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View Full Version : X-Rays, SI Joint, Educated Patient...


Derek Weaver
11-11-2010, 06:02 PM
A few months back I had a post where I questioned my lack of glute activation on my right side. It's been steadily improving. A variety of mobility drills, stretching, targeted activation stuff etc. has helped to even things out, though I have a long way to go.

Anyway, I started realizing some lower back pain, and then developed a popping through my pelvis on both sides. In addition, I get a pop kind of between the iliac crest and the outside of my left hip. Google says likely culprit is SI joint. Makes sense.

Went to the doctor, who is pretty on top of ex. phys for a GP, who said he thought it may be some funky stuff going on with a flexor tendon on the left side. Wasn't sure about the back pain. Worst the pain's ever been on a scale of 1-10 was a 6. I don't take any Tylenol or anything for less than a 7-8. Usual pain is like a 2-4 range.

He ordered an X-Ray and PT. X-Ray results came back with symptoms of arthritis, but nothing out of alignment, no factures etc. He also noted that I should maintain just about everything I have been doing so long as it doesn't cause more pain. At least until the PT gets to do his/her assessment.

The point of this long post is a) Does anyone know what kind of a flexor tendon issue could possibly mimic SI Joint issues? b) what should I be aware of going into my PT appointment to be an educated patient and get the most out of it.

I'm no stranger to PT work as I've been through it for ~9 months total pre and post op for my right shoulder, and did some work for a back and neck injury I had playing Rugby. Don't know as much about the hips and lumbar spine though.

Jarod Barker
11-12-2010, 09:07 AM
Well, I'm not expert on the SI, but I can share my experience. My pelvis was actually anteriorly rotated, and it took seeing a chiro to show me that. He took and xray from the side and showed me that my lumbar was excessively curved and it carried over to my sacrum. Now, I realize my SI issues were separate from this, but I have to say, once we started addressing my "hyperlordosis" my SI symptoms abated. I can't say that that is your issue either, but you might find that loosening up some other areas and correcting any overly misaligned areas may have a carry over effect. Especially for something like a tendon.

Steven Low
11-12-2010, 11:33 AM
Do what Starrett call informed freestyling for all the aspects of the muscles in your hip.... glutes, hip flexors, abductors, adductors, etc.

You'll usulaly find tight spots and for SI joint problems you'll usually find some stuff that's not the same on either side.

That should fix the problems if you can locate the tight spots.

Also consider using lacrosse ball or golf ball and rolling teh whole gluteal region from the sacrum area (especially along there) to the hip, glute medius and TFL. That tends to hit everything even the deep hip external rotators

Derek Weaver
11-12-2010, 12:16 PM
Chris,
I've pretty much always been in anterior tilt. When I was younger I used to get crap for being swaybacked. Part of it was just having a big ass, other part was being tilted in the pelvis. Last couple months it's lessened. Still working on it.

Steven,
I definitely some issues regarding external rotation on the left side, where the problem is. I dig in to the areas with my thumb, tennis, lacrosse balls etc. I'm just wondering how, or if it could be a flexor tendon popping as I lower my leg. Almost like doing an active straight leg raise, on the way down, I get a big pop.

I guess it may just be an issue of needing months or longer to straighten it out.

Steven Low
11-12-2010, 02:41 PM
It sounds like something (it could be a flexor tendon or anything) is pulling on the SI area which is popping because the SI area is gummed up by tight muscles of some sort.

Er, SI joint is more posterior? Is that or not? If it's between the hip and iliac crest it could be hip joint.

Both hips and Si joint tend to get gummed up by the same tight muscles cause a bunch of them cross is especially the glutes

Derek Weaver
11-12-2010, 04:23 PM
It sounds like something (it could be a flexor tendon or anything) is pulling on the SI area which is popping because the SI area is gummed up by tight muscles of some sort.

Er, SI joint is more posterior? Is that or not? If it's between the hip and iliac crest it could be hip joint.

Both hips and Si joint tend to get gummed up by the same tight muscles cause a bunch of them cross is especially the glutes

Right, SI joint being more posterior makes sense to me in that the back pain could be caused by it. I saw some article and I want to say a youtube video linked through your article on the EMI site that a light popping or clicking in the anterior hip could be a symptom as well.

Then again, nothing showed out of place on my x-rays. Done from side, front and back.

Could be that the joint wasn't slipped at that point though.

I tend to have a lot more tightness on the anterior side of my right hip, than my left. But I have more glute tightness and external rotation issues with my left hip opposed to my right.

I guess I'll dig, do what the PT says, and stretch til I can't stretch anymore.

Derek Weaver
11-12-2010, 05:08 PM
PS.
If anyone is interested, or experiencing any issues similar to mine (still fully functioning, low level symptoms etc.) I am willing to post whatever progress and information I get.

Of course, you'd have to accept that it's not medical advice, I'm not a trained medical professional etc. Informational only.

If not, I'll keep it to myself.

(I hate the whole CYA requirement)

Steven Low
11-12-2010, 06:58 PM
Dig in with hands and use the balls a lot. They tend to work better than stretching in most cases

Derek Weaver
11-12-2010, 07:37 PM
Yeah, what I'll usually do is "Find the business" like KStarr says and hang out until whatever it is relaxes. Then I'll stretch it out for however long it takes.

If I'm just stretching, I have been holding for anywhere from 90 seconds upwards of even 5 minutes or longer in some cases.

I know that Mike Robertson had noted he had some issues that were taking low level stretches of 20 minutes multiple times per day.

Yael Grauer
11-13-2010, 07:55 AM
I'd be interested. I've had anterior tilt forever but some work from a PRI guy helped a lot, plus what I call psoas torture and some mobility exercises. Then, I did a Gokhale seminar which helped a bit more but I am still a bit anterior (though it has lessened quite a bit.) I heard rolfing can help.

Derek Weaver
11-13-2010, 05:02 PM
Cool Yael. I'll keep some sort of a running journal on what information I collect in office, whatever stretching and SMR stuff I do etc. and how progress is.

Jarod Barker
11-14-2010, 07:17 AM
PS.
If anyone is interested, or experiencing any issues similar to mine (still fully functioning, low level symptoms etc.) I am willing to post whatever progress and information I get.

Of course, you'd have to accept that it's not medical advice, I'm not a trained medical professional etc. Informational only.

If not, I'll keep it to myself.

(I hate the whole CYA requirement)

I'd be interested, I've had alot of improvement, but it still gets a little funny now and then.

I'd be interested. I've had anterior tilt forever but some work from a PRI guy helped a lot, plus what I call psoas torture and some mobility exercises. Then, I did a Gokhale seminar which helped a bit more but I am still a bit anterior (though it has lessened quite a bit.) I heard rolfing can help.

Have you ever had rolfing done on anything? I had it done on my calf once, very painful, but effective. I was supposed to go back for multiple treatments, but opted for electrostim and ultrasound instead.

Yael Grauer
11-14-2010, 10:16 AM
I have never had rolfing done, though I've tried just about everything else. It can be pretty aggressive and I've seen people who have had dramatic structural changes from it but tend to revert to their old patterns afterwards, so I'm hesitant, but my PRI guy in Tucson thought it'd be a good fit for me.

Craig Brown
11-14-2010, 05:55 PM
Derek, more info is never bad. I think I've had at least some of everything mentioned on this thread!

Craig

Jarod Barker
11-15-2010, 07:51 AM
I have never had rolfing done, though I've tried just about everything else. It can be pretty aggressive and I've seen people who have had dramatic structural changes from it but tend to revert to their old patterns afterwards, so I'm hesitant, but my PRI guy in Tucson thought it'd be a good fit for me.

I'd say it's definitely worth trying. I couldn't believe how different my calf felt afterwards, but I just don't think it was beneficial enough for that particular injury. Perhaps if I had a purely muscular injury, I might try rolfing again.

Derek Weaver
12-10-2010, 03:44 PM
Update:
Been getting a lacrosse ball and doing work on the piriformis, hip flexors, TFL etc. Whatever I can dig into around the hip, both flexors, extensors etc. I get into. Once I find a spot that sucks, I hang out there and wait it out. At times this has taken more than a couple minutes.

Afterwards, I have been going through 2-5 minutes of stretching per area. If one area is tighter, even after the lacrosse ball or foam rolling, I hang out for as long as I can a) handle it, or b) til the muscle releases or I reach the end range.

After that, I'll do some iso work to get the glute on the right side firing a bit better.

I also began to address that my right foot was a bit externally rotated. I had these things going on forever, but thought it was how I was built. As I've worked on these two issues, my hips and lower back have been much better and I've had less popping.

Additional updates as they become relevant...

Steven Low
12-10-2010, 06:32 PM
Nope.... most people aren't "built" a certain way at all. They think it's normal when things ain't normal.

Even if you have structural problems they can sometimes be corrected although it's much easier to correct while you're still growing in the teens.

Glad to see you're on track and doing fairly well it seems.

Derek Weaver
12-11-2010, 01:37 AM
Thanks. I finally started looking more into the unfortunate truth that if something sticks a direction it normally wouldn't, it's usually not a genetic thing. Maybe a genetic predisposition to certain issue.

I still have some glaring imbalances, but since I've been working on loosening up my quads/hip flexors and targeting certain areas I've gotten a lot better.

One question though regarding the right foot being a bit externally rotated:

I've read a few schools of thought, and each has merit in my mind so I'd like to get a little clarification on my thinking.

One is that the internal rotators of the hip could be imbalanced and tight, causing the femur to internally rotate and the foot to overcompensate. This may be in response to a weak piriformis and glutes in general. I do seem to have a little extra tightness in the TFL area though from what I can tell. usually resolved with the lacrosse ball though. Likewise, externally rotated femurs may result in a pigeon toed stance.

The next one would be weak internal rotators and overactive glutes/piriformis causing external rotation of the hip that translates down to the ankle and foot. This doesn't seem to be the case given the imbalances between sides re: glutes

The first school of thought makes more sense to me given my set of circumstances. Any insight would be appreciated.

Steven Low
12-11-2010, 07:47 AM
The logical school of thought being that most people have a bit more excessive external rotation in the right ankle (rather pronation/eversion/etc.) is that they drive with their right foot and often don't move the whole leg to hit the brake and gas pedal and instead just move their ankle.

Since we're on the gas most of the time, the right foot gets in the habit of being pronated/everted.

It's true if you have really tight adductors or predisposition to valgus knees (caving knees weakness) the foot does tend to evert/pronate though.

You more see chronic external rotation in the hip in old people as the hip flexors get really tight (as psoas major, iliacus, etc.) are external rotators of the hip.

Depending on how you sit (legs crossed or not) also becomes an issue sometimes.

So usually it's multiple issues with people.


If it's only the right foot I would tend to think it's just the gas pedal thing and things we do unilaterally since most of the time if it's due to a weakness or tightness issue you're gonna get it bilaterally or on the weak leg (left leg for most people).

I have a bit of the same thing, and now hae to consciously rotate my leg or move the whole leg when I'm driving a bunch. So I know the feeling of how annoying this is to correct.

If that's not the case we'll try to figure it out from there, but gas pedal thing makes the most sense to me.

Derek Weaver
12-12-2010, 04:23 PM
Thanks for the replies and advice in this thread Steven.

Regarding gas pedal vs. tight adductors, some thoughts:
- I am pretty ambidextrous, but did favor jumping off my left leg, kicking with my right leg (thus, I am more stable balancing on my left leg) etc.

I was talking with my cousin last night who is also in PT school, and she first presented the gas pedal idea as well. Then we started talking about past sports and she noted that it's likely I have more stability and strength in the glutes, and hip extensors in general on the left side. Hamstrings are a touch stronger, glutes are definitely more active. On the right side, it seems I have overactive hip flexors and dormant hip extensors.

I think I noted it in this thread, or maybe elsewhere, but the big assessment that made me realize just how significant the differences left vs. right are is the seated 90/90 stretch. I am significantly tighter on the left side than the right. When doing glute bridges, I have to focus a ton to actually get the right side to fire. If I don't drive my heel, my high hamstring takes over completely. After several reps, this isn't as much of an issue. I do this before every deadlift session.

Final issue I noticed, and don't laugh, is that my left glute "complex" is more hypertrophied. It's not like I sit there and rub my own ass silly day in and day out, but I finally noticed this while doing some SMR stuff with the lacrosse ball. My ass is lopsided if you will.

I think I know the answer, but it seems that additional SMR on the left side + additional stretching to loosen things up, while also doing more isolation type strength and activation work (like the super dog, Cook hip lift), and mashing + stretching of the flexors and adductors may result in the foot eventually turning to a more neutral angle as well as continue to balance out the hips and potentially alleviate the SI issues?

Derek Weaver
12-12-2010, 04:23 PM
For the record, when squatting down, if I am not conscious of what I'm doing, my foot looks like this:
http://content.revolutionhealth.com/contentimages/nr551309.jpg

Steven Low
12-12-2010, 05:41 PM
Yeah, I have the same problem with my R leg... get a bit of pronation.

BUt it's my left glute that is a bit smaller compared to right. Mainly due to some compensation from ankle sprain. Strong L quad, L low back, R glute, R hammy... kinda sucks.

Plan sounds fine. Work proper biomechanics a lot and you'll be good.