Ah! I seriously have so many upcoming topics I’m planning to write about.
But here’s one thing that’s literally come up on four of my coaching calls in the past week. And, as you may know, when I start to see a certain topic coming up and over again, I take it as a sign it’s time to get something up on the blog.
So, what I wanted to talk to you about today is how to tell when a physical therapist (or other health professional) is experienced when it comes to SI joint adjustments.
As I’ve mentioned elsewhere in my site, I really think physical therapy is the best way to go, if you can find the right person. However, I know many of you are also seeing professionals such as osteopaths, and chiropractors, and I think this advice applies to them, too.
When someone is really skilled at SI joint assessment, they should be able to zoom in on the problem.
The right person should be able to look at your SI joints, on the first visit, and tell you whether or not you are in alignment.
When someone is really experienced in treating the SI joint, it isn’t something that finally occurs to them six months or a year into your treatment. It should really come up on day one, at your evaluation.
That’s because someone with experience in dealing with this problem knows what a huge deal it can be. And they also know what a huge deal it can be when an SI joint problem goes untreated.
It isn’t something they have to wonder about, or that you finally ask them to consider six months down the road.
Someone who understands this problem knows how important it is to figure out, ASAP.
They should be able to use specific terminology.
As I’ve mentioned previously, there are specific terms that have to do with the exact position of your joints, when they’re out of alignment.
When someone just says, “Well, I don’t really know, your pelvis just looks tilted to me,” that’s not the same thing.
Specific terms are things like upslip, posterior rotation, inflare, and outflare.
You know someone’s had advanced training when they know how to recognize all of these patterns.
They should be very specific about what they are adjusting, and why.
This one’s big.
When a healthcare practitioner is able to confidently assess your alignment, she will also know the specific adjustment techniques to correct what you’ve got going on.
She won’t need to “try and see” if mobilizing one of your joints feel make you feel better.
The right person understands the problem before doing the correction.
The people with the kind of training I’m talking about will know how to assess your alignment prior to doing a correction.
They may go step by step, where they check one thing, correct it, and then check the next thing.
But what you don’t want is someone who isn’t sure what the problem is, but pushes or pulls on you anyway.
Why it this?
For one thing, even when adjustments are done properly, they can be stressful on the body. As you may know, this is really why I prefer the Muscle Energy Technique, as it’s the most gentle. However, like anything, it’s still technically possible to overdo it
Additionally, specific patterns of imbalances have specific corrections. This is perhaps the biggest thing.
- If you have an anterior rotation, you want someone to do the correction for an anterior rotation.
- If you have a posterior rotation, you want someone to do the correction for a posterior rotation.
These two patterns of misalignment, as you may have guessed from the name, are technically the opposite of each other.
- The correction for an anterior rotation involves rotating the hip bone backward.
- The correction for a posterior rotation involves rotating the hip bone forward.
As you can imagine, if your hip bone is already rotated in a forward position, you definitely don’t want to be performing an adjustment that sends it even further forward.
Someone that truly understands the SI joint knows how much potential that has to make things worse– and would never risk doing it to you.
Ultimately, if a practitioner isn’t sure how you’re out of alignment, they shouldn’t be performing an intervention to try to correct it.
This is why I always say “less is more” when it comes to SI joint adjustments.
When someone knows what the problem is, it should be clear. They should be able to explain to you exactly which pattern of misalignment they see, how they made that diagnosis, and how they’re going to correct it.
And then the correction should be straightforward: they correct the problem you had, without overdoing it and without having to guess.
And then you should feel a clear result. I’m not saying all your pain should be 100% gone, but when your alignment has successfully been corrected, you’ll know, because everything will seem easier.
Not to worry– there are people out there who know how to do this.
The reason I’m able to write this post (and this blog, in general) is because I have been through it myself– the good and the bad. That’s how know how to help you find the good.
I also have some posts with tips on how to find a good physical therapist.
And, last but not least, one of the things I do on coaching calls is help people figure out their next step. I can help you sort through the list treatments you’ve already tried, and come up with some new ideas for things you haven’t tried yet.
I also put together a new section of my blog where you can find all my posts on SI joint alignment and corrections– it seems like this topic is coming up so much recently, because so many of you are looking for this information.
Hope this helps!
9 thoughts on “Why “less is more” when it comes to SI joint adjustments”
Useful post 🙂 I think you’re doing a great job educating people with our same issue. I live in LA and I saw one PT here and it’s been my worst nightmare 😦 he never explained to me if I was having posterior/anterior/outflare. Indeed, I saw a second PT after that who mentioned that I had left posterior rotation and his treatment was based on pushing forward my right ilium – which in the end caused me more problems that I’m currently dealing with 😌
Hi Rebeca, I’m so sorry you’ve been through all this, but I hope my blog can be of some help! That is so disappointing to hear you’ve had so much difficulty finding someone to help.
One piece of advice I always give my coaching clients is to really push your PT to tell you the specific terminology. They may be checking you for things like anterior rotation and outflare in their head, and just not saying it out loud.
Sometimes I think practitioners assume patients won’t be able to understand (or won’t care to), which is why it’s so important to articulate exactly what you’re looking for. If they still aren’t receptive too your concerns, or think it’s “too hard” to explain, they are probably not the right person for you!
P.S. I didn’t get an email address for your comment– normally I email people with this type of thing– but I just wanted to explain that I edited your comment to remove specific practitioner names. Unfortunately for legal reasons, I choose not to put negative comments out there about anyone. But I have definitely noted your concerns and will keep this in mind for any future recommendations I make!
I really hope you’re able to find the right person to help you, soon.
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Thank you for really spelling it all out!!
You are welcome! Always glad to know these are helpful ❤
Hello, I have just read all your blogs. I have been diagnosed with an SI joint problem. I have never been in as much pain in my life.
My question is, how are you supposed to do these strengthening exercises when you can barely stand or walk? How do I get to the point where I can start strengthening? I have been to the chiropractor and my medical doc. No one has been able to get me past the pain phase to start working on the actual problem.
I used to be a runner and very athletic. Now I am a pile of goo doing nothing waiting for the pain to subside so I can start to heal and workout again.
Any thoughts would be greatly appreciated
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Hi Cher, so sorry you are going through this. I’ve been through this stage myself, where it can be really hard to find a way to move at all that doesn’t hurt.
I can definitely share some exercise recommendations, although just as a reminder, all of the things I share on my blog are meant for readers to work through with their own physical therapist in person. (In general I think PT is a better approach than chiropractic).
I definitely recommend learning to activate the core: https://sijointsaga.com/2017/06/19/core-training/
As well as isometric glute squeezes: https://sijointsaga.com/2018/07/29/glute-squeeze/
Both of these types of exercises should allow you to start activating your muscle groups while placing very little stress on the joint.
I hope this helps! I’d be happy to do a coaching call with you for further info!
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Thank you SO much. It is refreshing to get guidance from someone who has actually had the same problem. I will bring these exercise recommendations to my PT.
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Great article and especially the warning about adjustments.
I think the biggest error is that the muscle spasm holding the SI in place in hypermobile or strained SI ligament cases is that some health care providers misinterpret that as a tight immobile joint. They then try and mobilize them (adjust) which is just straining them more and even risking tears. High velocity adjustments are the most dangerous in this situation. I have personal experience with this as do you so it is a wonderful warning for others to heed and find someone who has a lot of knowledge/experience in this area.
Hi Dr. Segel, I completely agree with everything you said! In my completely anecdotal experience conversing with readers, I’ve honestly yet to find someone who was successfully treated for a “hypomobile joint.” Pretty much everyone who’s ever come to me with this diagnosis ended up later switching to a different practitioner with a different treatment approach. In fact, a number of these readers later concluded they didn’t have an SI joint problem after all. From what I’ve observed, there doesn’t seem to be a very high success rate for the practitioners
giving out this diagnosis.
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