I began working with my client in December 2012, she is athletic and very slim other than her tummy that was saggy and hanging down, anterior pelvis with a rotation as right ASIS was anterior to left. She had tried exercise to tone her tummy but everything affected her lower back/sacrocilliac areas. Three C sections, children are 6, 5 & 1 the youngest is a very big boy that she carries around too much! lower back problems began after first child and had treatment from physio and osteopath. She has been attending weekly group Pilates and private sessions 2/3 per month. Pelvic stability is much better and she is feeling much stronger, abs are also looking more toned. All good other than the pelvic instability issue is still a puzzle, she quite clearly has unstable SIJ still as some side lying exercises cause a shooting sensation down the back of the leg, apparently not nerve muscular, the exercise was doing side lying on reformer in turn out with heel on foot bar, right was good activated gluts nicely, could not do on left. Although pelvic stability is loads better she still struggles to engage lower abs, I sometimes work with a cushion under tailbone. She also finds it really difficult to stand on right leg in a balance, this I found confusing as the right is the stronger, however she was leaning into the right leg which made it impossible to sustain, I did identify this but she was not able to overcome.
I hope this is enough information, i can’t seem to work out what is going on in the pelvic area, how do I properly identify where the weaknesses are and where the instability is. How would you work with this lady?
Thank you in advance.
Hi there – A very complicated issue. It is difficult as I have not got the client in front of me and can study her alignment, her gait, her feet and cervical spine/head placement. Also, if she has attended Pilates group classes in the past and maybe not been “corrected” and picked up bad habits? BUT I am sure you will have seen this by now, so I assume she understands the basic Principles.
What comes first – the instability or the muscle imbalance?
The SI-joint function is depending on a great amount of variables – breathing (diaphragm/psoas-connection) – could be an ascending problem, or a descending problem – stress from organs – or a combination of them all. Complex!!!
Has she been checked to see if she has a slipped disc in the back? You know that also degenerative arthritic joints in the spine can cause back pain, or a hip problem. When the body is experiencing pain, muscles tighten & compensate, causing asymmetry & misalignment of joints. Huge force onto the discs when tight.
Pain caused by the psoas (tighter one the one side?) often shows up as lower back pain, because other muscles have to overwork to support the spine. The force of the tight psoas putting pressure on the lumbar spine can cause the discs to pinch, and causing the QL to really over work on one side and strain, and hence the difficulty with standing up (spinal extension). The QL and Psoas oppose each other. A tight psoas makes the QL work that much harder.
Handling of the issue is therefore not an “easy fix” – its lifestyle ( Stop lifting / carrying children on the hip/twisting–and the rest.- It’s like going on a diet – it only helps when you’re on it. Home work, as in; Be aware how she ‘bends/twists/unloading the dishwasher/washing machine/putting child in car seat etc. Sleeping positions etc..
It is about muscle-imbalance – stretching and strengthening – plus an occasional adjustment. CORE strength and stabilization is the key. Is there a difference in leg length? Check or see if anyone has checked this.
Is there a mild Scoliosis? This can affect her pelvis and SI joint stability. CHECK or see if anyone has checked this…
Post natal women may have loose ligaments for a long time or the “rebound” after pregnancy when the relaxin has left the body and the ligaments start to tighten up again, the SI joint might become hypo mobile, maybe on just one side, and then an imbalance occur and there might then be a restriction of movement, and this will cause other muscles to compensate.
Some people have more movement of the joint than normal. Maybe she is very mobile in other joints too.
The primary stabilizers of the SI joint are the ligaments of the pelvis. The secondary stabilizers are the muscles which surround the pelvis, the hip, and the spine. Strengthening these muscles can provide stability to the SI joint, as we cannot strengthen the underlying ligaments….but focus on releasing and breathing and super correct any misalignment.
Go slow and build…
This is how I would approach it if she came to me with this issue, but like I said, it is hard as I haven’t assessed her and have her in front of me, so I can only offer the advice below…..
- Avoid asymmetric loading through the leg or pelvis—-
- Focus on gait and posture retraining—
- Bi lateral work; Breathing and releasing of the psoas—She needs to practice abdominal or belly breathing.
- Work gently and focus on really good alignment—
- Avoid excessive spinal movement
- Focus on TVA and pelvic floor work— and make sure that she does activate the obliques when necessary
- Side lying exercises/ Unilateral work might not suit everybody
- Try to go back to very basics…
- Cranial sacral therapy may also provide relief
- Check her leg alignment and feet when on reformer/( NO heavy springs)
Depending upon the level of pain & range of movement, bodyweight exercises such as a supported squat (adapting the depth of the squat & how far she can open her legs) will also improve strength & stability.
Hope this helps a bit. Take care and go slow and be precise…
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