How to find a good physical therapist, Part 3: Find someone with experience in treating the SI joint

Well, it sounds pretty obvious when I write it now.  But back in 2011, when I first developed this problem, it wasn’t so clear.

Find a PT who actually knows how to treat the SI joint.  Because most of them don’t.

I didn’t understand this at the time.  I figured anyone with a PT license ought to be able to treat me.  What I didn’t know is that, generally speaking, they don’t cover the SI joint in physical therapy school.  The PT’s who come to know more about the SI joint in depth tend to learn about it after graduating, through continuing education courses.  They might take a comprehensive course on low back pain, or pelvic pain, or even a course specifically focusing on the SI joint, like this one.

Looking back, I can see that one of the major mistakes I made was to work with PT’s who said they’d be able to treat me… without having enough specialized knowledge or experience in treating this condition.

The first PT I saw, Kristen, didn’t know anything at all about SI joint dysfunction.  I probably never would have ended up seeing her at all, except I was already seeing her for some knee issues which she did manage to successfully treat.  Because of this, I believed her when she said she could treat my SI joints as well.  (I only knew it was my SI joints because my chiropractor told me so).

Kristen explained that she hadn’t learned about SI joint dysfunction in PT school.  She’d briefly learned where the SI joint was, as one more joint on a diagram she had to memorize for a test, but didn’t learn anything about its actual dysfunction.  She’d heard of SI joint dysfunction, simply from working as a physical therapist, but had never treated it before herself.

She gave me exercises to strengthen my core, and lower back, and hip muscles.  These exercises were technically “fine,” as exercises go, but they were too much for me.  I’d come in to my appointments walking normally, and limp out with my SI joints locked up, desperate to go see my chiropractor again.

Kristen was definitely a worst-case scenario, because she knew basically nothing.  However, compared to later PT’s I saw, I would say that the first four PT’s on my list all basically fell into this category.

It’s not that they were bad physical therapists (the one exception possibly being #3, Heidi).  It’s just that they didn’t have enough specialized knowledge on the SI joint.

It’s like the saying goes, they didn’t know enough to know what they didn’t know. 

Because their knowledge of SI joint dysfunction was so limited, they were unaware of what a complicated problem it can really be.

#4, Amy, was a really nice person.  She seemed to know a tiny bit more about the SI joint than the first three.  Yet she just didn’t have enough familiarity with the subject to speak with a sense of expertise.  To her credit, she really wanted to help me, which is why she tried pretty hard to tell me about concepts she’d come across in passing.

But that’s the problem– it was mostly in passing.  She’d learned a little bit about the SI joint in some of the continuing education classes she’d taken, but the instructors hadn’t gone in-depth enough for that knowledge to really affect her ability to treat me as a patient.

So when she mentioned things to me that had the potential to be helpful, such as an SI belt or the Muscle Energy Technique, she just didn’t quite know enough to really help me.  It was kind of like having another patient explain things to me– she knew some of the basic concepts, and could show me how to strap the belt on, but didn’t seem to be very confident about much more than that.

Although the strategy for MET she showed me was technically correct, I had trouble doing it the way she showed me because it required more core strength than I had (Paula was able to modify it to make it easier, because she had more familiarity with its concepts).

Paula was the first PT I saw who could really say, convincingly, that she’d actually treated patients with SI joint dysfunction before.  

She had come across enough patients that had struggled with it that it motivated her to take some specialized classes and learn about it herself.

As I mentioned in my last post, I had a really good feeling about Paula during my initial visit because of the detailed explanations she was able to give me about the SI joints, as well as the structures of the pelvis overall.  She explained that the pelvis was sort of shaped like a bowl, sometimes referred to as the “pelvic ring” and that all of the structures in it were interconnected.

IMG_3682

She explained how it was important to keep in mind the functioning of all of the other structures in the pelvis, and how they worked together, in designing a treatment program.

I could tell she actually spoke from experience when she talked about how helpful it could be to develop core strength, as well as strength in the lower back and hip muscles.

Paula actually had successfully treated patients with SI joint dysfunction before, which I’m not sure was true for any of the first four people on my list.  

Looking back, I can’t believe I’m taking so much time to write about what seems like such an obvious point.  But hindsight is 20-20.  Just like the first few PT’s themselves, I didn’t know how much more there was to know about this joint at the time.  They made it sound like they’d be able to treat me, and I believed them.

Now, I would insist on finding someone who was familiar with the SI joint, and had taken classes that covered it in-depth. 

Or at least studied it PT school, as I imagine some programs are starting to cover it.

Or, someone like my PT Aide friend, who had learned all about the SI joint and how to perform the Muscle Energy Technique from a physical therapist she worked under.

And again, someone who could actually claim to have treated patients with SIJD before.

I found Paula because her company had a little online “bio” up for each staff member, and hers listed the sacroiliac joint under her clinical interests.

But you can also call around, and maybe get in touch with the clinical director of a given facility to ask if someone has expertise in the SI joint (this may work a little better than trying to ask one of the secretaries who schedules appointments).

I’ll have more tips for how to find someone with expertise in my next post.  For now, I hope this was helpful!

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