Upload
others
View
10
Download
0
Embed Size (px)
Citation preview
2
Abstract
TheSacroiliacJointisastrong,typicallystable,jointthatislocatedinthe
pelvisbetweentheiliumandthesacrum.Itissurroundedbyseveralsupporting
musclesandligaments.Thejointisresponsibleforshockabsorptionand
transferringweightbetweenthespineandthelegs.SacroiliacJointDysfunction
referstopainintheSacroiliacJointthatoccursduetoabnormalmovementofthe
joint.Itcanbecausedbyanumberofreasons,butisgenerallytheresultof
instabilityinthepelvicarea.Treatmentcanincludenon-invasivemethodssuchas
heat/ice,rest,anti-inflammatorymedications,stretching,exercise,orinmore
seriouscasesphysicaltherapy,injections,andsurgery.Pilateshasshowntobe
particularlyeffectiveinalleviatingpaincausedbySacroiliacJointDysfunction
becauseofthefocusonbuildingstabilityandstrengthinthesurroundingmuscles,
correctingimbalancesandcompensatorypatterns,andstretchingmusclesthathave
becometootight.
3
TableofContents
1.TitlePage
2.Abstract
3.TableofContents
4.AnatomicalDescriptionoftheSacroiliacJoint
5.SacroiliacJointDysfunction
6.CaseStudy
7.BASIPilatesConditioningProgram
10.Conclusion
12.Bibliography
4
AnatomicalDescriptionoftheSacroiliacJoint
TheSacroiliacJoint(SIJoint)lieswithinthepelvisnexttothebottomofthe
spine,andisformedbetweenthesacrumandtheiliumbones.ThereisanSIJointon
eithersideofthesacrum,andthearticularbonysurfaceofthebonesinterlockto
providestabilityandminimizemovementofthejoint.Thejointissupportedby
severalsurroundingligamentsthatprovideadditionalstability.Musclesaroundthe
jointalsoeffectitsmobilityandmovement.Theyincludetheabdominalmuscles,
iliopsoas,erectorspinae,multifidus,glutealmuscles,piriformis,hamstrings,and
quadratuslumborum.AhealthySIJointshouldonlybecapableofsmallamountsof
motion(about2to18degrees)anditsfunctionsaretoprovideshockabsorption
duringweight-bearingactivities,andtokeepthehipsandpelvisstablewhile
effectivelytransferringloadbetweenthespineandthelegs(Vleemingetal,2012).
5
SacroiliacJointDysfunction
SacroiliacJointDysfunction(SIJDysfunction)referstoimpropermovement
oftheSIJointduetoeitherhypermobility,inwhichthejointmovestoomuch,or
hypomobility,inwhichitmovestoolittle.ThetwosidesoftheSIJointgenerally
worktogetherduringmovement,sowhenonesidebecomestoostiffortoolax,the
sideswillnotmovetogetherandresultinpainorstiffnessinthearea.Aboutto10to
25%ofpatientswithlowbackpainarediagnosedwithSIJDysfunction(American
PhysicalTherapyAssociation,2017).Commonsymptomsincludelowbackpain,
upperlegpain,jointinflammation,sharporstabbingsensationsinthelowbackand
groinarea,numb/tinglingsensations,muscletightness/tenderness,andspasms.
Thesesymptomscanbemadeworsewithbending/twistingmovements,rolling
overinbed,standingupfromasittingposition,walking,andstandingorsittingfor
longperiodsoftime.SIJDysfunctioncanbecausedbyanumberofreasons,both
structuralandfunctional.Scoliosis,leglengthdiscrepancies,arthritis,ankylosing
spondylitis,pregnancy,prolongedvigorousexercise,muscularimbalance,andinjury
canallcontributetoSIJDysfunction.
Thegoaloftreatmentistocorrecttheunderlyingpathologyandalleviatethe
symptoms.Treatmentcanconsistofheat/ice,rest,anti-inflammatorymedications,
physicaltherapy,exercise,injections,andsurgery(Driver,2017).Pilatesis
particularlyeffectiveintreatingSIJDysfunctionbecauseofitsfocusonpelvic-
lumbarstabilizationandthedevelopmentofcorrectbodyalignmentandmuscle
recruitment.Strengtheningandstretchingmusclesaroundthejoint,particularlythe
6
abdominals,pelvicfloor,andgluteals,helptoprovidesupportforthejointand
assistinmaintainingitsproperposition.
CaseStudy
IchosetowritethisstudyonmypersonalexperiencewithSIJDysfunction.I
amahealthyfemale,28yearsold,andhavebeenactivemywholelife.Iexperienced
anSIJointinjurytwoandahalfyearsagowhiledoingabackbendduringayoga
class.Ididnotfeelanythingatthetimeoftheinjury,butstartedtofeeladullachein
mylowbackthroughoutthedayafterwards.Thenextmorningmybackwasin
excruciatingpainandIcouldnotgetoutofbed.Followingmyinjury,Iexperienced
severechronicbackpainandmusclespasms,andwassolimitedinmydaily
functioningthatatIwasunabletowalkorrolloverinbedontheworstdays.
Iattributetheinjurytobeinghypermobileandoverlyflexible,whilenot
havingthecorestrengthtosupportmystructure.AccordingtoIsacowitz,“itisoften
theseimbalancesthatdirectlyorindirectlyleadtoinjury…forexample,a[person]
maybeveryflexible,yetlackthestrengthtosupporttheextremeROMthatthe
activitydemandsandherjointsareabletoachieve.Ajointthatishyper-mobileisby
naturenotasstableasatightjoint”(2013).
Iwentthroughseveralroundsofphysicaltherapy,massage,anti-
inflammatorymedications,andonesteroidinjection,thoughnoneofitmadea
difference.WithinthelastyearIfoundanewphysicaltherapistwhoutilizesmanual
therapytorealignmypelvis,andthroughacombinationofthatandPilatesthe
resultshavebeenextraordinary.
7
BASIPilatesConditioningProgram
ThisistheprogramIcreatedformyselfinNovember2017,onceIhad
startedtoexperiencesignificantimprovementfromthemanualtherapy.Atthat
point,myphysicaltherapistsuggestedIfocusonmyPilatesworktobuildupmy
corestrengthandstabilityinordertomaintainthechangesthathewasmakingto
mybody.
Myprogramfocusedonworkingprimarilyinneutralspineinorderto
minimizeanymovementoftheSIJointandtoavoiddeepflexionandlowback
extension,astheywerecontraindicated.Ithoughtitwasimportanttobuildup
abdominalstrength,particularlythatofthetransversusabdominis(TA),asitis“the
mostimportantoftheabdominalmusclesintermsofstabilization”(Isacowitz,
2013).Otherareasoffocuswerestrengtheningmypelvicfloormusclesandgluteals,
whicharealsoimportantforstabilization,andstretchingmyhipflexorsandback
extensormuscleswhichhadbecometootight.Thisprogramwasdoneaminimum
ofthreetimesperweekfor6weeks.
Goalsweretogetmydeepstabilizingmusclestofireandtostrengthen
musclessurroundingmySIJointinordertoprovidesupportforthejointand
minimizemovement.Mybackextensormuscles,particularlytheQL,andhipflexors
hadbecomeoverlytightastheywerecompensatingfortheunderactivestabilizing
muscles,soIsoughttore-educatethosemovementpatternstorestorethe
relationshipbetweenmyagonistandantagonistmusclegroups.Ihopedthatonce
mybackmuscleswerenotbeingover-activated,itwouldhelptoreducespasmsand
lowbackfatigue.Theultimategoalwastorestorebalancebetweenallstabilizing
8
andcoremusclesinordertosupportpropermovementinmySIJoint,andachievea
healthy,pain-freestateofbeing.
WarmUpontheMat
PelvicCurl,SpineTwistSupine,ChestLift,ChestLiftwithRotation
FootworkontheReformer-2redsprings,1green,1yellow
ParallelHeels,ParallelToes,V-PositionToes,OpenV-PositionHeels,OpenV-
PositionToes,CalfRaises,Prances,Prehensile,SingleLegHeels,SingleLegToes
- FocuswasonpelviclumbarstabilityandTAengagement.
AbdominalWorkontheReformer
ShortBoxSeries:RoundBack,FlatBack,Tilt
- Focuswasontheco-contractionofabdominalsandbackextensorstoget
thosemusclegroupsworkingtogethertoprovidesupportforthespine.
RoundBackandTiltprovidedanicestretchfortightlowbackandside
body.
**IskippedTwist,RoundAbout,andClimb-A-Treeinthebeginningasthe
rotationandROMcausedpain.OnceIgainedthestrengthtosupportmyselfI
graduallyaddedtheexercisesin.
HipWorkontheReformer–1redand1bluespring
Frog,CirclesDown,CirclesUp,Openings
- Focuswasonmaintainingneutralspineandpelviclumbarstabilization,
hipadductorandhipextensorcontrol.
9
SpinalArticulationontheReformer–2redsprings
BottomLift,BottomLiftwithExtensions
- Focuswasonspinalarticulationandhipextensorstrength/control.
**OndayswhenmylowbackwasinpainIwouldmodifybykeepingmyhips
lowerduringBottomLiftwithExtensions,orwouldskipit.
StretchesontheReformer–1redspring
StandingLunge
-Focuswasonstretchinghipflexorsandhamstringstoalleviatelowback
tightness
FullBodyIntegration(F/I)ontheReformer–1blueand1yellowspring
ReverseKneeStretch
-Focuswasonrecruitingdeepabdominalmusclestoinitiatemovement
whilestabilizingmytrunk.Iusedlighterspringsinthebeginningsoasnotto
compensatewithothermusclegroups,andworkedmywayupto1red.
ArmWorkontheCadillac
ArmsStandingSeries:ChestExpansion,Hug-A-Tree,CirclesUp,CirclesDown,
Punches,Biceps
-Focuswasontrunkstabilizationwhileworkingarm,shoulder,andback
muscles.Ihadthetendencytogripmyglutessotrainedmyselftorecruitmy
TAformorestability.
LegWorkontheMat–2lbankleweight
GlutealsSideLyingSeries:SideLegLift,ForwardandLift,ForwardwithDrops
10
-Focuswasonmaintainingpelviclumbarstabilityinneutralspinewhile
strengtheninghipabductors.
LateralFlexionontheWundaChair–Onespringon4
SideStretch
-Focuswasonstrengtheningobliquemusclesandkeepingmyhipsstacked
inneutralwhilestretchingmysidebody.
Conclusion
Throughconsistentpracticeovera6weekperiod,Inoticedaremarkable
differenceinmybody.Mypainleveldecreased,aswellasthefrequencyofmyback
spasms.InoticedIwasabletomaintaintheadjustmentsmyphysicaltherapistmade
forlongerperiodsoftime,andmovedfromseeinghimonceperweektoonceper
month.Iwasabletoaddinotheractivitiessuchashikingandcycling,whichIhad
completelystoppeddoingaftertheinjury.
IfoundtheBASIapproachtobeparticularlyeffectiveasBASIfocuseson
workingthebodyasawholeandrestoringbalance.Theblocksystemensureseach
areaofthebodyisexercisedineveryplaneofmotion.Iwasalsoabletomodifymy
workoutsdependingonhowmybodywasfeelingeachdaybyeitheradjusting
springtensionorselectingdifferentexerciseswithinthesameblocksothatIcould
workonvaryingobjectives.AsIbuiltupstabilityandstrength,Iwasableto
progresstomoreadvancedexercisesandaddinblockssuchasFullBody
IntegrationattheAdvanced/Masterlevel,andBackExtension.Icontinuetopractice
11
Pilatesataminimumofthreetimesperweek,receivemanualtherapytreatments
onlyonanasneeded-basis,andamlivinggenerallypainfree.
12
Bibliography
Driver,MDCatherineBurt."SacroiliacJointDysfunction:SIJointPainTreatment."MedicineNet.N.p.,n.d.Web.05May2017.Isacowitz,Rael.StudyGuide:ComprehensiveCourse.CostaMesa:BodyArtsandScienceInternational,2013."SacroiliacJointDysfunction."AmericanPhysicalTherapyAssociation.N.p.,05May2017.Web.07May2017.Vleeming,A.,M.D.Schuenke,A.T.Masi,J.E.Carreiro,L.Danneels,andF.H.Willard."Thesacroiliacjoint:anoverviewofitsanatomy,functionandpotentialclinicalimplications."JournalofAnatomy.BlackwellScienceInc,Dec.2012.Web.03May2017.