2 (axis) were stuck, perhaps from a bicycle crash. Jerry released those with light traction of my neck by placing his flat hands on my temples for 2 minutes with my head slightly elevated by him while I was on my back.
The 3rd rib on my left side was stuck and mobility was spontaneously restored from his treatment of my sacral torsion.
The 3rd rib on my right side was stuck and mobility was restored while on my belly with my neck bent to my right and Jerry applying steady pressure to the rib for several minutes.
I had “left on right” or “left rotation on right oblique” sacral torsion that Jerry treated while I was face down. I didn’t understand what he did to correct it but could feel the before and after differences when he applied his spring test with his hand for mobility.
My coccyx (tailbone) was immobile and twisted. I don’t know what his correction was for it but he said it was a permanent fix.
Appointment Duration
Jerry booked me for 2 consecutive appointments, which seems to be his standard. He can correct some problems with the first visit but he appears to routinely see people back the next day, which is what he did with Victoria as well. It seems that his treatment strategy is a “peel the onion” one in which he wants to see a client the following day to assess the effects of his work and perhaps do more. In my case, the second appointment, which was expected to be 30”, extended past an hour because I was still having discomfort in my right buttock. On the second appointment, he did addition work with mobilizing my right rib.
Different Solutions for Different Problems
There has been a 4 year-long dormant period in the deepening of my understanding of sacral-iliac joint dysfunction (SIJD) and I am reveling in new clarity, an “ah-ha” moment. Like most complicated subjects, they are simpler once you understand them.
Only now do I know to think of SIJD as having one of 2 major sources. The dysfunction source with which I was previously familiar was when there is a tiny misalignment between the 2 bones at the joint on a relatively vertical axis when in standing. The misalignment occurs between the sacrum (triangular posterior pelvic bone in your midline) and one of the 2 ilium (the big bones on each side of the sacrum). Visualize a broken ceramic plate when the 2 pieces line-up just right, the jagged edges snap perfectly into place, almost seamlessly. That’s what your SIJ looks like when it is normal. Sufferers from misalignment at this junction often achieve relief from their pain by wearing an SI belt low on their hips, which provides the support for this delicate joint that the overstretched ligaments can no longer provide.
The other major source of dysfunction, the one that is new to me, is called sacral torsion. In sacral torsion, the SI joint itself likely isn’t disturbed but there likely is muscle tension putting torque on the SIJ in this condition. This condition is largely a muscle and/or nervous system triggered-problem that twists the sacrum and the ilium in out of the vertical plane.
The detailed studies haven’t been done to precisely know what occurs in SIJD and there may be overlap in these 2 misalignment conditions. Nonetheless, it is helpful to think of them as 2 different issues: bones shifting out of position relative to each other and likely lacking robust stabilization by the ligaments vs muscles or nerves that are triggered to cause a rotation of the 2 bones.
In my experience, the treatment and healing timeline of these 2 sources of SIJD are markedly different. When my SIJ bones were out of alignment, it took about 18 months for the overstretched ligaments crossing the joint to heal sufficiently for me to be comfortable and resilient. In contrast, sacral torsion can be resolved in about 2 minutes and “stick.”
My Treatment Experience with the Hesch Method
My Symptoms
In 2020, I was suspicious that I had an underlying structural alignment issue because of a recurrent cycle of muscle pain in my right buttock that triggered a cascade of spasms in the: Gluteus minimus, Gluteus maximus, TFL, inner thigh adductor, lateral hamstring, abdominal obliques (which caused back pain), and occasionally the psoas.
It was a painful cycle that had been brewing for years and had been particularly active for over 18 months; sometimes it would reduce me to slowing limping off of a hiking trail. I had been aggressively self-treating it with do-it-yourself myofascial release but I could not break the cycle of pain. Professional massage had been very effective in maintaining my high level of physical activity but it ceased to be available to me in the coronavirus pandemic, putting me into crisis.
The Hesch Method
Victoria, a new online, SIJD pen pal, took the opportunity to be treated by Jerry Hesch of Aurora, Colorado, when he was seeing clients in Ohio in early June. Two days after learning of her “miracle cure” in a 2 minute treatment of a 10 year-old cycle of SIJ pain, I sent an email inquiry to Jerry. Her ‘fix’ was unbelievably fast, but the theory behind the treatment was compelling to me.
Jerry replied overnight and by 10:45 the next morning, my husband and I were off to Golden, CO with our trailer. We had been outside of Grand Junction, CO for 2 months because the prevalence of coronavirus infections there was 1/4 - 1/3 the prevalence at home in the Pacific NW. Unfortunately, the Denver area was a hot spot for the virus, with the infection rate in Aurora being 10 times great than where we were in Fruita.
We had been employing our very best obsessive-compulsive skills for 3 months to avoid contact with the coronavirus and going for several one-on-one treatments of more than 15 minutes was against all of our best practices but my level of pain and dysfunction made assuming the infection risk seem like an acceptable trade-off. Of course, if we developed COVID-19, our opinion would change. Jerry didn’t share my level of concern about the risk of infection but he did oblige my request to wear a mask.
The Hesch Method of treating joints, especially the SIJ, was developed by Jerry Hesch, a physical therapist with advanced training. He has distilled a huge body of knowledge and experience down to very gentle, simple manipulations that he employs for 2 to 4 minutes at a time. It’s almost like energetic practices in its subtlety and a bit like chiropractic in his use of positioning. There is no pain, no ballistic movements; it’s very quiet and passive for the patient. It appears that his maximal treatment plan is 3 visits of 2 hours each on consecutive days.
Treatment Areas
My upper 2 vertebrae, C1 (atlas) and C2 (axis) were stuck, perhaps from a bicycle crash. Jerry released those with light traction of my neck by placing his flat hands on my temples for 2 minutes with my head slightly elevated by him while I was on my back.
The 3rd rib on my left side was stuck and mobility was spontaneously restored from his treatment of my sacral torsion.
The 3rd rib on my right side was stuck and mobility was restored while on my belly with my neck bent to my right and Jerry applying steady pressure to the rib for several minutes.
I had “left on right” or “left rotation on right oblique” sacral torsion that Jerry treated while I was face down. I didn’t understand what he did to correct it but could feel the before and after differences when he applied his spring test with his hand for mobility.
My coccyx (tailbone) was immobile and twisted. I don’t know what his correction was for it but he said it was a permanent fix.
Appointment Duration
Jerry booked me for 2 consecutive appointments, which seems to be his standard. He can correct some problems with the first visit but he appears to routinely see people back the next day, which is what he did with Victoria as well. It seems that his treatment strategy is a “peel the onion” one in which he wants to see a client the following day to assess the effects of his work and perhaps do more. In my case, the second appointment, which was expected to be 30”, extended past an hour because I was still having discomfort in my right buttock. On the second appointment, he did addition work with mobilizing my right rib.
Chest opener for the neck.
Exercises
I was prescribed 4 specific corrective exercises using foam props; a set of general back exercises that are done on the floor; and to use a lift to place under my left sit bone when sitting.
Sacral Torsion Correction
Place a 2” diameter foam piece or rolled towel about 1” above the top of your tailbone and about 1” below your waist while standing with your back to the wall. Your feet are hip width apart and about 6” from the wall. Let your shoulders drift to the wall. Begin the simple “sipping bird” movement by pivoting from the hips and taking your nose over your toes without rounding your back. It’s not a big movement: repeat 10 times. For me, this is a daily-forever exercise to maintain proper alignment of the sacrum as well as correcting any torsion. (See the first YouTube video below.)
Chest Opener for the Neck
I place a 4-5” high foam roll under each shoulder when face down and let my chest and head droop to the floor for 3-5 minutes. Jerry recommended doing it 3 days in a row and then once a week-forever. The same instructions were given for the following 2 exercises as well.
Rib Adjustment
Jerry had mobilized my right 3rd or 4th rib but wanted me to supplement his treatment at home. He gave me an irregular-shaped foam piece with a flat bottom to place on the floor and under my back ribs between my spine and shoulder blade. He recommended resting on it for 3 minutes.
Upper rib adjustment.
Buttock release.
Buttock Release
Resting on my back with a ½ round of foam lengthwise under the outer edge of my right buttock for 3 minutes was his last effort to eliminate the deep ache in my buttock. I was instructed to repeat it on the left side for symmetry. He also recommended using a roller to self massage the muscles, which I already was aggressively doing with myofascial release.
YouTube Videos (look for the “Skip Ads” button on the right)
https://youtu.be/ofyajuhIajI 12” DIY sacral torsion correction
https://www.youtube.com/watch?v=P93HsaDHuQU 17” sacral torsion & neck immobility
https://www.youtube.com/watch?v=oKDPKv4iV2c&t=51s 8” daily simple back mobility exercises
https://www.youtube.com/watch?v=-KNr9QN8KeY&t=21s 11”everyday body mechanics (including a great tip about pinching your shoulder blades together to stabilize the shoulder joints when reaching forward, which also applies to good posture on a bicycle and when hiking)
Resting on my back with a ½ round of foam lengthwise under the outer edge of my right buttock for 3 minutes was his last effort to eliminate the deep ache in my buttock. I was instructed to repeat it on the left side for symmetry. He also recommended using a roller to self massage the muscles, which I already was aggressively doing with myofascial release.
YouTube Videos (look for the “Skip Ads” button on the right)
https://youtu.be/ofyajuhIajI 12” DIY sacral torsion correction
https://www.youtube.com/watch?v=P93HsaDHuQU 17” sacral torsion & neck immobility
https://www.youtube.com/watch?v=oKDPKv4iV2c&t=51s 8” daily simple back mobility exercises
https://www.youtube.com/watch?v=-KNr9QN8KeY&t=21s 11”everyday body mechanics (including a great tip about pinching your shoulder blades together to stabilize the shoulder joints when reaching forward, which also applies to good posture on a bicycle and when hiking)
My treatment video #1.
My treatment video #2.
Comparison With Other Modalities
Here’s how I think of Jerry’s model in comparison with other modalities I’ve experienced:
Subtle Arts or Energy Practices
..craniosacral therapy
..Aston-Patterning
..acupuncture for orthopedic issues
Passive Positioning Systems
..Egoscue
..Hesch Method
Direct Intervention
..massage
..myofascial release
Ballistic Forces
..chiropractic
RECOMMENDATIONS
Massage
In an ideal world, or at least not in the midst of a pandemic, I would have received high-quality bodywork from one of the sports massage people I use both before and after seeing Jerry. One to 3 sessions beforehand would give them an opportunity to be clear as to what they thought the various troubled muscle groups were doing before the adjustments. I would welcome an equal number of massage appointments with that same person after my treatment sessions with Jerry. Doing so would add the bodyworker’s considerable wisdom to my journey, which they could then share with me, and their work would speed my muscles in adapting to the changed geometry in my body. I would welcome knowing what shifted in the muscle response with the joint work done by Jerry.
Egoscue
Both my friend Victoria and I experienced continued crankiness in our buttock muscles, our original complaints, after Jerry’s treatments were completed. We were both left hoping that our bodies would finish the healing journey, the rebalancing, on their own. I believe that we both would have found our end points, relief from pain, more quickly with the support of massage work.
Ten days after completing my treatments with Jerry, which was about 2 weeks after Victoria had finished hers, neither of us were free of our buttock pain. I continued doing the exercises that Jerry prescribed and added 4 hip exercises from the Egoscue method in the “Pain Free” book by Pete Egoscue.
Egoscue is a very subtle, passive, method of treating postural issues that I hadn’t used before though my husband had, with great success, in treating his chronic back pain. Like him, I started getting relief from my pain after my first self treatment. My routine of the Egoscue hip pain exercises took about 45” and was almost effortless. For the hips, it is largely a “put it in position and wait” approach. Each day on the trail, my speed and fluidity increased and my pain during and after my hike decreased. I added light myofascial release work on the floor with a massage ball to monitor and soften the still-cranky buttock muscles, though they were fewer in number.
At the time of this writing in early July of 2020, neither Victoria or I were pain free but we were both clear that Jerry’s Hesch method for realigning our SIJ and spines had given us a solid foundation for moving forward. If the spine isn’t aligned, the muscles cannot be calm. I continued supporting my healing with daily Egoscue hip pain exercises and using myofascial release technics on the buttock muscles, especially on the Obturator internus; Victoria resumed her preferred treatment of dry needling. Jerry’s sacral torsion fixes were holding for both of us.
PS
While I was being treated by Jerry, my husband, who wasn’t seen by him but who has had chronic, low-grade discomfort in the SIJ area, benefited from using Jerry’s sacral torsion fix after about 4 days of repeating the exercise. He used the ½ tube of foam on his sacrum at the wall and did about 10 reps once or twice a day as shown in the first video listed above. His low-grade ache disappeared. It’s a quick, easy self-care technic that we have both added to our daily routine to promote our larger goal of “exceptionally successful aging.”
I believe that Jerry’s mobility work, particularly at the base of my neck, dramatically improved the headaches and dizziness I was having from amiloride, a diuretic I take for hypertension. Both the headaches and dizziness were reduced after the first treatment and continued to improve over the following week. That improvement makes perfect sense in the chiropractic model though I doubt that my internist would make the attribution.
Cost
The total cost of my treatment excursion was about $1000. A little over half of that amount were charges for Jerry’s time; the remainder was for 4 nights at an expensive RV park outside of Denver and for gas for about 750 miles of driving.
Here’s how I think of Jerry’s model in comparison with other modalities I’ve experienced:
Subtle Arts or Energy Practices
..craniosacral therapy
..Aston-Patterning
..acupuncture for orthopedic issues
Passive Positioning Systems
..Egoscue
..Hesch Method
Direct Intervention
..massage
..myofascial release
Ballistic Forces
..chiropractic
RECOMMENDATIONS
Massage
In an ideal world, or at least not in the midst of a pandemic, I would have received high-quality bodywork from one of the sports massage people I use both before and after seeing Jerry. One to 3 sessions beforehand would give them an opportunity to be clear as to what they thought the various troubled muscle groups were doing before the adjustments. I would welcome an equal number of massage appointments with that same person after my treatment sessions with Jerry. Doing so would add the bodyworker’s considerable wisdom to my journey, which they could then share with me, and their work would speed my muscles in adapting to the changed geometry in my body. I would welcome knowing what shifted in the muscle response with the joint work done by Jerry.
Egoscue
Both my friend Victoria and I experienced continued crankiness in our buttock muscles, our original complaints, after Jerry’s treatments were completed. We were both left hoping that our bodies would finish the healing journey, the rebalancing, on their own. I believe that we both would have found our end points, relief from pain, more quickly with the support of massage work.
Ten days after completing my treatments with Jerry, which was about 2 weeks after Victoria had finished hers, neither of us were free of our buttock pain. I continued doing the exercises that Jerry prescribed and added 4 hip exercises from the Egoscue method in the “Pain Free” book by Pete Egoscue.
Egoscue is a very subtle, passive, method of treating postural issues that I hadn’t used before though my husband had, with great success, in treating his chronic back pain. Like him, I started getting relief from my pain after my first self treatment. My routine of the Egoscue hip pain exercises took about 45” and was almost effortless. For the hips, it is largely a “put it in position and wait” approach. Each day on the trail, my speed and fluidity increased and my pain during and after my hike decreased. I added light myofascial release work on the floor with a massage ball to monitor and soften the still-cranky buttock muscles, though they were fewer in number.
At the time of this writing in early July of 2020, neither Victoria or I were pain free but we were both clear that Jerry’s Hesch method for realigning our SIJ and spines had given us a solid foundation for moving forward. If the spine isn’t aligned, the muscles cannot be calm. I continued supporting my healing with daily Egoscue hip pain exercises and using myofascial release technics on the buttock muscles, especially on the Obturator internus; Victoria resumed her preferred treatment of dry needling. Jerry’s sacral torsion fixes were holding for both of us.
PS
While I was being treated by Jerry, my husband, who wasn’t seen by him but who has had chronic, low-grade discomfort in the SIJ area, benefited from using Jerry’s sacral torsion fix after about 4 days of repeating the exercise. He used the ½ tube of foam on his sacrum at the wall and did about 10 reps once or twice a day as shown in the first video listed above. His low-grade ache disappeared. It’s a quick, easy self-care technic that we have both added to our daily routine to promote our larger goal of “exceptionally successful aging.”
I believe that Jerry’s mobility work, particularly at the base of my neck, dramatically improved the headaches and dizziness I was having from amiloride, a diuretic I take for hypertension. Both the headaches and dizziness were reduced after the first treatment and continued to improve over the following week. That improvement makes perfect sense in the chiropractic model though I doubt that my internist would make the attribution.
Cost
The total cost of my treatment excursion was about $1000. A little over half of that amount were charges for Jerry’s time; the remainder was for 4 nights at an expensive RV park outside of Denver and for gas for about 750 miles of driving.