SacroiliacJointDysfunction

EmilyHoffSeptember22,2016

ComprehensiveTeacherTrainingProgram2015SolanaBeach,CA

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Abstract

Duetothenatureofsacroiliacjointdysfunction,thissyndromeisrelatabletothe

commonclientandthePilatesindividualduetothefactthat15-30%ofthepopulation

experiencessometypeofchronicinjury,duetothesacroiliacjoint,atsomepointintheir

lifetime.

Sacroiliacjointdysfunctioninvolvesthestructureoftwodifferentbonesthatare

joinedtogetherbyligaments,thesacrumandtheiliacmakeuppartofthepelvisandthe

sacrumconnectstothespineatthelumbervertebrae.Duetothenatureofthesetwobones

thereislittlemovementthatoccurs,butinspecialoccasionsthebodycanmoveinacertain

waythatmaycauseirritationtothisjoint.Thebodyreleaseshormonesthatcancausethe

ligamentsthatholdthesetwobonestogethertobecomelaxandthereforecause

separation.WiththehelpofPilatesandstretchingthemusclesthatsurroundthisjointcan

supportthesebonesandeliminatepain.

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TableofContentsPage

Abstract2

AnatomicalDescription4

CaseStudy6

ConditioningProgram8

Conclusion12

Bibliography13

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AnatomicalDescription

Thesacroiliacjointsitsatthebottomofthespine;thesacrumconsistsoffivefused

bonesandconnectstotheiliaconeitherside.Theiliac,whichisthepelvicbone,connects

allthewayaroundandjoinsinthefrontbyapubicsymphysis.Thesacrumsitsattheback

ofthepelvisandatthebottomofthespineconnectedtothelumbarvertebrae.In-between

thesetwobonesarehyalinecartilageandfibrocartilageallowingforsomesortof

movement.

Theprimaryfunctionofthepelvisistoprovideattachmentforthemusclesthat

balanceandsupportthetrunkandmovethelegs.Thebasin-shapedcomplexofbones

housesseveralorganswhileprotectingthem,thisisextremelyimportantwhenafemaleis

havingababy.Inthiscasestudywewillbeobservingafemaleanatomyduetoapregnancy.

Whenafemaleishavingababythereareseveralchangesthatcanoccurtotheshapeand

laxationoftheligaments.Thebodyreleaseshormonesthatcausethepelvistoexpand

allowingthebabytogrow,duetothishormonereleasetheligamentsbecomelaxandifthe

individualbecomestoolaxtheninjuriescanoccurinthesacroiliacjoint.

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Sacroiliacjointdysfunctioncancauselowerbackpain,buttockspain,sciaticleg

pain,groinpain,hippainandseveralothersystems.Thisiscausedbyadisturbanceinthe

connectionbetweentheiliaandthesacrum.Severalmusclesthatholdthesejoints

togetherarethepiriformis,rectusfemoris,gluteusmaximusandminimus,erectorspinae,

latissimusdorsi,thoracolumbarfascia,andiliacus,theyallplayanimportantrolein

maintainingstabilityinthepelvis.Ifoneofthesemusclesisaffectedinanywaythenthe

pelviswilltrytocompensatebylengtheningthemuscle.Duringpregnancysincethe

musclesarebeingstretchedoutandthepelvisisexpandingthepelvicgirdleisundergoing

somemajorstress.Therecanbesomemovementthatoccursandcausesatiltinthepelvis

andthereforepain.

“TheSIjointisapain-sensitivestructurewhichisinnervatedbyacombinationof

unmyelinatedfreenerveendingsandtheposteriorprimaryramiofthespinalsegmentsl2-

S3.”(Wikipedia,Sacroiliacjointdysfunction)Thisexplainswhysomeonemightexperience

paininthelowerbackandleginaccordancewiththestructuraldamageonthatspecific

side.Duetothecompensationinthepelvistheremightbesometightnessinotherareasof

thebodytryingtoprotecttheareafromfurtherdamage,andthismightconsistofthe

hamstringsoriliotibialtract.

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CaseStudy

Thesubjectofthiscasestudyisa30-year-oldfemalewhoworksinanoffice,forall-

intenseandproposessheiscalledClaire.Clairecametomeafterhavingababy,she

deliveredvaginally,anditwasanormalpregnancywithnorealcomplications.Shenoticed

somepaininherlowerspinwhensittingandhaddiscomfortwhenshesleptonherleft

side.Shewasactivebeforethepregnancybutsloweddownduringthepregnancyandafter

shedeliveredshehadahardtimemotivatingherselftogetbackintoaworkoutregime.She

wenttotheDoctortofindoutwhattheproblemwasandtheysuggestedPhysicalTherapy.

AftersometimewithPT,theysuggestedtomoveintoaphysicalactivitythatwaslighton

thelumberspineandjointsandwouldstrengthenthehipsandsacralregion.Thepainis

mostlyontheleftsideandmovesdownthelegtowardhercalf.Shewasnotdiagnosedwith

anynervedamagebutlaxityinthejointsthatholdthepelvistogether.Themainproblemis

betweenL5andS1,SacroiliacJointDysfunction.Thereasonsfortryingtofixtheproblem

wasbecauseofherjobandlifestyle,sheisforcedtositforlongperiodsoftimeatadesk,

andcommutingbackandforthtowork.Shemainlywantedthestrengthbackinhercore

andevennessthroughoutherlowerbackandpelvis.Thediscomfortcameonmoreat

nighttimeafteralongdayatwork.Shefeltreliefwhenstandingandtriedtomakesureto

dothisafter20minutesofsitting,butfoundthatwashardattimes.Stretchingwasalsoa

reliefandusedtheraballsorfoamrollerstohelpwithreleasingthetension.SheusedThe

AlexanderMethodwhenusingthefoamroller,whichisamyo-facialreleasetechnique,that

helpsrelax,contractedmusclesandimprovebloodflowandcirculationtotheaffectedarea.

Thistechniquewasincorporatedintohertherapytohelpopenupthefrontofherhips,and

hipflexors,sothattherewasn’tananteriortiltofthepelvis.Thisprocessalludedtoamore

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neutralpelvisduringherworkouts,whilestrengtheningtheglutealmuscles,whichiswhat

ourmainfocuswaswhilecompletingourprograms.AfterseveralmonthspracticingPilates

shehasnoticedahugedifferenceinherbodyanddoesn’tfeeldiscomfortasoftenasshe

usedto.ThegoalwastotryandeliminatealldiscomforttogetherandstopPhysical

Therapy,sothatshecouldraceinahalfmarathonbytheendoftheyear.

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ConditioningProgram

Claire’sgoalsaretoincreasemusclestrengthonherleftsideandencouragemobility

throughoutherpelvistocreateastablepelvisbilaterally.

• Strengthenglutealmusclesandhamstrings,whilelengthenthehipflexorstocorrect

alignment.

• Focusingonbilateralmovementtocorrectimbalancesfromweaknessesontheleft

sideofthebody.

• Strengthentheabdominalmuscles,focusingonthetransverseabdominusto

supportthelowerback.

Blocks Sessions1-10 Sessions11-20 Sessions21+

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Warm-Up

Mat(fundamental)PelviccurlSupineSpineTwistChestLiftChestLiftw/rotation

Mat(fundamental)PelviccurlSupineSpineTwistChestLiftChestLiftw/rotation

MatPelviccurlSupineSpineTwistChestLiftChestLiftw/rotationOrCadillacRoll-upwithTRUPMiniRoll-upsMiniRoll-upsObliquesRoll-uptopLoaded

Footwork ReformerParallelHeelsParallelToesVpositiontoesOpenvheelsOpenVtoesCalfRaisesPrancesSinglelegheelsSinglelegtoes

Reformer/CadillacParallelHeelsParallelToesVpositiontoesOpenvheelsOpenVtoesCalfRaisesPrancesSinglelegheelsSinglelegtoes

Reformer/CadillacParallelHeelsParallelToesVpositiontoesOpenvheelsOpenVtoesCalfRaisesPrancesSinglelegheelsSinglelegtoes

AbdominalWork

ReformerHundredPrepHundredCadillacRoll-UpTopLoadedWundaChairStandingpike

ReformerHundredPrepCoordinationShortBoxseriesCadillacMinirolluptoploaded/minirollupwithrotation

ReformerHundredPrepLegsinstrapsCadillacTeaserBreathingw/pushthroughbarWundaChairTorsopresssit

HipWork ReformerFrogCirclesDownCirclesUpOpenings

Reformer/CadillacFrogCirclesDownCirclesUpOpenings

ReformerCirclesDownCirclesUpExtendedFrogExtendedFrogreverseCadillacFrogCircleDownCircleUpWalkingBicycle

SpinalArticulation

ReformerBottomliftBottomliftw/extension

ReformerShortspinLongspinCadillacMonkeyTowerPrep

CadillacTowerWundaChairJackKnife

Stretches ReformerStandingLung

ReformerKneelinglung

ReformerSideSplit

FullBodyIntegrationI

ReformerKneestretchroundbackKneestretchflatback

ReformerUpstretch1ElephantCadillacPushthroughseriesSittingforwardSidereach

ReformerDownstretchUpstretch3CadillacThighstretchw/rollupbarKneelingcatstretch

ArmWork ReformerArmsSupineseriesExtensionAdductionCirclesUpCirclesDownTriceps

ReformerArmskneelingseriesChestExpansionUpcirclesDowncirclesTricepsBicepsCadillacArmsStandingseriesChestExpansionHug-atreeCirclesup

ReformerSideKneelingSeriesDeltoidReachCrossarmpullTricepsArmsoverheadCadillacArmsStandingseriesChestExpansionHug-atreeCirclesupCirclesdownPunchesBiceps

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ArmWork ReformerArmsSupineseriesExtensionAdductionCirclesUpCirclesDownTriceps

ReformerArmskneelingseriesChestExpansionUpcirclesDowncirclesTricepsBicepsCadillacArmsStandingseriesChestExpansionHug-atreeCirclesupCirclesdownPunchesBiceps

ReformerSideKneelingSeriesDeltoidReachCrossarmpullTricepsArmsoverheadCadillacArmsStandingseriesChestExpansionHug-atreeCirclesupCirclesdownPunchesBiceps

FullBodyIntegrationII

ReformerBalancecontrolfrontBalancecontrolbackprepCadillacSittingBack

LegWork WundaChairLegPressStanding

ReformerSinglelegskatingWundaChairFrogFront

ReformerJumpingSeriesParallelpositionVPositionSinglelegparallelLegchangesCadillacSingleLegSideSeriesChangesScissorsCircles(forward,back)

LateralFlexion/Rotation

WundaChairSidestretch

ReformerSideoveronboxMermaidCadillacSideLift

WundaChairSidePike

BackExtension ReformerBreaststrokeprepWundaChairSwanBasic

ReformerLongboxPullingstraps1Pullingstraps2CadillacProne1

ReformerLongboxBreaststrokeCadillacProne2

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Conclusion

Allinall,Clairewentthroughsomeupsanddowns,someweeksshemadehuge

leapsandotherweeksshedidn’t.Clairewentthroughsomedifficultlywithpainand

discomfortbutsheworkedthroughit,andwhenshehadpainwewouldstretchand

messagethoseareasandthatmadeherfeelbetter.Sowefoundaroutinethathelpedher

increasestrengthwithoutcausinghertohavepainorexasperateherdysfunction.We

workedincoordinationwiththePhysicalTherapist,sinceshewasgoingtwiceaweekfor

sixweeksandthendowntoonceaweekforsixmoreweeks.Thiscommunicationwiththe

therapistwasvitalandpartofClaire’srecovery.Clairemadelastingimprovementsfrom

Pilatesandhascontinuedtoworkoutwithme,andIhaveenjoyedworkingwithher,

improvingtheworkoutsfromweektoweekandwatchinghergrow,asanindividualinthe

Pilatesworldhasbeenawonderfulexperience.Shewillstrugglewiththisproblemtherest

ofherlifebutshelovesPilatesandislookingforwardtothefutureandthebenefitsthat

shehashadbecausesheisgettingherphysicallifestylebackandforthatsheisvery

grateful.

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Bibliography

Driver,CatherineBurt,MD.SacroiliacJointDysfunction(SIJointPain).2016.

http://www.medicinenet.com/sacroiliac_joint_pain/page3.htm

Isacowitz,Rael.StudyGuide:ComprehensiveCourse.BodyArtsandScienceInternational.

2013.CostaMesa,California

Wikipedia.SacroliliacJointDysfunction.

https://en.wikipedia.org/wiki/Sacroiliac_joint_dysfunction

Yeomans,StevenG.ScroiliacJointDysfunction(JointPain).2010.http://www.spine-

health.com/conditions/sacroiliac-joint-dysfunction/sacroiliac-joint-dysfunction-si-

joint-pain