Now that my SI joints themselves are actually staying stable (thank God!) I can begin to identify other factors that may have been contributing to my pain, and causing my sense of being off-kilter, all along.
What I’m referring to specifically in this post is tightness in the muscles of the lower back. When these muscles are tight they can pull on the spine and pelvis unevenly. In my experience, this can lead to a general feeling of being “off-balance,” or that your pelvis is rotated.
The technical term for when some muscles are overactive, and others underactive is muscle imbalance. It can happen anywhere in the body, not just the low back. It basically just means that your muscles aren’t functioning optimally. Some are doing way more than their fair share of work and pulling too much; others are underactive, and not completely doing the job they were meant to do.
There were many times, over the years, when I went to see my chiropractor and he told me that muscle tightness was causing some of my discomfort. I would feel as though my pelvis and spine were “twisted.” Sometimes it would feel like one side of my pelvis was up higher than the other, or that one side was more “forward” than the other.
I couldn’t really tell what he was talking about at the time, however, because all I could think about was my SI joints, and how desperate I was to be able to move my legs normally again. There wasn’t really any way for me to separate out different aspects of the problem– it was all just one big giant mess to me, and all I knew for sure was that I felt better when I walked out of his office. (Temporarily better, anyway–chiropractic adjustments ultimately turned out to cause more problems than they were worth, for me).
Five years later, I’m in a completely different place mentally and physically. The two aspects of my learning went hand in hand. The more I learned in my physical therapy prerequisite classes, the more I understood. And then the more knowledge I had to apply to my own research of the SI joint. This, in turn, helped me to develop more targeted exercises and build muscle strength (with the help of a great physical therapist, of course– thank you, Paula!).
Now I can tell you that my SI joints are staying stable, but sometimes I do have muscle tightness that causes me to have a “rotated” sensation through my pelvis.
The biggest difference, though, is that when this rotated feeling is caused by muscle tightness, nothing is “stuck.” I can still move my legs freely, unlike when the problem is coming from the SI joint. I still feel off-kilter, but at least I can walk.
And because in the case of muscle imbalance because nothing is “stuck” like the SI joint, the problem is much easier to reverse. I usually find that when muscle tightness causes this rotated feeling, it’s just because I’ve tired out the muscles in my lower back doing one thing or another. (They’re still pretty weak from being underused for the past five years, so it doesn’t take too much to aggravate them).
However, now, if I just give things a few days to calm down, usually that “rotated” feeling improves.
One of the best things I can do for this muscle tightness as well is going to the pool and doing exercises where my legs are hanging beneath me. The exercise itself is great for increasing circulation through tight muscles and flushing out the toxins and other junk that can accumulate during muscle spasms, and when you let your legs “hang,” it allows gravity to create a little bit of space between all of your joints.
As my physical therapist Paula explained to me, all healthy joints have a little bit of space between bones, but in cases of dysfunction, sometimes that space can be compressed. When you let your legs “hang” it opens a little bit of space back up in joints that may have been feeling cramped. (In terms of low back pain, I’m referring to both the SI joints as well as the joints of the spine).
I find that “hanging” my legs in the pool can sometimes fix that feeling of pelvic rotation pretty quickly (at least, when it’s caused by muscle imbalance).
If you’re curious what I’m referring to what I mean letting your legs hang, you can check out the following video, which shows a physical therapy patient using flotation devices to support her upper body while letting her legs hang beneath her. (The entire video is worth watching, but the specific part I’m referring to is at the 2:25 mark):
And in addition, if you’re interested in more detailed explanation of the benefits of working out in a pool, you can check out this post I wrote that covers more of the science.
Hope this was helpful!
My Sacroiliac Joint Saga 
Thanks so much for this post. My experience has been so similar! My physical therapist said that it is in response to pain. The body moves away from the painful area, compressing my right side and over stretching my left side so everything is twisted. My left hip raises up and pulls on my torn hamstring tendon. We still are keeping my aquatic therapy only in the shallow end; deep end work still sets up trigger points in my back and destabilizes my SI joints. My left locks up and my right rotates in.. Do you have any stretches to “untwist” yourself?
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Hi Gail, I can suggest a few things, but I definitely wouldn’t recommend trying anything without first running it by your PT (especially with that torn hamstring tendon!).
In general I think it’s really important to keep the muscles of the lower back, and in the back of the SI joints (the “glutes”) loose. I have probably recommended this to you before, but I really think the single-leg knee to chest is the best: https://sijointsaga.com/2017/11/16/glute-stretch/
I don’t recommend any specific stretches involving a twisting motion, which you may have been picturing, because I don’t think it’s ever a good idea it for the SI joints. (Even if you’re trying to twist yourself back in the opposite direction, it will probably just make things worse). You should be able to stretch all of the muscles you need to gently, keeping your pelvis and spine in neutral.
This is also a post which shows a few stretches for the hamstrings– a few I like, and a few I don’t like. You’ll see that the ones I like involve keeping the pelvis and spine in a more neutral position, as well as your body weight symmetrically balanced between the two hips. https://sijointsaga.com/2017/11/10/hamstrings-stretches-sacroiliac/
I hope this helps! Let me know if you have any more questions!
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Hi there! I just obsessively read almost every post of yours for the last couple hours. I feel like I am on the road to a better state as this injury has truly been so difficult. Hearing your story sounds so familiar. I, too, had to go through 5 PTs, I got a lidocaine injection, and have had two rounds of PRP (I am curious on your thoughts on that). There are some things that are better since seeing my newest, amazing PT who finally gets it but I am so weak from the PRP I just feel like I have lost so much time and tone trying to recover that things I was doing before even if I was in constant pain I can’t even get close to doing (e.g yoga which I used to do 1-2x/wk). The pain I experience now is this burning pain that feels like nerve irritation in my injured si joint. My joint isn’t out or stuck but it burns after bending in yoga moves or walking fast in the treadmill for more than 20 min. I feel like I’m in a plateau (my PT is discharging me to continue m strengthening on my own and I’m terrified) but considering a water program may also be the next step to get me over the hurdle so thanks for that. My question to you is in regards to the neurotags for pain. Do you think that my pain is actually just heightened bc I’m scared to try other things or the burning is because my body remembers the trauma of this injury constantly? What can I do to reverse this? Is it like a hypnosis thing or a meditation concept? Thanks for all your posts!
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Hi Heather, well… the first thing that strikes me while reading your posts is… why is your PT discharging you? This is somewhat of a rhetorical question because I’ve been in your position myself. I’ve had many PT’s feel they are under pressure, from their company as well as insurance, to demonstrate that you’ve made a clear improvement in “x” number of visits, and then get you out. I suppose I can understand your PT’s perspective, in that from a biomechanical standpoint, you don’t need supervision to progress through your exercises.
However, to me, it sounds as though you are grappling with questions you shouldn’t have to deal with on your own. It is absolutely possible that the pain is your body’s attempt to protect you.
The funny thing about my story is that I went through a lot of this *before* developing SI joint problems. But I think the fact that I’d already gone through it and come to understand how my nervous system tended to work meant my SIJ symptoms weren’t worse.
What helped me was actually working WITH a PT who could sort of calm my fears from an intellectual standpoint. Because, as pain science research has shown, as long as you have any doubts– even unconscious– about whether an exercise is safe, your nervous system will continue to try to protect you (with pain!). I did all my exercises with a coach by my side, who could give me feedback on whether or not something was likely to be biomechanical, or my nervous system trying to protect me. This helped to calm my nervous system, because I trusted him and didn’t feel like I was alone.
I think the best thing– if at all possible– would be for you to find a PT with advanced training in pain science/pain neurophysiology education/therapeutic neuroscience education… and ALSO some knowledge of the SI joint. Yikes… I know this might not be easy to find. But this is what I would recommend, in an ideal world.
Because your PT might be right that it’s totally fine for you to do all these exercises. However, I think it sounds a little bit harsh to tell you to go out and work through your very real questions and fears on your own.
It sounds like this person really was a great fit for you, in improving your SIJ. But sometimes, as I have found, one person can be the PERFECT person for you, at one point in time, but then the time comes when you need another perspective.
In terms of reversing a pain neurotag… I think that something like meditation can definitely *help* (not so sure about hypnosis). But with meditation… it’s a very general way to calm your nervous system. Which is, of course, great and has been proven to have tons of benefits, but…
For me, working through pain neurotags was actually more specific. It was about specifically changing my mental image of my body, and what it could and couldn’t handle. This is why working with a PT was key– he reassured me that I wasn’t going to bring back some of my same injuries just walking down the street, when it had taken running 5 miles a day to bring them on.
I needed to specifically know what was and was not “dangerous” for my body, which as a patient, isn’t something you should be expected to figure out on your own.
I think you may have already seen these posts, but if not– this series tells of my very first experience with pain neurophysiology education, back when I was dealing with more generalized chronic pain/fibromyalgia: https://sunlightinwinter.com/calming-nervous-system/
And thank you for asking this! I haven’t gotten too many questions about pain science on this blog, but it’s SUCH an important topic! So I’m happy you brought it up!!!!
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MY PT had been great and I have been seen since end of March beginning of April. He has helped me more than anyone else has and finally got me to periods of pain free but now he is cutting me free and I wish I could continue. I tried to talk about it but he left it as I could always come back to continue what he’s taught me. I was considering going back to my physiatrist to see what he thought. I feel like my irritation now is sacrolitis and I don’t get stuck anymore but I am so weak still. How long did you stay in PT and what was the frequency weekly? I am a SLP so I work in rehab and I get the discharge process so I’m not sure where to go from here. This journey has been so long and emotional.
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I was a bit of a unique patient. Once I found the PT who really helped me, I went in once a week for the first three weeks, until she was confident I was doing MET correctly. But I needed to be doing aquatic exercise, and although this PT was certified in aquatics… she didn’t currently work at a pool. Because of my academic background I was able to get away with meeting in her office to discuss, and then doing exercises on my own. I only went back when I wanted to check in about my exercises or add something in. I know this path probably wouldn’t work for everyone.
Certainly, you need to make the decisions that work best for you. But I still think you might benefit from speaking with a PT who is knowledgeable on pain science. In my personal experience as a patient, this was the only thing that could ever help me sort of “turn down” the volume on my hypersensitive nervous system.
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