Physical Therapy Update: How to Rehab SI Joint Problems, Pelvic Rotation, and ITBS

Let's just go ahead and start this post off right, with a horrifying picture of my left thigh following some deep tissue massage.  The PT warned me that I would have "some superficial bruising."  I think that was most likely an understatement. 

Lovely, I know.  This is the result of an instrument made by Hawk Grips and I would like to note that it did not hurt while it was being used on me.  Fascinating.

Okay, I've had four PT sessions, each one about two hours long.  I am going to Premiere PT, which I really can't say enough good things about.  They really understand athletes, don't talk down to lay people (which I HATE in the medical profession...seriously, grounds for walking out of an appointment), and they are dedicated to doing whatever it takes to get you healthy again.

I feel like I fully understand my injury now, which is the key to preventing future problems.  Most likely, this originated during pregnancy, when hormones loosen your tendons and ligaments, and added weight and pressure stress your hips.  As a result, the two sides of my pelvis became rotated out of alignment with one another (right hip tilted forward and left hip tilted back).  This is called pelvic rotation.  My sacrum (tail bone) was also pulled out of alignment, with a lower left posterior torsion.  You can see a diagram of this injury type right here.  It is called either sacral torsion or SI joint dysfunction.

Ultimately, all of this misalignment resulted in ITBS (iliotibial band syndrome) on the left side.  The symptoms were general soreness and pinching across my left buttock, and deep aching in my left hip, along with severe and sharp pain across the outside of my left knee.  It was much worse when running downhill or climbing stairs. 

I'm being very specific with all of these descriptions, because this is sort of an unusual injury, and you don't read much about it online.  Also, the ITBS I had is much different from "normal" runners' ITBS, which is a repetitive and progressive overuse injury.  I hope anyone with the same symptoms or diagnosis might be able to find this post and somehow benefit from it.

Treatment for the ITBS has focused only on relieving pain and inflammation.  That has meant a combination of ice/heat, electrical stimulation treatments, deep tissue massage, and topical anti-inflammatories.

Treatment for the alignment issues has been a little more focused and intense.  At each PT session, the therapist "sets" my hips and lower back into the correct alignment using physical manipulation.  Some of these adjustments are more painful than others, but with each visit I am closer to proper alignment.  At this last session (the fourth), I did not need adjustment at all.

Preventative treatment has been the bulk of my PT sessions, and it has taken three forms:

1.  Correcting my motor habits in daily life,
2.  Strengthening key supporting muscles, and
3.  Retraining my running gait to be more efficient and relieve stress on my SI joint.  

For the first one, I am avoiding crossing my legs, sleeping on my side, or stressing my hips with awkward or asymmetrical postures.  I have switched to sitting with both feet on the floor, sleeping on my back, carrying heavy loads in the center of my body, etc.  It has made a HUGE difference already!

The exercises I am doing include:
"Clam shells" with a TheraBand - 30 supine, 30 on the left, 30 on the right
Standing leg extensions with a TheraBand - 45 in each of four directions, for each leg
Bosu ball lunges - 30 on each side
Lateral lunges on a 4" block - 3x15 on each side
Hip adduction on the weight machine - (40) 3x12
Hip abduction on the weight machine - (40) 3x12
Hamstring curls on the weight machine - (30) 3x12

They also have me doing the elliptical on very high resistance, which SUUUUUUUCKS.

For the running gait, I had a video evaluation based on digital video of my treadmill running form, taken from the front, rear, and side.  I was so pleased to learn I have a nice gait that doesn't need a lot of work!  Such a stupid thing to be proud of, I know.  My stride length and cadence are right where they should be.  My legs are positioned properly in relation to each other.  I have no unnecessary lateral movement in my knees.

The therapist does want to work on two changes to my gait.  First of all, I need to eliminate "vertical translation," which is basically how you "bounce" up and down during your stride.  Because of my particular gait, my head, shoulders, and hips should remain level in relation to the ground so I can push off faster.  This also will remove impact from my hips.

Secondly, I need to move toward a forefoot strike.  Getting off my heels when I run will activate my glutes more and take pressure off my hips.  This is something I have been trying to work on over the past several months, but I need to make it a habit. 

I have worked up to feeling comfortable with six or seven miles on the treadmill.  And, I'm faster on the treadmill than I have been before, so I'm hoping that will translate to faster outdoor runs.  According to my therapist, I *should* be able to run outdoors without pain.  Honestly, I think I have PTSD from some of those agonizing runs from late March and it's going to be very difficult to start getting back out there.  I have an easy eight-miler scheduled for tomorrow morning with the Track Club, and I have zero expectations for my performance.  Wish me luck! 


Lizzy said…
Good luck tomorrow!

Thanks for sharing the details of this injury. I've had a nagging tightness/pinching in my left buttock for about two weeks now and I suspected that it is connected to some lingering ITBS issues on my left side. It's nice to see some support for that hypothesis, though I've never been pregnant, so it's clearly for different reasons. I've been getting back into the Myrtle routine and spending more time with my foam roller and it seems to be helping, so regardless of whether or not ITBS is the underlying cause, the treatment seems to work. It seems like the PT you've been working with is really helping you out, so hopefully you'll be back to running well in no time.
Rosery Merry said…
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