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Old 02-02-2009, 09:18 AM   #1
Erica Cirigliano
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Default PM Interview + injury from anterior-rotated pelvis

I am intrigued by the interview w/ Neil Rampe in this month's Performance Menu. He mentioned an anterior-rotated pelvis as being a common dysfunctional movement pattern, and I wonder how this relates to the lower back arch that is encouraged (at least at my gym) in weightlifting. Could an excessive arch, which as far as I can tell requires an anterior-rotated pelvis, cause injury?

Im a CrossFitter whos been sidelined with iliopsoas bursitis which flares up when I do anything even remotely resembling squatting (which has meant no CrossFit). The instructors at my gym have often commented on how great my form is, but Im now wondering if it wasnt an excessively forward-tilted pelvis that caused the problem, and continues to aggravate it.

Due to pain in my left SI joint, left groin and left knee, I rested for 6 weeks starting at the beginning of December. Still had sharp pain in groin after the rest period and got the diagnosis 2 weeks ago (the orthopedist did no imaging, just a history, some manual rotation of my leg and some muscle tests).

I've been in physical therapy for 2 weeks with no improvement, and a major setback as of last Friday when I started doing side-stepping and clamshell exercises. Feeling discouraged that physical therapy won't help, but maybe a setback indicates we're closer to pinpointing my weaknesses? I don't have much experience with long-term injuries or PT, so I'm also curious what others' experience is.
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Old 02-02-2009, 10:10 AM   #2
Craig Brown
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The Psoas are very, very strong little puppies that when they go wrong most definitely make you suffer. Add in SI joint going out of whack, and you have the on-and-off tale of 2008 for me. Sucked. I found a yoga instructor/bodyworker who has been able to get me mostly back to normal- I'm still not doing loaded barbell squats or deads for some time, until I get everything working optimally under lighter load.

Was you setback psoas or SI joint or both?

I really had to work on improving my standing and sitting posture to get through this. That 'low back arch' was my normal position, so I WAY overdid it when I started to think about it.

There is a viscous and hard to access trigger point release in the Trigger Point Therapy Workbook that helped me some. Learning to him the piriformis trigger point (sitting on a small hard ball) also helped a lot. But at this point yoga with someone who has a theraputic practice and a sports med background (I lucked out) is what has worked for me. That and avoiding the shit that kept reinjuring me (which pisses me off to no end) like heavy squats and deads.

Best-

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Old 02-02-2009, 10:24 AM   #3
Mike ODonnell
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Take up Yoga couple times a week....you'd be surprised how much that may help your muscle tightness and imbalances (which are the causes for most injuries).
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Old 02-02-2009, 12:04 PM   #4
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You may want to have a look at this thread:
http://www.cathletics.com/forum/show...ghlight=esther

This is "homework" that could help you a lot in the long run.

I've found the part in the free sections of the above book about "engaging the inner corset" have been very helpful for me in the beginning of squat reps. I've been doing yoga and joint mobility for a long time, so this mental picture comes easily to me--what I do at the beginning of a squat rep is mainly lengthening the spine, especially the lumbar area, and moving the posterior-inferior ribs forward (anteriorly).

Note that this is different in intention (and result) than "lifting the chest and sticking the butt back". Just using the free stuff from the book (which is simple) both during and between my sets has reduced my normal midback pain appreciatively.

Esther Gokhale (the book's author) does not believe in reducing the pelvic tilt necessarily, she believes there should be a good angle at L5-S1. She's more into reducing the general lumbar lordosis and thoracic kyphosis (thus making the spine curve less, so it is more stacked like bricks). I really like her approach. Make sure to watch her Google Video, it's very good and makes a lot of sense.

Do your posture work as part of your warm-up and between sets of strength work. Note that hard metcon will tend to collapse the general posture to horrid levels as one gets more and more fatigued--head goes forward, shoulders round, etc.... Another reason IMO to do power-biased metcon, with some rest period to re-set the posture and not create bad habits (while exercising in an effort to create better health!).
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Old 02-02-2009, 06:34 PM   #5
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Anteriorly rotated pelvis may be fine IF it's not being caused by tight hip flexors... this is generally what is can cause a lot of problems.

Remember, we do want lordosis in the lumbar spine but not HYPER lordosis. When it becomes too bad because of anteriorly rotated pelvis that's when you're going to be having problems. Otherwise, no.

SI joint dysfunction is for the most part a whole other problem.. slippage for example can occur because of uneven impact on the legs or trauma to the hips. It all depends.

A competent PT should be able to figure it out and get you back on track.
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Old 02-05-2009, 07:52 AM   #6
Erica Cirigliano
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Thanks to everyone for their great input.

Because I live in Los Angeles, where you're not allowed to sign a rental agreement or purchase property unless you own a yoga mat, I not only know what dwi pada viparita dandasana is, but I can do it. I'll spare everyone my rant about yoga only to say that I find it to be overrated. Working with a yoga instructor who knows sports medicine, however, sounds wonderful. I'm not sure such a person exists in LA, where the focus is on chanting and chakras (oops-that was a little rant).

I will definitely check out the Gokhale book. I had been purposely, with muscular strength, tilting my hips forward both when I was lifting and when I was sitting at my desk, thinking that this was the way to maintain a "good lumbar curve." However, I now know I was in hyper-lordosis. My PT worked with me on Monday to find a neutral pelvis and I can already feel changes in my psoas and SI joint as I sit at my desk. I'm hoping as those return to normal, the bursitis will ease up. I've tried a few bodyweight squats, but it's just not clear to me how to keep good form and not go into hyper-lordosis, so I have hope that the Gokhale method will help me find that form when the time comes.

And Craig, I'm right there with you, that time can't come soon enough. I have been alternately furious and morose over my inability to work out (which makes for good times for my husband). My first line of attack was the trigger point book, and I found some trigger points in the QL that really helped my SI joint, but nothing made a dent in the bursitis pain. I think that training my posture must also be a part of the solution, as was your experience. My worst days are when I lose hope of ever recovering. As long as I'm making incremental progress every day, I do okay. I would prefer a short road to recovery rather than a long road, however. I read with some envy Yael Grauer's post that her condition got better in a week working with a PRI practitioner. The closest one to me is in Santa Barbara, which is 2 hours away, but even that doesn't mean I'm ruling it out.

And finally, yes, crazy metcon can lead to bad form, though I have to say that my crossfit style is to go slower and keep good form because I have no hope whatsoever of getting a fast time anyway, so I might as well not hurt myself. It's the height of irony to me that my striving for what I thought was very good form IS what hurt me. I had actually been working through the Starting Strength program, which is not metcon at all, when this all started. Oh, well. Lift and learn.

Thanks again to everyone who posted.
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Old 02-05-2009, 10:01 AM   #7
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No prob man. Hope your recovery goes well. Keep us updated.
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Old 02-05-2009, 11:45 AM   #8
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Were you able to get to that psoas trigger point you hit by lying on you back/side and coming in with your fingers in your abdomen? That one just took a touch to both take my breathe away and release a TON of pain/tension. Hard to do, though.
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Old 02-05-2009, 12:16 PM   #9
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I think you'll be just fine. Make sure to keep the positive outlook, give each thing you try a real honest chance (like 2 months), and if you don't find the answer then keep searching.

My middle back pain (which still is not completely resolved) is what started my career in medicine, to figure it out!
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