Why do “perfectly good” exercises sometimes not help?

I haven’t written a ton on my multiple physical therapy failures yet, because unfortunately there are so many.

For now, let me just say that my physical therapist Paula, who finally helped me, was actually the fifth physical therapist I saw over the course of this journey.

The first four offered varying degrees of helpfulness vs. unhelpfulness, but ultimately what it came down to was that they just didn’t have enough experience (or any experience) with the SI joint.

The first PT I saw was a really nice person.  I’d actually already been seeing her for the injury I had that preceeded my SI joint dysfunction, which was something called chondromalacia patella in my knees.

This PT, Kristen, really did help me with my knees.  But over the course of this period of time is when I also developed SI joint dysfunction.  (I think that getting weak and out of shape and limping constantly set me up to fail, although the watershed moment was when I accidentally slammed my butt down on a metal bar– long story).

I was still seeing Kristen as my SI joint dysfunction was getting worse, and at first, we both thought she’d be able to treat it.  Even though she’d never learned anything in particular about the SI joint.  They’d never covered it in PT school, except maybe as one name on a diagram in a general anatomy course.

So she gave me exercises to strengthen all the relevant muscles around the joint.

The problem was that every time I did them, I got worse.

***

What I’ve later come to believe is that doing these exercises with healthy, unsprained SI joint ligaments is very different from doing them with sprained ligaments.

Healthy ligaments do their job and hold your joints in place and transmit force across the joint the way they were intended to.

Sprained ligaments can’t transmit forces optimally, meaning that when you move or otherwise subject the joint to force, the stress of that motion isn’t going to end up where it’s supposed to, and will instead end up going in other, non-ideal directions.

For me it was like a cascade, a snowball effect.

I wanted to what it took to get better, and do the exercises Kristen gave me, but with every passing day, I’d just get worse.

I’d show up at physical therapy and try to do the crab walk, only to find I was limping more and more by the end.

I’d try to sit on the saggy, partially deflated exercise ball to build core strength, but sitting on such an unsupportive surface as that would actually cause my SI joints to move out of place more.

In retrospect, Kristen clearly had no idea what she was doing, in terms of treating the SI joint.  It’s not that the exercises she gave me were “bad” or “wrong,” but they were wrong for someone with compromised SI joint ligaments.

I wish now that she’d had enough insight to see that she was out of her league, that she shouldn’t have been taking matters into her own hands and trying to treat a condition she’d really only ever heard about in passing.

It wasn’t enough just to give me any old exercises to strengthen those muscles.  I needed to find a way to strengthen without constantly re-spraining the ligaments, and making things worse.

***

Of course, different things work for different people.  I do realize that the shape of my SI joints makes them way less stable than other peoples’.  Maybe some people with more stable joint shapes than me could start off by doing some of the exercises Kristen gave me.

But they weren’t right for me, and someone who was familiar with SI joint dysfunction should have been able to see that right away.  In fact, it wasn’t hard for anyone at all to see, as I came in to the appointment walking somewhat normally and left hobbling.

What are some of the exercises that made me worse:

Crab walk with band

Glute bridge

(Again, just a reminder– I’ll never link to anything from this blog that I think is absolutely horrible.   The two links I’m showing you are actually pretty good and helpful links for legitimate exercises.  They are just NOT great for sprained SI joint ligaments.  But I mean no disrespect to the people behind these sites at all– if your site is THAT bad, I won’t even use your link :).

Exercises such as these sent way more force through my SI joints than my ligaments were equipped to handle, and instead just increase inflammation, irritation, and led to them potentially being sprained more.

This is why I’m such a fan of aquatic exercise— it lets you do a lot more, with way less stress on your joints.

There are also gentle core exercises you should be able to do while lying down without increasing your pain too dramatically (the key is to make sure you’re doing them correctly, engaging your abs rather than arching your back).

I’ve had many requests for information on my exercises– I hope that what I’ve written out so far has been helpful.

It definitely takes a lot more skill and also courage to create exercise visual aides and put them on the Internet than I ever realized before I thought about doing it myself.  Now I see how much easier it is said than done, but I hope to keep my own helpful resources coming!