Posterior lumbar and pelvic skeletal and surface muscle anatomy with SI joint pain

SI Joint Pain – Help at Home

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Do you have one small, painful spot on your back? Right where the blue arrow is pointing?

ICK.

Pain in this area is one of the main indicators of sacroiliac joint (SI joint, or SIJ) pain. This pain can occur when the joint between your sacrum (your tailbone) and your ilium (the big curved bone of your pelvis) gets pulled out of alignment, usually because of tight muscles around the hip.

Wait, I have a joint there?

You do! The pelvis isn’t one solid block of bone. It’s actually made up of five bones that fit together like puzzle pieces to form a more-or-less solid girdle. I say more or less because there can be some slight give in the joints between the bones. The three bones of the hip (the ilium, the ischium, and the pubis) are fused, and your SI joint is the connection between your sacrum and your ilium.

This joint functions a little like a zipper, with strong layers of ligaments holding the two pieces together while still allowing some small amount of movement. But it’s built for stability, and too much movement or pull in any one direction and you’ll know about it, often with a pain at the back of the hip, towards the top of the SI joint.

Posterior pelvis skeletal anatomy with SI joint pain

The Snowball Effect: The SIJ version

When we have pain or trauma (like slipping and falling, or jarring a joint) to joints, muscles, or other tissues, the body quickly tightens muscles around the area to help protect it from further damage or irritation. Great! Except that the protective tension can also lead to additional irritation via the misalignment discussed above.. And the ball rolls on until you put a stop to it.

Ok, so what should I do if my SI joint hurts?

Joint misalignment is often due to tight muscles, fascia, and other soft tissues; Your SI joint has a lot of muscles and fascia surrounding it. (If you want to dive deep into the muscles, ligaments, and bone related to the SIJ, go here. So loosen them up!

Trigger point self-therapy in the glute region, the adductor region (inner thigh), the outside of the hip, and even through the lower back can provide relief from SIJ pain. All you need is a tennis ball! Here’s how: sit or lay on the tennis ball, or lean into it by pinning it against a wall in the areas shown below.

Trigger Point for Glute (Bum) Muscles

SIJ Line Glute Trigger Point for SI joint pain

Sit with the tennis ball pressing into the soft tissue to the side of the sacrum (tailbone). Roll it or move it up and down to find tight spots and hold it until the tension or soreness disappears. Use a moderate amount of pressure – it should feel like “good hurt”.

Trigger Point for Adductor (Inner Thigh) Muscles

Foam roller adductor trigger point for SI joint pain

Lay face down with one knee out to the side, hooked over the roller so the roller is pressing on the inner thigh, foot to the outside of the roller. Roll it or move it up and down to find tight spots and hold it until the tension or soreness disappears (it’s safe to apply pressure this way anywhere between just above the knee and the crease of the hip). Use a moderate amount of pressure – it should feel like “good hurt”.

Trigger Point for TFL and Glute Min (Outside Of Hip) Muscles

TFL and Glute min Trigger Point for SI joint pain

Lay on your side with a tennis ball in the fleshy part of the outside of your hip, or pin the ball against the wall in the same area. Hold pressure until the tension or soreness disappears, then move to find a new spot (move towards the front or back of the hip). Use a moderate amount of pressure – it should feel like “good hurt”.

Secondary causes can be tight muscles farther from the joint. Give them a stretch with one of the following stretches:

Kneeling Hip Flexor Stretch

Kneeling Hip Flexor Stretch

Kneel on one knee and take a BIG step forward with the other side. Squeeze the glute on the back leg, and drop the hips forward to stretch the front of the hip on the back leg. Not feeling the kneeling? Here are other ways to stretch your hip flexors.

Pretzel Glute Stretch

Pretzel Glute Stretch for SI joint pain

Lay on your back and cross one ankle over the opposite knee. Draw the knee back towards your chest, bringing the ankle with it, and hold in place by wrapping your hands around your shin or the back of your thigh (between your thigh and calf).

Knee Hook Stretch for TFL and Glute Min

Knee Hook TFL and Glute stretch for SIJ pain

Lay on your back with both knees bent, then drop both knees to one side. Hook the ankle of the bottom leg over the knee of the top leg to pull the knee slightly towards the floor.

Important Safety Reminder!

The trigger points and stretches above are great for SI joint pain, but that doesn’t mean they are right for every single person. If you feel pain with any of these, please stop immediately and seek treatment with a remedial massage therapist, an osteopath, or a physiotherapist (or physical therapist). They’ll be able to give you a better idea of what’s going on, and to treat you appropriately.

two medicine balls for at home strength training exercise and fitness

Client Question: What is functional exercise?

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This is a great question!!

“Functional” has been a buzzword in the fitness industry for years now. It likely conjures up images of someone exercising while standing on one foot, doing much of their workout sitting (or standing – though please don’t!) on a big rubber fit ball to switch on their core. Spoiler: This isn’t actually what it means!**

In reality, most exercise can be functional exercises: Functional exercises are those that have a direct benefit to the movements you make in real life, whether that’s going about your day to day activities, going to the gym to get stronger, starting a beginners running program, or even training to compete in a big race. There is no particular group of exercises that are “functional”.

** As people (personal trainers, coaches, clients, and athletes) have seen how little the above types of exercise help in daily life and performance, the industry has moved away from the balance and instability elements that are the hallmark of the early “functional” trend. In fact, these exercises can lead to poor exercise technique, increased compensation patterns, and minimal additional benefit. They aren’t terrible across the board, but you can make better choices with your time!

Writing A Functional Exercise Program

When I see a client who’s interested in getting into functional movement or exercise, I get really excited, since it lets me stretch my creative juices a bit (and also because these clients have the highest chance of long term success – winning!). The process starts with a good chat about what real life looks like for you, what kind of movements you might struggle with, what kind of movements you get pain with, and what you would like to be able to do more easily. We’ll do a brief movement screen to let your body tell it’s side of the story, since most of us have movement compensations we are not aware of, and then we’ll get started on creating a balanced exercise program to match your needs and goals.

Here’s where the art comes in. When I think about what exercises should go in this program, I think about the movements you make in daily life and/or training. I’ll pick exercises that are similar to those movements to help strengthen the muscles that keep you going day to day. I’ll also pick exercises that will turn on any muscles that aren’t quite pulling their weight in your normal movements (under-active muscles play a key role in injury rates) and exercises that provide a balance to your main working muscle groups, which will further decrease injury risk. You should be able to recognize your in your workout exercises that mimic the movements of your job, or that help you improve strength or cardiovascular fitness levels so that the activities of everyday life become easier.

Common Examples of Functional Exercises

Functional Exercise

Similar Real Life Movement
Squats Sitting down and standing up, as from a chair
Step Ups Walking up stairs
Bicep Curls Picking up a small child
Farmers Carry Carrying the grocery bags

Is Your Program Functional For You?

Whether it’s called functional or not, the best program will evaluate your daily movements, energy needs, and lifestyle goals, and focus on exercises that will improve or maintain your abilities in these areas. Not every exercise will seem like something a movement you make every day, since creating strength for movement can require different muscles and joint angles than you might expect. Your body is a complex machine, and it’s rare that you’ll ever sit down, stand up, walk, carry, or lift things in the same perfectly straight line every time! Overall though, you should be able to see the similarities to your daily life, and within a few weeks should be able to feel the benefits.

If you’re not sure that your program is ticking these boxes, HealthFit can help. Your exercise physiology program is designed to be done in-home, at your gym, or anywhere else you feel the most comfortable and likely to do it, and if that’s not functional, I don’t know what is!

HealthFit looks after residents of inner city Brisbane and the western suburbs, including Spring Hill, Paddington, Bardon, Rosalie, Milton, Auchenflower, Toowong, Taringa, St Lucia, Indooroopilly, Chapel Hill, Kenmore, Graceville, and Chelmer. 

Want more info about how HealthFit can help you? Get In Touch! 

 

Hypermobile woman doing the splits

Improving Hypermobility

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Joint hypermobility is a condition where the ligaments surrounding a joint aren’t as tight as they would normally be, which gives that joint greater movement ability than someone without hypermobility would have. Many people call this condition being “double jointed” or having “loose joints”; clinically we talk about having various degrees of joint laxity.

Joint hypermobility isn’t a black-and-white diagnosis. It actually occurs on a spectrum – everyone has more or less laxity in every joint. Hypermobility is seen more commonly in younger people, since your joints will naturally stiffen as you age. And interestingly, your level of hypermobility can greatly vary between your joints. You may be hypermobile in your elbows and shoulders, and much more stiff in yours wrists and knuckles. You’ll generally be diagnosed as hypermobile when you have extreme ranges of motion in several joints. The most common test for hypermobility is the Beighton Score. You can read more about that test at this link.

There’s a small percentage of the population that stays hypermobile throughout their lives. This can be a positive for some sports and activities, like gymnastics, dance, and martial arts, but for many people, hypermobility can lead to moderate to significant muscle and joint problems: When we look at normal physical structure and function (anatomy and physiology), we see that the role of ligaments are to hold the bones in a joint together in a way that allows smooth, pain-free function. When these ligaments are loose (increased joint laxity), the bones won’t be held together as securely. This can lead to increased wear and tear on the bones and cartilage in the joint. Muscle tension around the joint will also increase as the nervous system tries to create substitute support for the joint.

As such, hypermobility can lead to several annoying or painful symptoms:

  • Pain and tension in muscles and joints
  • Joints that click or pop
  • Joints that dislocate or sublux (come out of correct position) easily
  • Tiredness or fatigue, thanks to your muscles working hard
  • Increased joint injury risk for things like twisted and sprained ankles, or for joint overuse injuries

The most common complaints that my hypermobile clients have are muscular tension, sometimes leading to muscular aches, referred pain, or headaches (when the joints of the neck are affected). Many people don’t actually realise that hypermobility is the fundamental cause of this, instead thinking that it’s stress, or something they are doing in their daily lives that’s creating these aches and pains.

Now, the important part: What do to about hypermobility

There’s no “cure” for hypermobility (short of having surgery to shorten your ligaments, and you’d be hard pressed to find a surgeon who would do that!). It’s also not something that you should think is “wrong” with you. It’s just how your own body works. There are lots of ways that you can help manage hypermobility symptoms though, if you’re finding it to be unpleasant.

DON’T StretchFor Hypermobility

This might seem counter-intuitive, since tight muscles often feel like they need a good stretch. However, if you’re hypermobile, your joint laxity means you’re already “stretched” longer than your body wants you to be. Since stretching may further decrease your joint stability, it can actually backfire and increase muscular tension.

What to do instead?

Get A Remedial Massage

Remedial or deep tissue massage can decrease muscular tension without increasing muscle and connective tissue length. This tension often occurs in both the small stabilizer muscles and the larger muscles that power movement. It’s important to note that the body is using this tension to create joint stability and protect the joints, so by decreasing tension, you’ll have a small drop in joint stability. A good remedial massage therapist will be able to gauge how much tension to relieve. (Great remedial massage choices in Brisbane are Just Knead It and No More Knots.) This is still the number one way to decrease the feelings of tension though, so don’t skip out on it. Instead, think of it as one half of managing the symptoms.

What’s the other half?

Build Strength In The Muscles Surrounding Hypermobile Joints

Strength training builds muscle tension. This might sound bad (and too much of it can make you feel uncomfortably tight), but with hypermobility, this tension is actually a good thing. Stronger muscles hold a slight contraction at all times, even at rest, which can provide the joint stability that your body is looking for. As such, your nervous system won’t be pushing your body so hard to protect your joints, so you end up feeling less fatigued, feeling less muscular aches and pains, and may see a decrease in joint popping, clicking, or otherwise doing weird things. Plus you get all the other benefits of strength training too!

A strength training program for hypermobility should have a large focus on building activation ability and strength in your stabilizer muscles, since these are what the joint rely on for support and integrity. You can follow a program that address that alone, or that incorporates stabilizer training into a well-rounded fitness program.

Hypermobility is one of the more common complaints that HealthFit Coaching provides sessions for. If you’re in Brisbane and are interested in finding out how exercise physiology can help you manage your hypermobility, get in touch today!

 

Want more info? Check out these links:
Gazit, Y., Jacob, G., & Grahame, R. (2016). Ehlers–Danlos Syndrome—Hypermobility Type: A Much Neglected Multisystemic Disorder. Rambam Maimonides Medical Journal, 7(4), e0034. doi: 10.5041/rmmj.10261 Read it here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5101008/
Joint hypermobility symptoms and treatments. (2019). Read it here: https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/conditions/joint-hypermobility 
Featured Image Sourced From: https://commons.wikimedia.org/wiki/File:Yoga_Split_2.jpg?fbclid=IwAR1mgs9wappmEXULt8ZfSYoD9zCuduyozzEwukYqWI_qFrETlyeGYOAjpHU

Three Top Tips for Injury Prevention

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So you want to prevent injuries? If you’re in one of the three following groups, injury prevention should be on your mind, because you’re at higher risk of muscle strains, joint sprains, and overuse or repetitive stress injuries. High(er) risk groups include:

  • Aging bodies (disappointingly, physically this means over the age of 35-ish)
  • People who train hard, often, or both, especially without appropriate physical recovery
  • Weekend warriors, or those who go longer periods of time between workouts or physical activity

Kickstart Things With Hands-On Massage Therapy

Daily life is hard on your body. The normal activities of daily life frequently create tension in muscles and connective tissues, either shortening them or overstretching them. Changed tension and length can create joint stress through misalignment and instability. In turn, this can increase injury risk for both joints and muscles.

What to do? Get some help! Remedial massage therapy, also called deep tissue massage or manual therapy, is the best way to kickstart your injury prevention efforts. While there are many things that you can do at home to mimic hands-on treatment, the fact is that you probably won’t make the at-home effort for the same length of time as a standard remedial treatment. Even if you do, you probably won’t be able to target the soft tissues (muscles and connective tissues) in the same way. You just won’t get the right angle on it!

A good remedial therapist will be able to target the muscles and connective tissues putting you at highest injury risk. They do this by asking you about your injury and exercise history, and by finding out what you would like to be able to do moving forward, whether that’s simply staying pain free or being able to keep up with the kids on the mountain bike. The long term goal for any hands-on therapy should be to get you feeling good so that you can maintain it with just a tune-up every now and then.

For Brisbane’s best remedial massage, check out Just Knead It or No More Knots.

Keep Things Moving Well – At Home

There are many, many different approaches to home-based injury prevention programs. The hallmarks of any good program: Exercises to maintain good muscle and connective tissue tension, and exercises to build and maintain joint mobility. (Joint mobility is the ability to actively move a joint through its full range of motion – similar to flexibility, but with additional contributing physical factors.)

Foam rolling and trigger pointing are two of the most common “exercises” to help maintain good soft tissue tension. They aren’t exercise in the traditional sense, though they can take some work! Instead, they are essentially a DIY remedial massage. These are usually completed by sitting, laying, or leaning on a foam roller or a spikey trigger point ball (or a tennis ball, which works just as well). Holding the pressure on a muscle-y area will trigger a nervous system response that causes the muscle to relax. How long to hold? There’s no single answer to this. It depends on a number of factors including positioning and how long the tissue has been building tension, but I always ask my clients to aim for a minimum of 30 seconds per spot. The wonderful thing about your body is that no matter how tight you might feel, if you do this consistently, you’ll be much looser, very quickly – especially if you’re starting this process after having remedial massage treatment. Once you’re feeling good, aim to maintain this by checking in with your body once or twice a week.

Joint mobility exercises are similar to flexibility exercises, in that they’ll challenge your body to move beyond its normal muscle lengths. As with static stretching, you’ll feel… stretching. The big difference is that with most joint mobility exercises, there’s a movement element as well as the stretch. Paying attention to your body alignment, you’ll move into a stretch in a controlled manner then move back out of it. This lengthens short muscles and connective tissues, provides some slack to overstretched areas, and teaches your brain to control movement through the entire range of motion available the joint(s) you’re working on.

Pro tip: Always do your soft tissue work before doing your joint mobility work. The decreased tension from the foam rolling or trigger pointing will give you more range of motion.

Get Strong

Being able to move your muscles and joints easily is vital to staying injury and pain-free – but only if you’re strong enough to control them! This doesn’t mean that you need to go to the gym and lift heavy weights every day. Rather, it means sticking with a plan for gradually challenging your muscles to get stronger, which can happen at a gym, at home, at the park, or in a group fitness class. A strength training program for injury prevention should, generally speaking, provide the following:

  • Exercises for all major muscle groups of the body
  • More “pulling” exercises than pushing (think moving a weight or resistance toward your centre of gravity rather than pushing it away)
  • Exercises that require large joint movement, preferably through multiple joints

Individualised injury prevention programs will take into account what movements and postures are most common for you on a day to day basis, any injury or exercise history you have, any current injuries or niggles you’re dealing with, and most importantly, what being injury-free (and worry-free) will let you do with your life! For most people without major sporting goals, an injury prevention program can be done in 20-30 minutes a few times per week. A small investment for lifelong peace of mind!

 

Have questions about what exercise physiology can help you with? Get in touch! 

HealthFit Coaching looks after inner city Brisbane and the western suburbs, including Spring Hill, Paddington, Bardon, Rosalie, Milton, Auchenflower, Toowong, Taringa, St Lucia, Indooroopilly, Chapel Hill, Kenmore, Graceville, and Chelmer.

Blue theraband being stretched between hands

A New Approach To Stretching Tight Hamstrings

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Feel like your hamstrings are always tight?

Tension along the back of the thighs is one of the most common complaints I hear as both an exercise physiologist and a remedial massage therapist. And when I ask people what they focus on when they stretch, the answer almost inevitably includes hamstrings. Why are these buggers always so tight?

There are many reasons your hamstrings could be tight, having to do with your normal activities, posture, or how you generally use your body. Let’s focus on one of the most common reasons your hamstrings feel tight, and more importantly, what you can do about it!

Tight Hamstrings Often Come From Your Hips

As cliche as it sounds, everything in the body is connected. Your hamstrings run along the back of your thigh, and attach to the bottom back of your pelvis, on bony areas often referred to as your “sit bones”. Your hip flexors are shorter muscles that run from various spots on the front of the pelvis to the top of the thigh bone (your femur). They may be small, but they pack a punch!

Side view of pelvis with hip flexor and hamstring attachment points highlighted

Hip Flexor attachment and direction of pull in blue
Hamstring attachment and direction of pull in green

When you sit a lot, and most of us do, your hip flexors rest in a shortened position. Stay in a shortened position long enough, and the body will adapt to that, essentially resetting to a “new normal” – a short one. This tilts your pelvis forward slightly during sitting, standing, and movement, a lower back, pelvic, and hip posture we call anterior pelvic tilt.

This has a flow-on effect on your hamstrings. When the pelvis tips forward, it pulls the top of the hamstring muscles up towards your head. Because the bottom of the hamstrings don’t move upwards, the muscles become stretched out. Much like stretching a rubber band, this stretching leads to increased hamstring tension, and you’ll feel like you need to stretch your hamstrings.

Since you now know that they’re already stretched, what can you do to get rid of the tension feeling?

Stretch Your Hip Flexors

Lengthening the hip flexor muscles at the front of your pelvis and hips can decrease the pull on the hamstrings muscles, which in turn can decrease the feeling of tension along the back of the thigh. Try these three stretches:

Kneeling Hip Flexor Stretch

How To: 

  • Kneel on one knee and take a big step out front with the opposite foot.
  • Keep the hip, knee, ankle, and foot on your back leg aligned (most of us tend to twist the hip so the foot twists inward.) Front leg can be aligned, or can move slightly out to the side.
  • Tighten the glute muscles (the muscles of your bum) – this is key to the hip flexor stretch. Drop your hips forward and down. Keep your torso more or less vertical. Your front shin should stay vertical or knee slightly extended, and your weight should stay through your front heel to protect your knee.
  • Extra credit: Lengthen along the entire front of the body by reaching up and slightly backward with the arm on the same side as the stretching leg.

Hold your stretch for: At least 30 seconds, at an intensity of around 4 or 5 out of 10. Don’t bounce, and breathe easily. If you can’t breathe easily, decrease the intensity of the stretch.

You should feel: A stretch through the front of the hip and/or thigh. You may only feel it stretching one area or the other – that’s ok. All the muscles are being stretched. Your brain just pays attention to the one that is stretching the most.

Not ok with kneeling? Try this version:

Standing Hip Flexor Stretch

How To: 

  • Take a big step backward with one foot, and a big step forward with the other foot.
  • Keep the hip, knee, ankle, and foot on your back leg aligned (most of us tend to twist the hip so the foot twists inward.) Front leg can be aligned, or can move slightly out to the side.
  • Tighten the glute muscles (the muscles of your bum) – this is key to the hip flexor stretch. Drop your back knee halfway to the ground, pushing your hips forward. Keep your torso more or less vertical. Your front shin should stay vertical or knee slightly extended, and your weight should stay through your front heel to protect your knee.
  • If needed, take a slightly larger step forward, or drop the back knee down towards the floor more, which will help keep the back thigh and torso vertical.
  • Extra credit: Lengthen along the entire front of the body by reaching up and slightly backward with the arm on the same side as the stretching leg.

Hold your stretch for: At least 30 seconds, at an intensity of around 4 or 5 out of 10. Don’t bounce, and breathe easily. If you can’t breathe easily, decrease the intensity of the stretch.

You should feel: A stretch through the front of the hip and/or thigh. This standing version tends to feel like more of a quad stretch (front of thigh), but the hip flexors are lengthening too, especially with the glute squeeze.

If you want even better results, add this next stretch in. It targets the quads, which are the muscles at the front of your thigh. One of these muscles also acts as a hip flexor due to it’s attachment point on the pelvis. Most of us don’t spend nearly enough time on stretching the muscles at the front of the body anyway.

Standing Quad Stretch

How To:

  • Stand upright with feet together. Without bending or rotating your pelvis or hips, or shifting your weight too much (some shift will occur), bring one foot up behind your hips and hold it there.
  • Keep your knees together and torso upright, and squeeze your glutes.

Hold your stretch for: At least 30 seconds, at an intensity of around 4 or 5 out of 10. Don’t bounce, and breathe easily. If you can’t breathe easily, decrease the intensity of the stretch.

You should feel: A stretch through the front of the hip and/or thigh. This standing version tends to feel like more of a quad stretch (front of thigh), but the hip flexors are lengthening too, especially with the glute squeeze.

Do these stretches daily for two weeks, then drop back to doing them 3 to 4 times per week to help keep your hips and hamstrings feeling good. As an added bonus, you’ll also be helping your lower back stay healthy and pain-free, and will make your workouts more effective. You can also substitute your own preferred hip flexor stretches. If you’d like, tell us about your favorite in the comments 🙂