how to resolve chronic sacroiliac joint...

How To Resolve Chronic Sacroiliac Joint PainApplying movement-based solutions for long term relief

with Sam VisnicNeuromuscular Massage and Corrective Exercise Therapist

Tuesday, January 7, 14

Here’s what you’ll learn...• How to identify potential sacroiliac joint problems

• Most common SIJ tests and their usefulness

• The simple SIJ correction technique that works in MOST cases, and takes only moments to perform

• How focusing on JUST the sacroiliac joints may cause you waste valuable time at resolving the root cause

• A corrective program blueprint to address muscle imbalances and instability

• Q + A at the end

Tuesday, January 7, 14

Copyright  Sam  Visnic.    2013

Disclaimer!

This is an educational webinar ONLY. It is not meant to diagnose and/or treat any conditions, nor does it substitute as medical care. Always seek the advice of your medical doctor before beginning any exercise or nutrition program. In

other words, make good decisions.

Tuesday, January 7, 14

Why should you listen to me?with Sam Visnic

Neuromuscular Massage TherapistCorrective Exercise Therapist

Nutritionist

Elite Athletes

A-List Celebrities

Weekend WarriorsTuesday, January 7, 14

Copyright  Sam  Visnic.    2013

SIJ Pain?

•Tenderness directly over the bony protrusions at the lowest part of back (PSIS)

Tuesday, January 7, 14

Copyright  Sam  Visnic.    2013

SIJ Pain?

•Band  across  lower  back  and  upper  glutes

Tuesday, January 7, 14

Copyright  Sam  Visnic.    2013

Referred Pain?

• SIJ issues can also include a disc component

Tuesday, January 7, 14

Copyright  Sam  Visnic.    2013

Medical Testing

•Difficult!

•Visual  diagnosBcs•ProvocaBon  (uncommon)

•InjecBon  of  pain  killers

Tuesday, January 7, 14

“Less than 15% of LBP patients can be given a precise

patho-anatomical diagnosis.” -Craig Liebenson, DC

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Meaning that over 85% of common lower back pain is

“non-specific!”

Tuesday, January 7, 14

Why the emphasis on visual tests?

• The false-positive rate for identifying clinically significant herniated disc or degenerative conditions with imaging is so high as to make the tests clinically inappropriate as screening procedures.

• The fact that advanced imaging modalities show that a large percent of asymptomatic individuals have herniated discs means that their presence in symptomatic individuals is often coincidental.

Craig Leibenson

Tuesday, January 7, 14

Why the emphasis on visual tests?

• In my opinion, disc involvement is over-exaggerated, and most lower back pain involves functional imbalances in the locomotor system.

Karel Lewit

Tuesday, January 7, 14

Why the emphasis on visual tests?

• Diagnosis of sacroiliac joint problems is just as much, if not greater a problem!

• It appears that a combination of tests helps determine where the problem may be

Tuesday, January 7, 14

Copyright  Sam  Visnic.    2013

Joint Tests: Best of 5?

• Gaenslen

• FABER test

• ASIS distraction

• Side-lying sacral compression

• Femoral shear test

• TIME is an issue!!

Can  find  these  on  Youtube!

Tuesday, January 7, 14

Copyright  Sam  Visnic.    2013

Movement Testing

• Backward bending

• Forward bending

• Sometimes side-bending and/or rotation

• Sitting/standing for long periods of time brings on pain

Tuesday, January 7, 14

Copyright  Sam  Visnic.    2013

Postural Illusions

Elevated   RotaBon

ShiNing  of  the  soN  Bssues  can  be  tricky!    Are  the  bones  really  moving?

Tuesday, January 7, 14

Copyright  Sam  Visnic.    2013

Summing Up Joint Testing

• Manual approaches suffer same problems

• Everything is a clue

• Correction confirms diagnosis?

Tuesday, January 7, 14

Copyright  Sam  Visnic.    2013

Richard DonTigny

•Tremendous amount of research• 650 slides leading to:• S3 subluxation

www.TheLowBack.com

Tuesday, January 7, 14

Copyright  Sam  Visnic.    2013

Anterior Pelvic Tilt

• Correlated with forward head posture• Correlated with flat feet or no arches

when standing

Tuesday, January 7, 14

Copyright  Sam  Visnic.    2013

Simple Correction

hQp://endyourbackpainnow.com/blog/cool-­‐gif-­‐image-­‐for-­‐sacroiliac-­‐joint-­‐mobilizaBon-­‐2/

Generally  10  repe::ons  performed  for  3  sets  each  side,  in  alterna:ng  fashion.    

Tuesday, January 7, 14

Copyright  Sam  Visnic.    2013

Over-Reliance on Manual Therapy

•Magical adjustment or mobilization?• Instead, use the correction as a “quick fix” to break the pattern, but stop thinking it

is supposed to last!• Combination with focus on movement as SOON as possible

Tuesday, January 7, 14

The movement toward movement!

• More and more people are becoming aware of the correlation between movement and pain

• Lewit calls problem “Functional Pathology Of The Locomotor System”

Tuesday, January 7, 14

Movement is a complex task...

• Involves multiple muscles working together as a chain, not in isolated parts

• Efficiency is the name of the game

• Reduce, produce, and distribute forces to minimize stress

Tuesday, January 7, 14

Copyright  Sam  Visnic.    2013

Muscle  Chains  =  Stability!

Your  body  works  as  ONE  big  funcBonal  system!  

Tuesday, January 7, 14

When things go wrong...

• Some muscles work more

• Some muscles work less

• = “faults” in the movement chain

• Fatigue, trigger points, tissue overload...

Pain!

Tuesday, January 7, 14

Ever feel pain when...

• Sitting for long period of time

• Standing for long period of time

• As you get into a run, bike ride or physical event

• Key element: TIME

• Correlates with “dull ache”

Tuesday, January 7, 14

Focusing on the wrong area!

If you are constantly focusing on the painful area, you may be missing the kink in the hose!

Tuesday, January 7, 14

How do we know which kink to fix?

Since we never know HOW important any given kink is, we must keep peeling away the layers of them until the work “sticks”!

Example: The big toe shoulder problem...

Tuesday, January 7, 14

Kink TestsFaulty Movement Patterns

• Hip Abduction

• Hip Extension

• Trunk Curl

• Shoulder Abduction

• Cervical Flexion

• Respiration

Tuesday, January 7, 14

How to fix faulty patterns: The Corrective Blueprint

• Relax the tight and overworked

• Strengthen the weakened and under-active

Tuesday, January 7, 14

Example: Faulty Hip Extension

Tight

• Hip flexors (Hip Flexors and Quadriceps)

• Calves

• Groin

Weak

• Glutes

• Hamstrings

• Abdominals

Tuesday, January 7, 14

Example: Faulty Hip Extension

Weak

• Glutes

• Hamstrings

• Abdominals

Tuesday, January 7, 14

Example: Faulty Hip Extension

Tight

• Hip flexors (Hip Flexors and Quadriceps)

• Calves

• Groin

Tuesday, January 7, 14

A pattern is essentially a Habit!

How do you break a habit?

• Interrupt

• Choose new pattern

• Repeat over and over again until it becomes subconscious

Tuesday, January 7, 14

How long does it take

The thing we hate...Patience

• Creating a pattern can take as little as a few hundreds repetitions

• Re-patterning can take THOUSANDS of repetitions!

• Not necessarily the SAME exercise, but same pattern of activation

Tuesday, January 7, 14

Junk in = Junk out

You must do your corrective work with super high degree of precision or it may not produce an ideal outcome.

Tuesday, January 7, 14

What happens

• Coordination occurs rather quickly and produces MOST of the initial results

• Metabolic changes occur over weeks and weeks

• Pain relief, however, can occur quite rapidly

Tuesday, January 7, 14

Blocking factors to success

• Lifestyle; ergonomics, bending and lifting, sleeping postures

• Diet; don’t discount the influence of biochemistry

Tuesday, January 7, 14

Do you see how powerful the process of addressing SIJ pain with a movement-

based approach can be?

Tuesday, January 7, 14

Visit:http://www.endyourbackpainnow.comto learn more about the Back

To Stability Program

Tuesday, January 7, 14