Discover the shocking truth about the SI joint in this informative video as we delve into the facts versus fiction surrounding joint dysfunction. Most pain and dysfunction attributed to the SI joint has nothing to do with the joint! Avoid the misdiagnoses and learn the truth about the SI joint, sourced from medical studies.

Chapters

00:00 Introduction to SI Joint Pain Research

00:48 Understanding the SI Joint

01:41 Trigger Points and Pain Referral 03:33 Medical Studies and Findings

07:07 Orthopedic Tests and Misconceptions

13:17 SI Joint Pain in Pregnant Women

14:47 Leg Length Discrepancy and SI Joint Dysfunction

16:02 Conclusion and Future Research

Transcript

[00:00:00] What I've been doing over the last few weeks is I've actually been really diving into the medical literature on SI joint pain and dysfunction. And I've only like touched the research of it previously. And I don't know, I just got that bug where I really felt like seeing what the medical literature had to say about it.

Because in my experience, SI joint pain I have never found it there to ever to be an actual problem with the joint itself. It was always solvable relatively quickly with work on the muscles. And so I was very curious to see what kind of the prevailing medical paradigm had to say about it.

So I really dove into the research and I'm going to be. Preparing some more formal articles and videos a series about this. But I just thought I'd touch upon some of this stuff and give you a preview. So basically reviewing the medical literature the SI joint is an extremely stable joint.

It has very limited ability to move. It is a synovial [00:01:00] joint, so it does have synovial fluid. But in the in the scientific studies, it only can move in millimeters. Two to four millimeters is general. And then it can only move one to four degrees of rotation. And it, but even then it's baffling to most medical people, SI joint pain and dysfunction.

They always think that there is a problem in the joint and that there's too much laxity. It moves too much. It's unstable. You hear that a lot. You hear that a lot in the yoga and corrective exercise and PT and ortho world. That the SI joint is not, your SI joint is not stable if you have pain there.

And you, people that are CTB members know that our take on this it's almost never a problem in the joint and that's backed up by the pain clinic studies as well. 82 percent of pain presented to clinics where the medical practitioners actually understand trigger point therapy, 82 percent of people coming to pain clinics are [00:02:00] diagnosed with myofascial trigger points.

as their primary pain source and treated very quickly and with great success. Even using like the old school methods, injection and the old trigger trail and Simon said methods. So it's basically the joint itself has a regular surfaces to it and it's extremely stable, extremely small.

And it's basically like a cushion. It's a little tiny shock absorber that basically helps transmit forces from the upper body to the lower body. And it is supported by some of the strongest ligaments in the body. The thing that turned me on to doing research on this was a yoga teacher, like a trainer, like an anatomy expert, telling me that the joint can rip apart, And so I had to dig through the science to show her that no, it can't rip apart.

In fact, from the cadaver [00:03:00] studies, you need 400, 500 pounds of force per inch to actually change the spacing of the joint. And basically that's enough force to break the sacrum or break the break the pelvis. So that would only really occur in like a high impact collision say like a car crash or something.

So to change the spacing manually of that SI joint. It takes a lot of force and you can't do it through regular movement or exercise stuff. You just don't generate that type of force. It's not possible. According to orthopedic doctors, these are the common symptoms.

Low back pain, also pelvis and buttock pain, lower extremity pain in general, hip groin pain, problems sitting, sleeping, or walking. So those are very general. And in terms of trigger points I don't know. Can anyone tell me what are some prime suspects that would generate these types of [00:04:00] referrals?

Anybody want to throw that in the chat?

Even one? Yeah, exactly. Glute medius. We'll refer right there into the SI joint area sacrum. Glute minimus, of course we know, sciatica muscle sends referral down the leg. We got some piriformis iliopsoas, yep, iliopsoas has a vertical pattern and can go over the SI joint area.

Yeah. That's pretty much that's pretty much the list. No one. Oh, yeah. Someone said yes. Stephanie said ql is a prime suspect in all of on all of this stuff hip groin pain. Okay. So, that's the trigger point understanding of it. So here's just a couple things from the medical literature that I found very enlightening.

They did movement studies where they were able to measure these really small movements [00:05:00] in a, with a technique called RSA. And they use these little beads that are like less than a millimeter and they actually implant them into the pelvic bones. So in, according to these studies, they revealed that nutation, which is one of the it was like the forward rotation of the sacrum.

Mutation occurs when patients loaded their spine by means of rising from supine towards a sitting or standing position. And the authors demonstrated that movements do not differ between the symptomatic and asymptomatic sides. So if someone has SI joint pain on one side and not on the other they're the movement of the SI joint didn't have anything to do with that.

So I thought that was very interesting. Another study here, they take, this is a little kind of medieval, but they, for people that have really intense pain, they actually use this device called a Hoffman status frame. And they actually. Attach it to the pelvis, [00:06:00] and they, what they think that they're doing is stabilizing the SI joint, and then that will reduce the pain.

But then what they found out when they actually measured the movement of the SI joint that they weren't, there wasn't any change in the movement. Nothing changed with the movement of the SI joint, even with this contraption. So the manipulation did not alter the position of the sacrum in relation to the ilium.

The results seem to indicate that effective manipulation is in, is not dependent on positional change of the joints. So people would get some relief from this. stabilization, but it had it, but it didn't do anything to the joint. It didn't change the joint in any measurable way. So this just to me, you completely, it looks like what we can just say what is it doing then?

What is it stabilizing if it's not stabilizing the SI joint? To me, it's stabilizing the lumbopelvic hip complex. It's stabilizing your lumbar spine, and how [00:07:00] it's working with the with the pelvis. So it's helping you it's helping your QL muscle, so I thought that was very interesting.

Also there's a a. Like a handful of tests, orthopedic tests that are generally used as part of the diagnostic evaluation for SI joint pain. And in the medical literature all of the high quality studies showed that they were very That they weren't very reproducible and that they were not good diagnostic methods.

And so some of them actually, some of them are provocative tests where basically they, they will produce the pain if you do the test and that's a positive for the court. So here's one of them called the favor test. And you can see, it looks. suspiciously what we would call the figure four test.

And so this is, the person's leg is abducted and externally rotate a little bit, and then they push the leg down towards the mat. So what do you guys think is could be [00:08:00] happening here in terms of muscles? Like what muscles are being lengthened or shortened in this? That could cause pain referral into the SI joint.

Throw it in the chat.

Pure form is shortening. Yep.

Yeah yep. Glute medius lengthen adductors. So the one, the big thing that, that comes to my mind is the is the glutes, you're really bunching up the glutes. So they're going into a shortened position and that could easily cause this test to be positive for SI joint pain. And that's probably what's happening in these tests since the actual joint spacing is not being altered and really can't be altered by these types of movements.

So you were probably looking at the biggest suspect to me would be a glute medius going [00:09:00] short. And then also people often will get is, we'll get the Glute minimus referral here as well. They might get some sciatic type symptom down, down the leg in the thigh or in the lower leg.

So there's, that's one test that is, is not very actually helpful in determining if your SI joint is dysfunctional. You're probably testing glute shortness.

And there's the referral picture for glute medius. The referral goes right to the sacrum. It also goes into the glutes and come up above the iliac crest in the low back area. Here's another one. This one is called the Gillette or Gillet test. And then, and so this is a lot of people use this, chiros use this test and they try to actually measure the movement of the aside joint and then compare it from side to side, like the side that has pain in the side that doesn't have pain.

And [00:10:00] what the actual studies did when they did careful measurements was that the results showed that there were minimal changes. of movement in that, in the SI joint, like it didn't really move very much. And there was no difference in the movements between the symptomatic and asymptomatic sides.

And then what they said, then the the study authors said that patients are physically challenged leading to bilateral increased force closure of the SI joint. So they attribute it to the, they attribute the pain provocation to be still at the because of increased force closure.

So that's what they that's what they're still hanging onto because they don't understand trigger points is that there is some type of force operating at the joint. And that force is making the joint, doing something to the joint, even though the assumed SI joint motion during the test doesn't actually occur.

And the authors conclude that movement of the external pelvis relative to the hips gives the manual illusion that [00:11:00] the SI joint. is being repositioned, but it's not. And so this is where somebody like stands on one leg and then the other leg, the contralateral side they flex the knee at 90%. So that's supposed to that's supposed to put movement into the SI joint then, and that's supposed to be measurable, but it's actually not, but somebody will could get pain during this, usually on the standing leg.

And so what do you what do you think that could be from go ahead and put in the chat

when muscles are getting stressed by a one legged standing.

Yep, glute medius, glutes again, QL, exactly. Those are the big ones, glutes and QL. So that's probably what's happening in this test as well. And that's where the, that's where the the pain is actually coming from. It's coming from QL or the glute referral. There's a glute medius picture again.[00:12:00]

Here's our QL referral. Notorious goes right into the SI joint. So I actually did that Faber test that I showed earlier. I actually, I just laid down on the floor and did that 10 minutes ago. And and I got a SI joint pain when I did it.

So I guess my SI joint's dysfunctional. Yeah, that's the funny thing is when I'm doing my, I do provocative things in my own like yoga my kind of my own maintenance yoga program that I do for myself every day. And I often get like little nigglings of a side joint pain. And, that to me, that's a good thing, because I'm doing things that are stressing the stabilization especially the Q on the glutes.

And I'm doing things to, to strengthen them. And then I also often do like a contract relax stretch as a resolving thing. And I sometimes will then get some of these referral pains and, but it's not like something that lingers or lasts, it's like just something that I get when I seriously lengthen or shorten these [00:13:00] muscles, some kind of.

provoking that by bringing out the referral patterns. And that's part of my own kind of self treatment is keeping these muscles healthy by, making these trick, getting these trigger points to actually, resolve and doing things to actually minimize them. Let's see what else.

Okay. So the other big myth with SI joint pain is with pregnant women. There is a relaxin hormone that loosens ligaments, prepares the pelvis for wide, wideness, being wider during childbirth. But what the sexual studies show in terms of SI joint pain with pregnant women is that pregnant women with moderate or severe pelvic pain have the same, SI joint laxity, the same amount of space and movement in the joint as pregnant women with no or mild pain.

So it's the whole thing again, blaming the joint when there is actually no correlation there. I think probably what's happening with low back pain and SI joint pain with pregnant women is that, hey, they're suddenly [00:14:00] carrying a lot more upper body weight than they were before. So if and they're actually being challenged with they're going to be, their spine is going to be getting more like lumbar lordosis by the nature of the pregnancy.

So that's going to be shortening this, the QLs and putting more stress on them to stabilize. So probably it's the same story. It's probably the primary players are gluten QL referral. And did my my sister in law actually, I treated her when she was pregnant for SI joint pain and she had a significant leg length difference.

And I did the trigger point work at her, use the lower body protocol, like the normal and set her up with heel lift and. That went away, right away. So, that's my experience. The other thing that I found interesting, and this is my last slide here, is that they attributed a leg length difference as being something that.

contributes to this SI joint dysfunction. [00:15:00] So they said a dysfunctional SI joint is normally not related to a subluxed position of the joint, but to increased or decreased compression force closure due to asymmetric forces acting on the joint. So again, they think there's, it's just a matter of the forces acting on the joint and the joints having problems stabilizing.

And they did a finite element modeling that And that showed that a leg length discrepancy as small as 1 centimeter increases the load across the SI joint 5 fold. Not only does, they're going to keep saying that the SI joint, the load, the the load is increased because of the asymmetric forces.

But, we know as trigger point therapists that it's increasing the load, that asymmetry is increasing the load in the whole lumbopelvic hip complex. It's challenged. It puts a lot more challenge into your glutes and your QL particular. So again, it's, they're probably looking at trigger point referral, but they're going to keep talking about [00:16:00] it as joint force closure.

That's, so that's it. That's my preliminary research into it. So I plan to do some more some more stuff and put out some more videos and articles on different aspects of this and explaining it more in terms of the trigger point referral. So there you go.