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Back Health: The Sacroiliac Joint

1/28/2016

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'My hips are out of alignment,twisted or stuck' These are common descriptions people give when they have Sacroiliac(SI) joint dysfunction. 'One hip is higher or one leg is longer' are other common signs. Of course there are many types and intensities within the term dysfunction. It can start as an ache while sitting or driving. Inflammation can progress and make bending forward to tie your shoes a challenge.


The typical presentation of Sacroiliac(SI) joint dysfunction is: worse in the morning, pain with flexion (bending forward), pain with prolonged sitting and relief with walking or gentle motion. These are the typical symptoms but can often show up as one or two of these findings with an additional set of often strange referral pains. Pain down the front of your thigh, tight band across your entire lower back or pain travelling up towards the flank can be attributed to the SI joint. On the rare occasion it can even mimic sciatica.


The mechanism of injury provides useful information. However, there are often no immediate causes and can gradually stiffen up throughout a day or you can just wake up stiff. In these cases


Proper assessment is key to determining which type of dysfunction, if any, there is in a SI joint. Chiropractors are trained to assess mobility and function. It is important to determine whether the joint is bound or too loose as those two scenarios require different treatment strategies. The sacroiliac joint is a complex joint that changes as we age. It translates vertical pressure laterally towards the hips. It needs to be strong yet mobile (within its limited range). There are no muscles that cross the joint in a significant fashion but there are many that influence how it moves. A tight SI joint needs mobilization and stretching whereas a hyper-mobile joint requires strengthening of the surrounding muscles. It is a large joint with complex motion that maybe hyper-mobile in one dimension and limited in another. Typically acutely inflamed SI joints require stretching and mobilization in the early stages regardless of joint stability. The amount of mobilization at this point is key as anything but a gentle motion may further aggravate the situation. Here are some stretches that will help restore motion in a tight or acutely inflamed sacroiliac joint. Make sure you visit your local Chiropractor or other healthcare professional for acute lower back pain.

Dr. Nelson

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When is the best time to stretch?

10/6/2015

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     There are different reasons for stretching: injury prevention, improved flexibility, and injury recovery. Each of these goals will have a different routine of timing, type and frequency. For all three, consistency is very important.
     Stretching to prevent injury works on two levels. The first is a warm type stretch which will increase circulation and bring blood to muscle you intend to use. The second is greater overall flexibility can reduce injury frequency. I will discuss this under the improved flexibility goal. A warm up stretch is of course best done before any vigorous exercise. The type of stretching is the key. Static stretching, eg the sit and hold a pose, is not the best choice before exercise. When your muscles are cold they have less flexibility and blood flow. You won't gain much in terms of flexibility stretching cold, and you won't get the blood flowing in a static posture. Dynamic stretching is best pre-exercise. Leg and arm swings anterior/posterior and lateral, shoulder shrugs, high knees and leg kicks are all good examples of dynamic stretches. Focus on the muscle groups you intend to use, start slow and build up intensity for 5 to 10 minutes. 

      Stretching to improve flexibility comes in different forms. Many people think of yoga or ballet and the extremes of flexibility. Increasing your flexibility can reduce injuries, up until a point. There is a trade off of strength for flexibility. Think of it as a bell curve, or inverted U curve. Inflexible people are prone to injury because their limit of flexibility is low and they push their boundaries easily. Extremely flexible people can give up strength for more range at their end limits which can lead to injury as the muscles become a larger portion of stability than the joint capsules and ligaments. More is not always better. That said, extreme flexibility is far less of an issue than limited flexibility. The best time to increase flexibility is when muscles and ligaments are already warm. Traditional static stretching will receive the most benefit following exercise. Balance is key, if you stretch your hamstrings, stretch your quads as well. Also, do not stretch into pain. Dynamic stretching such as during a yoga class is a great way to increase flexibility. If you have attended a class before you may have noticed that they generally start out light and build in intensity. The most vigorous stretching is near the end where you will get the most benefit. Yoga also incorporates balance work, which I personal feel is a great attribute to improve. Consistency is important which ever method you choose. If you stretch once a week then you may see benefits a year later. If you stretch 3 times a week or do a 40 day yoga challenge you may see benefits much more quickly. Everyone's body composition is unique and will progress and different speeds.

     Stretching is a vital component of recovering from injury. After an injury your body lays down scar tissue to hold together the damaged tissue. Initially scar tissue is disorganized and has a random arrangement. Movement breaks through that randomness and helps your body remodel the scar tissue to have a similar function to the tissue it is replacing. It is best to stretch without pain and at a mild or moderate level. The key for injury recovery is consistency. Stretching 3 or 4 times a day will help the tissues regain their former flexibility. It is an organic process that can take up to a year or more depending on the age and severity of the injury. Chiropractic care can facilitate this process by breaking scar tissue in difficult to stretch areas.

Dr. Nelson

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    Dr. Matthew Nelson

    A Vancouver chiropractor who pursues the outdoors year round with a passion for health and wellness. 

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