My sacrum has recently started “flipping” into an awkward rotation causing the entire pelvic bowl to sort of twist (if that makes any sense?!) and thusly creating some major imbalances, muscle spasms, etc etc… Its as if you held me by the hips (illiacus) and tipped one side down (anterior side rotates inferior, posterior rotates superior) while tilting the opposite side up (anterior side rotates superior, posterior goes inferior). I have been a comprehensively trained Pilates instructor, professional dancer & teacher trainer for many many years so I have tapped into all of my experience and resources, yet still having the recurring problem. Have been working with a massage therapist 1x week to get through the fascia and loosen the sacrum to get movement/bloodflow back into pelvis, but still… I am desperately seeking corrective exercises to help me stabilize this wonky pelvis!!!
Interesting question. As both a physiotherapist and someone who has injured his SI twice, I would love to share my input here.
I treat heaps of patients’ with SI pain whether it be a ilium rotation on the sacrum or a sacrum issue on the ilium. There are 12 different dysfunctions that can occur.
If you are a dancer, I agree with some previous responses. Also haven treated many dancers of all types over the past 12 years, sacrum issues/Sacroiliac joint issues are a problem.
From the research though, there is minimal movement that the ilium undertakes on the sacrum.
With your stating that your sacrum started “flipping,” I have never heard that before.Can you elaborate? If you are experiencing muscle spasms, you are spot on, there is not only muscle imbalances present, but also a ilium on sacrum dysfunction or a sacrum on ilium dysfunction.
Then other muscles commonly the hip flexors, ITB, paraspinals and piriformis will shorten to protect.
I would stop with the massage and you need to see a musculoskeletal physio who has extensive experience to fix this. One time usually whereby the physio uses a technique called “muscle energy” is extremely effective which uses the opposing non-affected side to counter rotate the dysfunction(this is with a ilum on sacrum problem). With a sacrum on ilium problem, sacral mobilizations, soft tissue and specific manual therapy techniques are warranted if it is hypomobile. Your condition sounds like it is hypermobile(has too much mobility), and sacral belts can be very effective for pain relief, then isolative lumbopelvic stabilization training and core training(static) to dynamic is what has worked for all of my patients.
Stop with the massage, try these techniques and email me at [email protected] for more help if you are unable to obtain qualified help and relief.
I would say look at the functional anatomy of what is going on. What causes the body to be pulled in that direction? Then look at the synergist (synergistic dominance) to that muscle and see if there are any imbalances. Are you stable where you should be and mobile where you should be? Do you have symetrical mobility and flexibility? Check out Gray Cook’s new book Movement, I think it will shine some light on what could be happening.
If it were me I would look at any repetitive movements or postures that emphasize this pattern…the way you sleep, sit, is your car seat even, do you lean to a side when you sit, do you sleep on your side….etc. Always look above and below a problem joint, in most non-traumatic issues it is a symtom of a different problem that you are unaware of yet. A message therapist will only give you temporary relief until you find the underlying cause of the shift.
Greetings! I absolutely agree with Joanne on the fact it is difficult to suggest what corrective exercises would be helpful when we don’t have access to the results of a movement screen. However, If you stand on one leg, do you have positive Trandelenburg? You eluded to that in your description but I wasn’t sure if you were standing or laying down. If YOU DO have hip drop, the standing leg “load” glutes may be weak. But let’s talk about a few other things…first of all…do you have sharp pain or any pain? If you have sharp pain, you should see your primary care physician or physical therapist.
Keep in mind several things: 1) The SI joint is the most complicated joint of the body. 2)It is held together by 5 ligaments, 3) The joint should not have great movement, meaning less than 1/4 inch when I did research several years ago, 4) sometimes the pain is caused by an unstable low back. Do you have any low back pain accompanying this problem?
So without going through a lot more, let me stop and suggest if you rule out any structural (fractures, breaks, etc.) and acute stage (happened within last 3 weeks), and you have been to your physician or therapist, you might want to try some spinal stabilization (isometric work), and gluteal strengthening in an unloaded mode (supine position).
If you are the client, here are a couple of exercises ….place a small ball between the knees of a client who is supine on a table with bent knees. With elbows bent next to the body, connect hands together above the abdomen. With you at their side, have them contract the ball, place one of your hands on the side of their knee and the other hand on the opposite side of their hands. Now, have them press against your hands (which will be in opposite directions) and you provide resistance. this is an isometric contraction to stabilize the cylinder core (multifidus, transverse abdominus, pelvic floor, diaphram, etc.)
Another exercise is again to have them in a supine position on a table and place one hand on the outside of their knee and your other hand on the other side of their knee. Have them press out, but only about 6-8 inches, then place your hands on the inside of their knee and have them squeeze your hands together. You can alter the “in presses” and the “out presses” about five times each.
I would suggest you avoid a lot of repetitive flexion, loading of spine, and transverse plane movement until you are stronger, or don’t have pain in the supportive tissue. Sometimes people are so strong that the compensation takes over and exercises have to be programmed that you or a client can’t access so that the muscles that are being recruited can be primary.
Crunches and dead bug exercises will come but right now do this…….let me know if this helps… There are lots of options, here..these are just a few.
Thanks…..hope this gives you another option