I realized yesterday that everything I’ve written about my own road to healing really comes down to two factors:
- Letting sprained ligaments heal
- Building muscle strength
These two factors make up two equally important sides of the same coin. You need both for healing. The key is to balance one against the other.
Why? Let’s look in more detail.
1) Letting sprained ligaments heal
Basically, SI joint injuries occur when some sort of trauma or overuse sprains the ligaments that are meant to hold them in place.
When a ligament has been sprained, it means there has been “a stretching or tearing of ligaments — the tough bands of fibrous tissue that connect two bones together in your joints” (check out this article from the Mayo Clinic).
The unfortunate reality is that when a ligament has been sprained/stretched out, it may never completely heal and shorten back up to its original length.
However, it can still heal and tighten back up to an extent, so that at least the acute injury phase/inflammation is over, and it becomes a little more stable.
So part of recovering from an SI joint injury requires allowing the ligaments to heal, and not continuing to perform motions or activities that continue to re-injure them, or possibly cause them to become even more stretched out.
For me, this corresponds to the parts of my story where I talked about learning to adjust my movement patterns and habits, so as not to put more strain on the joint.
It also meant eventually coming to the conclusion that receiving chiropractic adjustments to the area were more trouble than they were worth, because of how they stressed the ligaments.
Essentially, you need to cut way back on anything that stresses the joint, so that your ligaments have a chance to calm things down. If you keep stressing them and continually pushing them outside of their normal range of motion, you’ll prolong your healing process (or possibly never heal).
(Side note: This is why people use prolotherapy: its purpose is to try to help ligaments tighten back up).
2) Building muscle strength
The other equally important thing you need to do is build your muscle strength back up to where it was before the injury– and then some.
Because the truth is, you’ll probably never be able to count on your ligaments to the way you were able to before your injury (not that it’s something you ever had to think about consciously! They were just quietly doing their job).
However, when your muscles are strong enough, they can “take over” for ligaments that have been stretched out.
You have all sorts of major muscle groups that contribute to the stability of the SI joint, and when they are strong enough, they can support the joint to the extent that you may no longer notice your ligaments being sprained.
This is essentially what happened for me. I know my ligaments will never quite tighten back up to the way they used to be. But once I stopped constantly re-spraining them with chiropractic adjustments and got physically stronger, my joints stopped moving out of place. I stopped having to think about my movement patterns as much, because my muscles were holding my joints stable.
- See my corresponding post When muscle strength takes over for weak ligaments
3) Uniting the two factors
Unfortunately, when your ligaments are already sprained, building muscle strength is not always the most straightforward.
Your muscles and joints were designed to move with your ligaments holding things in place. Without them doing their job, things get a little bit tricky. Normal movements that wouldn’t have hurt before can end up putting way too much stress on your joint.
That’s why it’s so important to have a strengthening program that takes your ligaments into account. So many people get stuck in a cycle where they’re working with PT’s and medical professionals who just don’t get it, and give them cookie-cutter strengthening programs. Generic back-strengthening programs don’t work for this, because they continue to place pressure on the ligaments instead of allowing them to rest.
That’s why, to truly move past this injury, you need to be able to strengthen while allowing your ligaments to heal.
The right exercise program will allow you to start building strength, while putting minimal stress on your ligaments– and shouldn’t cause any pain!
Update, May 2022: As many of my readers know, I used to think aquatic exercise was the only way to strengthen while rehabbing your SI joints. I wrote that because it was the best advice I knew how to give at the time.
However, I’ve learned sooo much more now. Although I still think aquatic therapy is great, I also know that there are tons of options to help you start strengthening, even if you can’t get to a pool. There are super gentle core training exercises you can do, and even certain techiques to improve how your nervous system communicates with your muscles. As long as you’re doing all of these things with an awareness of what’s happening with the ligaments– that’s the part that’s truly key.
For more info, check out my Strengthening posts:
- Three major muscle groups to strengthen for SI joint dysfunction
- The goal of strenghtening is to maximize your body’s own support system
- The core and transverse abdominis
And you can also check out my posts on Aquatic Therapy, which can be a great way to strengthen while being gentle on your ligaments:
- The importance of pool exercise to my recovery
- One of the best things you can do for yourself in a pool: traction
Gosh. Okay, that was a lot of information!
The SI joint is a super complex subject– which is what can make it kind of fun to write about. But it’s also why I personally struggled with it for over five years before finding the answers I needed. That’s why I’m so determined to share what I’ve learned.
What did you think of the post?
Have you been able to strike a balance between strengthening and letting your ligaments heal? Let me know in the comments below!
And just a note–
There are many people who decide to proceed with SI joint stabilization surgery, or require other forms of treatment such as prolotherapy. The purpose of this post is not to make a value judgement on anyone else’s path to healing, or imply that you should be able to heal without surgery.
I am simply sharing what worked for me, and I’m grateful that the extent of my injury wasn’t worse, so that I could recover in the way I did. What worked for me may not work for everyone, which is why I make an effort to address other potential avenues for healing on my blog.