sacroiliac joint dysfunction - teacher training · 2017-04-21 · sacroiliac joint dysfunction can...
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SacroiliacJointDysfunction
EmilyHoffSeptember22,2016
ComprehensiveTeacherTrainingProgram2015SolanaBeach,CA
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Abstract
Duetothenatureofsacroiliacjointdysfunction,thissyndromeisrelatabletothe
commonclientandthePilatesindividualduetothefactthat15-30%ofthepopulation
experiencessometypeofchronicinjury,duetothesacroiliacjoint,atsomepointintheir
lifetime.
Sacroiliacjointdysfunctioninvolvesthestructureoftwodifferentbonesthatare
joinedtogetherbyligaments,thesacrumandtheiliacmakeuppartofthepelvisandthe
sacrumconnectstothespineatthelumbervertebrae.Duetothenatureofthesetwobones
thereislittlemovementthatoccurs,butinspecialoccasionsthebodycanmoveinacertain
waythatmaycauseirritationtothisjoint.Thebodyreleaseshormonesthatcancausethe
ligamentsthatholdthesetwobonestogethertobecomelaxandthereforecause
separation.WiththehelpofPilatesandstretchingthemusclesthatsurroundthisjointcan
supportthesebonesandeliminatepain.
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TableofContentsPage
Abstract2
AnatomicalDescription4
CaseStudy6
ConditioningProgram8
Conclusion12
Bibliography13
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AnatomicalDescription
Thesacroiliacjointsitsatthebottomofthespine;thesacrumconsistsoffivefused
bonesandconnectstotheiliaconeitherside.Theiliac,whichisthepelvicbone,connects
allthewayaroundandjoinsinthefrontbyapubicsymphysis.Thesacrumsitsattheback
ofthepelvisandatthebottomofthespineconnectedtothelumbarvertebrae.In-between
thesetwobonesarehyalinecartilageandfibrocartilageallowingforsomesortof
movement.
Theprimaryfunctionofthepelvisistoprovideattachmentforthemusclesthat
balanceandsupportthetrunkandmovethelegs.Thebasin-shapedcomplexofbones
housesseveralorganswhileprotectingthem,thisisextremelyimportantwhenafemaleis
havingababy.Inthiscasestudywewillbeobservingafemaleanatomyduetoapregnancy.
Whenafemaleishavingababythereareseveralchangesthatcanoccurtotheshapeand
laxationoftheligaments.Thebodyreleaseshormonesthatcausethepelvistoexpand
allowingthebabytogrow,duetothishormonereleasetheligamentsbecomelaxandifthe
individualbecomestoolaxtheninjuriescanoccurinthesacroiliacjoint.
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Sacroiliacjointdysfunctioncancauselowerbackpain,buttockspain,sciaticleg
pain,groinpain,hippainandseveralothersystems.Thisiscausedbyadisturbanceinthe
connectionbetweentheiliaandthesacrum.Severalmusclesthatholdthesejoints
togetherarethepiriformis,rectusfemoris,gluteusmaximusandminimus,erectorspinae,
latissimusdorsi,thoracolumbarfascia,andiliacus,theyallplayanimportantrolein
maintainingstabilityinthepelvis.Ifoneofthesemusclesisaffectedinanywaythenthe
pelviswilltrytocompensatebylengtheningthemuscle.Duringpregnancysincethe
musclesarebeingstretchedoutandthepelvisisexpandingthepelvicgirdleisundergoing
somemajorstress.Therecanbesomemovementthatoccursandcausesatiltinthepelvis
andthereforepain.
“TheSIjointisapain-sensitivestructurewhichisinnervatedbyacombinationof
unmyelinatedfreenerveendingsandtheposteriorprimaryramiofthespinalsegmentsl2-
S3.”(Wikipedia,Sacroiliacjointdysfunction)Thisexplainswhysomeonemightexperience
paininthelowerbackandleginaccordancewiththestructuraldamageonthatspecific
side.Duetothecompensationinthepelvistheremightbesometightnessinotherareasof
thebodytryingtoprotecttheareafromfurtherdamage,andthismightconsistofthe
hamstringsoriliotibialtract.
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CaseStudy
Thesubjectofthiscasestudyisa30-year-oldfemalewhoworksinanoffice,forall-
intenseandproposessheiscalledClaire.Clairecametomeafterhavingababy,she
deliveredvaginally,anditwasanormalpregnancywithnorealcomplications.Shenoticed
somepaininherlowerspinwhensittingandhaddiscomfortwhenshesleptonherleft
side.Shewasactivebeforethepregnancybutsloweddownduringthepregnancyandafter
shedeliveredshehadahardtimemotivatingherselftogetbackintoaworkoutregime.She
wenttotheDoctortofindoutwhattheproblemwasandtheysuggestedPhysicalTherapy.
AftersometimewithPT,theysuggestedtomoveintoaphysicalactivitythatwaslighton
thelumberspineandjointsandwouldstrengthenthehipsandsacralregion.Thepainis
mostlyontheleftsideandmovesdownthelegtowardhercalf.Shewasnotdiagnosedwith
anynervedamagebutlaxityinthejointsthatholdthepelvistogether.Themainproblemis
betweenL5andS1,SacroiliacJointDysfunction.Thereasonsfortryingtofixtheproblem
wasbecauseofherjobandlifestyle,sheisforcedtositforlongperiodsoftimeatadesk,
andcommutingbackandforthtowork.Shemainlywantedthestrengthbackinhercore
andevennessthroughoutherlowerbackandpelvis.Thediscomfortcameonmoreat
nighttimeafteralongdayatwork.Shefeltreliefwhenstandingandtriedtomakesureto
dothisafter20minutesofsitting,butfoundthatwashardattimes.Stretchingwasalsoa
reliefandusedtheraballsorfoamrollerstohelpwithreleasingthetension.SheusedThe
AlexanderMethodwhenusingthefoamroller,whichisamyo-facialreleasetechnique,that
helpsrelax,contractedmusclesandimprovebloodflowandcirculationtotheaffectedarea.
Thistechniquewasincorporatedintohertherapytohelpopenupthefrontofherhips,and
hipflexors,sothattherewasn’tananteriortiltofthepelvis.Thisprocessalludedtoamore
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neutralpelvisduringherworkouts,whilestrengtheningtheglutealmuscles,whichiswhat
ourmainfocuswaswhilecompletingourprograms.AfterseveralmonthspracticingPilates
shehasnoticedahugedifferenceinherbodyanddoesn’tfeeldiscomfortasoftenasshe
usedto.ThegoalwastotryandeliminatealldiscomforttogetherandstopPhysical
Therapy,sothatshecouldraceinahalfmarathonbytheendoftheyear.
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ConditioningProgram
Claire’sgoalsaretoincreasemusclestrengthonherleftsideandencouragemobility
throughoutherpelvistocreateastablepelvisbilaterally.
• Strengthenglutealmusclesandhamstrings,whilelengthenthehipflexorstocorrect
alignment.
• Focusingonbilateralmovementtocorrectimbalancesfromweaknessesontheleft
sideofthebody.
• Strengthentheabdominalmuscles,focusingonthetransverseabdominusto
supportthelowerback.
Blocks Sessions1-10 Sessions11-20 Sessions21+
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Warm-Up
Mat(fundamental)PelviccurlSupineSpineTwistChestLiftChestLiftw/rotation
Mat(fundamental)PelviccurlSupineSpineTwistChestLiftChestLiftw/rotation
MatPelviccurlSupineSpineTwistChestLiftChestLiftw/rotationOrCadillacRoll-upwithTRUPMiniRoll-upsMiniRoll-upsObliquesRoll-uptopLoaded
Footwork ReformerParallelHeelsParallelToesVpositiontoesOpenvheelsOpenVtoesCalfRaisesPrancesSinglelegheelsSinglelegtoes
Reformer/CadillacParallelHeelsParallelToesVpositiontoesOpenvheelsOpenVtoesCalfRaisesPrancesSinglelegheelsSinglelegtoes
Reformer/CadillacParallelHeelsParallelToesVpositiontoesOpenvheelsOpenVtoesCalfRaisesPrancesSinglelegheelsSinglelegtoes
AbdominalWork
ReformerHundredPrepHundredCadillacRoll-UpTopLoadedWundaChairStandingpike
ReformerHundredPrepCoordinationShortBoxseriesCadillacMinirolluptoploaded/minirollupwithrotation
ReformerHundredPrepLegsinstrapsCadillacTeaserBreathingw/pushthroughbarWundaChairTorsopresssit
HipWork ReformerFrogCirclesDownCirclesUpOpenings
Reformer/CadillacFrogCirclesDownCirclesUpOpenings
ReformerCirclesDownCirclesUpExtendedFrogExtendedFrogreverseCadillacFrogCircleDownCircleUpWalkingBicycle
SpinalArticulation
ReformerBottomliftBottomliftw/extension
ReformerShortspinLongspinCadillacMonkeyTowerPrep
CadillacTowerWundaChairJackKnife
Stretches ReformerStandingLung
ReformerKneelinglung
ReformerSideSplit
FullBodyIntegrationI
ReformerKneestretchroundbackKneestretchflatback
ReformerUpstretch1ElephantCadillacPushthroughseriesSittingforwardSidereach
ReformerDownstretchUpstretch3CadillacThighstretchw/rollupbarKneelingcatstretch
ArmWork ReformerArmsSupineseriesExtensionAdductionCirclesUpCirclesDownTriceps
ReformerArmskneelingseriesChestExpansionUpcirclesDowncirclesTricepsBicepsCadillacArmsStandingseriesChestExpansionHug-atreeCirclesup
ReformerSideKneelingSeriesDeltoidReachCrossarmpullTricepsArmsoverheadCadillacArmsStandingseriesChestExpansionHug-atreeCirclesupCirclesdownPunchesBiceps
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ArmWork ReformerArmsSupineseriesExtensionAdductionCirclesUpCirclesDownTriceps
ReformerArmskneelingseriesChestExpansionUpcirclesDowncirclesTricepsBicepsCadillacArmsStandingseriesChestExpansionHug-atreeCirclesupCirclesdownPunchesBiceps
ReformerSideKneelingSeriesDeltoidReachCrossarmpullTricepsArmsoverheadCadillacArmsStandingseriesChestExpansionHug-atreeCirclesupCirclesdownPunchesBiceps
FullBodyIntegrationII
ReformerBalancecontrolfrontBalancecontrolbackprepCadillacSittingBack
LegWork WundaChairLegPressStanding
ReformerSinglelegskatingWundaChairFrogFront
ReformerJumpingSeriesParallelpositionVPositionSinglelegparallelLegchangesCadillacSingleLegSideSeriesChangesScissorsCircles(forward,back)
LateralFlexion/Rotation
WundaChairSidestretch
ReformerSideoveronboxMermaidCadillacSideLift
WundaChairSidePike
BackExtension ReformerBreaststrokeprepWundaChairSwanBasic
ReformerLongboxPullingstraps1Pullingstraps2CadillacProne1
ReformerLongboxBreaststrokeCadillacProne2
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Conclusion
Allinall,Clairewentthroughsomeupsanddowns,someweeksshemadehuge
leapsandotherweeksshedidn’t.Clairewentthroughsomedifficultlywithpainand
discomfortbutsheworkedthroughit,andwhenshehadpainwewouldstretchand
messagethoseareasandthatmadeherfeelbetter.Sowefoundaroutinethathelpedher
increasestrengthwithoutcausinghertohavepainorexasperateherdysfunction.We
workedincoordinationwiththePhysicalTherapist,sinceshewasgoingtwiceaweekfor
sixweeksandthendowntoonceaweekforsixmoreweeks.Thiscommunicationwiththe
therapistwasvitalandpartofClaire’srecovery.Clairemadelastingimprovementsfrom
Pilatesandhascontinuedtoworkoutwithme,andIhaveenjoyedworkingwithher,
improvingtheworkoutsfromweektoweekandwatchinghergrow,asanindividualinthe
Pilatesworldhasbeenawonderfulexperience.Shewillstrugglewiththisproblemtherest
ofherlifebutshelovesPilatesandislookingforwardtothefutureandthebenefitsthat
shehashadbecausesheisgettingherphysicallifestylebackandforthatsheisvery
grateful.
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Bibliography
Driver,CatherineBurt,MD.SacroiliacJointDysfunction(SIJointPain).2016.
http://www.medicinenet.com/sacroiliac_joint_pain/page3.htm
Isacowitz,Rael.StudyGuide:ComprehensiveCourse.BodyArtsandScienceInternational.
2013.CostaMesa,California
Wikipedia.SacroliliacJointDysfunction.
https://en.wikipedia.org/wiki/Sacroiliac_joint_dysfunction
Yeomans,StevenG.ScroiliacJointDysfunction(JointPain).2010.http://www.spine-
health.com/conditions/sacroiliac-joint-dysfunction/sacroiliac-joint-dysfunction-si-
joint-pain