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Walking, sacroiliac dysfunction and hip painI was going to write about insulin this week, but I've been noticing something in my practice, and I figured I'd better write about it before it slipped my mind. So my apologies to those of you that are eagerly awaiting the next installment in the endocrinology series.
I should also apologize to all my wonderful SI joint teachers who took the time to really coach me with respect to SI joint dysfunction, (Diane Lee and Linda Joy Lee, Marcy Dayan, Paul Chek, Shayne McDermott, David Ewert, Mark Finch, Tom Myers, and most recently, Richard DonTigny), because it is very probable that you actually did teach me this, and I forgot and have now simply relearned it for myself.
For those of you that are not in the exercise or physiotherapy field and have no idea what and where the sacroiliac joint is, it is the joint between the sacrum, or the triangular bone at the bottom of our spines that the tailbone is a part of, and the pelvis. People that have SI joint pain frequently point to the "pelvic bump" area in the very low back where the dimples are as the achy spot, and that pain is often one-sided.
For non-exercise people, skip to the next paragraph where I'll explain this more simply, but for those in the field, what I've noticed is that most people that get SI joint pain seem to walk using their hip flexors as the prime movers. While walking quickly, the pelvis is frequently in anterior tilt and/or there is a distinct forward lean of the trunk, and very often the person with the dysfunction is "pulling" their legs forward rather than "pushing" them. In my practice at least, using the hip flexors to walk seems to be a far more obvious pattern in SIJ dysfunction than a Trendelenburg sign, although the patterns do frequently go together. I realize that someone in anterior tilt also tends to have poor local stabilizer and poor glute function, but I have found that even when someone has generally improved their pelvic position and been trained to connect to those muscles in other functional patterns such as stand-to-sit-to-stand, unless their faulty motor-recruitment pattern in walking is also corrected, the SIJ pain does not go away due to the constant forces trying to unlock the joint. So I have put gait to the top of the priority list, and have been spending a lot of time recently teaching people how to walk - and it seems to be helping. Because I frequently see this same faulty walk pattern in those that have had or are about to have hip replacement surgery, I think it is possible that overuse of the hip flexors during gait may pull the femur slightly forward in the acetabulum, potentially creating a wear problem leading to the need for hip replacements. Therefore in my opinion, correcting this faulty gait as soon as it is recognized (possibly in late childhood or adolescence) may go a long way toward not only reducing future pain and suffering, but also reducing the need for hip replacement surgeries. If a study has not already been done on this, I think the idea has potential!
Probably the easiest way to explain this concept is to actually try it and feel it in your body. So, stand up, and pretend that your pelvis is a bucket, and you are pouring water out the front. You should feel like you are sticking your butt out behind you, and you have a big arch in your low back. Now try walking while maintaining this pelvis position. Notice how you have no choice but to use the front of your hips to move your legs? Notice how effortful this is? Not good. Hard on your SI joint, hip joints, low back, turns off your local stabilizers and your gluteus maximus, and way over uses the hipflexors and quads. If you have SI joint or hip pain or if this is how you tend to walk, it may be worth your while to try a different way.
First, stretch your hip flexors gently for a minute or two. Then, while hanging onto something, try standing as tall as possible on one leg on a small stable stool or a stair, tucking the tail under slightly (hold the bucket level so no water spills out) without squeezing the buttocks, so that the other leg can hang down completely suspended from the hip socket. You should be able to swing the leg like a pendulum with no muscles gripping the leg bone at all - it pretty much moves by itself with no muscle effort. That is how one's leg should feel in the swing phase while walking - loose, like it's hanging, and pretty much moving by itself. So, now get down from the step and try walking. The trick is to walk while standing as tall as possible - this will frequently be enough to bring your pelvis to a neutral position. If you can't get that "hanging" feeling at the hip joint while you walk, stretch your hip flexors again, stand taller, and tuck your tail under a bit more by using your lower abdominals to gently pull up the pubic bone. If you are walking correctly, you will not only feel like your legs are floating, but you will also feel that any work that is happening is coming from the back side of the body rather than the front side.
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Lee, Diane The Pelvic Girdle Churchill Livingston, 2004.
Lee, Diane and Lee, Linda Joy An Integrated Approach to the Assessment and Treatment of the Lumbopelvic-Hip Region DVD, 2004
Lee, Diane and Lee, Linda Joy Postpartum Health for Moms - An Educational Package for Restoring Form and Function after Pregnancy CD ROM 2006.
Lee, Diane Assessment Articular Function of the Sacroilac Joint VHS
Lee, Diane Exercises for the Unstable Pelvis VHS
Richardson, C, Hodges P, Hides J. Therapeutic Exercise for Lumbopelvic Stabilization: A Motor Control Approach for the Treatment and Prevention of Low Back Pain Churchill Livingston 2004.
DonTigny, Richard Pelvic Dynamics and the subluxation of the sacral axis at S3 The DonTigny Method.
Myers, Thomas Body Cubed, A Therapist's Anatomy Reader "Poise: Psoas-Piriformis Balance" Massage Magazine, March/April 1998.
Myers, Thomas Body Cubed, A Therapist's Anatomy Reader "Fans of the Hip Joint" Massage Magazine, Jan/Feb 1998.
Myers, Thomas Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists Churchill Livingston, 2001
Chek, Paul CHEK Level 1 Advanced Back Training Chek Institute.
Johnson, Jim The Multifidus Back Pain Solution: Simple Exercises That Target the Muscles That Count New Harbinger Publications Inc. Oakland CA, 2002.
Lee, Diane Understanding your back pain - an excellent article explaining the concept of tensegrity and its importance in stabilizing the pelvis and spine.
DeRosa, C. Functional Anatomy of the Lumbar Spine and Sacroiliac Joint 4th Interdisciplinary World Congress on Low Back & Pelvic Pain, Montreal, 2001.
Gracovetsky, S. Analysis and Interpretation of Gait in relation to lumbo pelvic function 4th Interdisciplinary World Congress on Low Back & Pelvic Pain, Montreal, 2001.
Dananberg H. Gait style and its relevance in the management of chronic lower back pain 4th Interdisciplinary World Congress on Low Back & Pelvic Pain, Montreal, 2001.
Online at www.kalindra.com A fantastic website devoted to sacroiliac dysfunction.
Copyright 2007 Vreni Gurd