This article is a transcribed edited summary of a video Bob and Brad recorded in April of 2023. For the original video go to https://www.youtube.com/watch?v=ZtJNlTs_bCc
Brad: Are you having SI pain or sacroiliac pain? It’s right in the buttocks and lower back. If you have it, you know it. It goes down the leg to the knee. We’re going to do five techniques that have worked in the clinic, for our commenters, and for me personally.
Mike: We’re going to show you how to do them all and you just pick which ones work for you. Some are exercises and some are other strategies to try to relieve that pain.
Brad: That’s right. I’m excited because these really work. Let’s do a little anatomy on the SI joint. First, we say SI, that's an abbreviation for sacroiliac. That comes from the sacrum and ilium, so the sacroiliac joint. This is a nice model we have because it moves. Now, in a real human, there are a lot of ligaments holding this joint together, quite solid, it doesn’t move very much. A little bit of movement can cause a fair amount of pain.
Mike: Pain is very common with weight-bearing activities or walking. It can be sharp, and it can go down to the knee if it gets that bad.
Brad: Right, usually not below the knee. What we’re going to show you is how to stabilize this and keep it from moving with five different exercise options. The first two techniques are going to be done lying down. You can do this on your bed or on the floor. They’re muscle energy techniques. What happens is your muscles, because of an isometric contraction will put force on the pelvis and a rotational force and put it back into place. It’ll feel better if you’re doing it properly. If you’re doing it wrong and it’s going in the opposite direction, it will hurt. In that case, you simply stop that exercise. Mike is going to show the first one.
Mike: You’re going to bring the side that is painful first. You’re going to bring that knee up to your chest as far as you can. Your other leg will be relaxed. What I’m going to do is push my foot towards Brad, while resisting with my hands. You’re going to hold this for six seconds, then relax. How many times should we do that?
Brad: If it feels good, you’re going to repeat it up to five times and then do it every hour until things start to feel better. Again, if it hurts, then you’ll stop and go to the next one.
Mike: Should we try this on both legs?
Brad: You can. You’re probably going to do it on the side that hurts. You can try it on the other one and only continue if it makes things feel better. As a therapist, we can zero in on one side or the other because we’ve done a complete assessment. In your case, you’ll just have to try and listen to your body. Only progress with that technique if it makes it feel better and that goes for all of them. Should we do the next one in this position?
Mike: Sure.
Brad: All right. With this, you’re going to need a stick. You can use a mop or a cane or you can use a Booyah Stik if you have one. They’re a little longer than you need though. We’re going to put the stick under your knee.
Mike: It’s going to go under the painful side, in the crevice of your bent knee. Your leg is going to push down like it did before, but you’re going to use your other leg to pull up toward your face simultaneously. Sometimes when you do this, the cane is going to move a little, so you’re going to have to stabilize it with your hand. Hold that for six seconds. Pushing and pulling in opposite directions and then you’re going to relax. It’s the same concept as the first, just a little more advanced.
Brad: Right. Do it one way, if you don’t have good results, try it the other way. If neither of those works, go on to the next one. The third option and this is one of my personal favorites is massage. I have right SI problems from time to time. I’ll get a massage gun out. This is our UNI massage gun and it works quite well. You need to have a massage gun that reciprocates back and forth. We have about 10 millimeters of amplitude on this one. You’re going to want either the round or air-filled head. Not all massage guns have air-filled heads but when using it on the SI joint it is almost necessary unless you know how to use a round head. This is exactly how I do it. I lie on my side with the problem side facing up. Flex the hip, in other words, bring my knee up and relax it. Get the massage gun going and put it at about half power. Work not on the sacrum, that’s the bone. It doesn’t hurt because I have an air-filled head but it’s not doing much good either. You want to go in on that and simply go where it feels good. You may work down on the ischial tuberosity, which is part of the pelvis to get things moving in the right direction. If you have a round head, turn it sideways, it’s less aggressive. As you want to get more aggressive, you rotate the gun directly into it and use as much force as you need. It should only feel good, if it hurts it’s not the right technique for you. You can also do this with a chair. Just put your problem side leg on the chair or stool and work it that way as well, if you have good balance. You’re going to work on this for one to two minutes.
Mike: So we should say the point of the massage gun is to calm down the muscles surrounding the SI joint that are irritated right now to get them to relax. It’s not going to solve the original problem, but it will feel good and help relieve some of that pain.
Brad: Right. If things relax and you work it, it will hopefully slide back into place. You’ll know. Now, the fourth option, I personally have not had success with, but I’ve had several patients and so has Bob have success with this. It’s using an SI belt. We’re going to show you one you can buy, but you don’t necessarily have to buy one. You can just use a belt from home. The placement of the belt is critical. What the belt does is it squeezes together and prevents that SI joint from moving, creating that pain. The belt goes around, below the iliac crest. Right around the pelvis and then tighten the belt and simply stand up and walk around. You’ll know it works because if it hurts to walk after the belt is on, the pain will go away dramatically, and you know you’re on the right track. If that’s the case, you should go ahead and buy a real SI belt. They work better and they’re more comfortable.
Mike: There are many brands you can choose from. We’re not saying any are better than the other. We just happen to have a Serola belt. This is what Deb Riczo, who is an SI joint pain PT master kind of, recommends and sells this one. This one has two straps you can pull apart and tighten to make more pressure on that SI joint in there. Just go to whatever feels comfortable. Make sure you buy the right size for you.
Brad: Before you do that, I want to give a little more attention to the belt. You’re going to put it on and it’s going to go lower than you think, lower than your normal belt. Pull it as tight as you can. I had a patient last fall do this. He was excited. He used his belt for the whole treatment. Do not wear it to bed, just when you’re up and walking, and for a few days to a week. Maybe two weeks and things will settle down.
Brad: The fifth exercise is one of the go-to's for me for maintenance, particularly to keep my SI joint in place. I’ll do this hip flexor stretch. Get a stool, park bench, or whatever is available that is steady and solid. Put your foot on it and lean forward to stretch it. It should feel good. If it doesn’t, do not do it. I’ll spend about 20-30 seconds stretching and I’ll do a little noodling or move my hip around. So, work on all five, pick the ones that work for you that feel good. Good luck!
Mike: You can do it on stairs, you can do it on anything. Pick what height is comfortable for you and you feel like you're not going to fall over. So, again, we're working on the right side if that is the painful side. Then bend forward, just kind of noodle around like Brad said. I'm moving more from my backside, or you can just move the hip more. Whatever feels best for you, there's no right or wrong to this. It's just supposed to help relieve some of that pain and get that pelvis tilted where it needs to be for the SI joint.
Brad: Yeah, very good. Excellent job, Mike. That noodling thing is kind of going to kind of weird some people out. Well, we learned it from one of the experts.
Mike: Kelly Starrett.
Brad: Kelly Starrett, yeah. So, blame it on Kelly, if you don't like the term noodling. He's a heck of a nice guy. He's a really, really outstanding therapist. All right. SI joint, pick out the ones that work for you that feel good.
Mike: And let us know what works for you and what you like in the comment section below.
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