I’ve been noticing a theme coming up often in my coaching calls lately:
A lot of you are out there doing all the right things– going to physical therapy, wearing an SI belt, working on core strengthening– and still not seeing improvement.
However, one thing that seems to be the case for many people is that their PT has not actually told them what is going on with their alignment.
As a patient, you may not yet have learned that there are specific ways that the SI joints can move out of alignment. These patterns of misalignment each have certain terms that can be used to refer to them, and different methods that can be used to identify and even treat them.
For example, this video shows you one pattern of misalignment you can have:
One type of treatment, which can be done by a PT, is called the Muscle Energy Technique. It made a big difference in my own journey, and my PT was even able to teach me to realign my own SI joints at home, so I became a lot more independent.
Yet, many of you have been in PT for months, and haven’t yet encountered this. Why is this?
The unfortunate truth is there are a lot of physical therapists out there who are treating patients for SI joint issues, without necessarily having the right experience.
There are a few reasons for this.
One reason is that the SI joint is not always included in physical therapy or even medical school curriculum, although hopefully things are changing. I personally encountered a few very well-meaning PT’s who really wanted to help me– they just really had no idea what to do for the SI joint.
On the other hand, some PT’s and doctors believe that although the SI joint can sometimes cause pain, it can’t really move out of alignment.
This school of thought, which I personally have not found helpful, states that although an SI joint may become inflamed, it is not possible for it to move out of alignment. If a PT doesn’t believe the SI joints can move out of alignment, they may give you core strengthening exercises and counsel you about how to live better with chronic pain– but they won’t actually try to realign your joints.
Whether or not the SI joint can move out of alignment is now the subject of debate throughout the fields of physical therapy and medicine. For the purposes of this blog post, I won’t be able to fully summarize it here! We definitely need more research in this subject area, however I am convinced that in time, more evidence that the SI joint can move will arise.
So, for now…
If you’re in PT, and you’ve been given exercises, and maybe a belt, but no one has actually assessed your alignment… it’s time to stop and evaluate.
Ask your PT if he or she has assessed your alignment. I recommend you ask questions such as:
- “How is my alignment?”
- “Are you able to assess the alignment of my pelvis?”
Specifically, you are looking for someone who is familiar with terms such as:
- Anterior or posterior rotation of the hip bone
- Sacral torsion
It isn’t always easy to find someone with the right training, who can assess you for all of these things, but it can be done.
One of my readers recently shared a story where she’d been doing exercises and wearing an SI belt for a year, only to switch PT’s and find out she had a sacral torsion. That PT was able to adjust the sacral torsion and her pain diminished significantly, to the point where she stopped needing a belt.
This type of story is exactly why I’m writing this post today.
I myself found, throughout my journey, that when I was out of alignment– which, for most of my five-year journey, involved a posterior rotation of the hip bone— every little thing I would do would hurt. Walking, exercising… sitting… everything was painful.
By contrast, moving the joint back into alignment would take most of the pain away instantly. (I used to rely on a chiropractor for this, until my PT taught me to adjust myself using the Muscle Energy Technique!).
When you’re in alignment, it’s not only better for your SI joint– it’s that the joint is part of a system, and everything else in that system is going to work better when the joint is in place too.
That is why, when your joints are in the proper position, you’ll likely find that you’re in a lot less pain, and that movement is easier, too.
That is why I really recommend working with a knowledgeable PT who can not only assess your alignment, but teach you the corrections that can help get things in the right place again.
Hope this post was helpful!
For more info, you can check out:
- Muscle Energy Technique
- Key Points of My Recovery, #7: Learning to adjust my own SI joints
- How to find a good physical therapist, Part 1: Persistence (outlines all of my attempts at finding a good physical therapist, and why I’m so glad I kept going!).
- What happens when an SI joint gets stuck? Explains posterior rotation of the hip bone — the main pattern of misalignment that I experienced.
To read a great take on the controversy around SI joint treatment:
- The SI Joint Upslip — blog post by Brett Windsor, PT, from the North American Institute of Orthopedic Manual Therapy. I totally love this blog post!
Although it specifically refers to another pattern of misalignment, known as an upslip, I think this is a great perspective on the SI joint overall, and why this particular therapist believes that it can move out of alignment. I really hope to see more practitioners sharing this perspective in the future!