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  1. #1
    I wasn't Kung Fu fighting
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    Any SS riding Sports Medicine PT's reading

    this forum? If so, I'm looking for free advice. I've been riding 80-90% single speed only... mtn and road for about 5 years. I only use my geared bikes for rides over 3 hours, and with 2 kids, that is not too often. However, over the last 2 months or so, SS rides have left me with huge amounts of pain in my hip and low back. I haven't changed anything on my bikes, so It's not rider position. I've gone to the bone cracker and my SI joint has been so swollen he has been unable to move it back into place. The only thing that helps is a week off the bike and copious amounts of advil. I always assumed knee pain would put me back to gears one day, but I'm only 36, I thought that would happen 10 - 20 years from now. Anyone experienced this? Know of stretches or strength building excercises that might help... Or should I just polish up the gearies and leave SS behind?
    Everyone has the right to be stupid, but you are abusing the priveledge.

  2. #2
    Rohloff
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    I'm a mostly geared, occasional SSing, certified bone cracking sports physician. I own and operate a rehab facility where I employ physical therapists.

    Does your pain go away on your geared bike?

    Is your "hip pain" on the outside edge of your hip or kind of around to the back on the butt?

    Do you get any pain, tingling or numbness in your legs or feet?

    Do you get pain with long periods of sitting or driving?

    Is the pain better when you lay down or stand?

    When the pain is bad, go lay on your stomach on the floor and prop yourself up on your elbows like this (https://www.easyvigour.net.nz/fitnes...enzieExt2.gif). You might notice a little back discomfort, but does the hip pain go away?

  3. #3
    I wasn't Kung Fu fighting
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    Thanks for the quick reply

    Does your pain go away on your geared bike?
    No, it doesn't go away riding a geared... but if I only ride geared it doesn't start. Once the SS causes a flare up, I can't get near a bike.


    Is your "hip pain" on the outside edge of your hip or kind of around to the back on the butt?
    It on the back part just above the butt, ranging from the spine to the outside of the hip joint. Almost like piriformis muscle pain, but those stretches don't help at all.

    Do you get any pain, tingling or numbness in your legs or feet? No

    Do you get pain with long periods of sitting or driving?
    The pain is never caused from long drives or sitting, but when it begins after riding, drives and sitting are agony. It also seems to aggravate the problem once it's begun.

    Is the pain better when you lay down or stand?
    Standing for short periods is OK... lying on a firm surface is better.

    When the pain is bad, go lay on your stomach on the floor and prop yourself up on your elbows like this.
    No... but it does make my low back feel better.
    Everyone has the right to be stupid, but you are abusing the priveledge.

  4. #4
    Rohloff
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    It's not crystal clear but you may be suffering from a painful disc, which is radiating pain into your hip/buttocks. The disc is in the front of the spine, so activities such as cycling where you bend forward to the handlebars can put pressure in your disc causing your pain. Cranking hard on your SS may be making it worse. Try rotating your pelvis foward a bit and sag your belly as you sit on your bike. This will help you arch your back backwards and take pressure off your disc. Take it a little easy and ride your geared bike for a while. After you ride and periodically throughout the day, you should get on the floor and prop yourself on your elbows for a while.

    That's my over-the-internet best guess. It's worth a shot. It's certainly worth what you paid for it. If that doesn't work, I recommend seeing a chiropractor specializing in sports injuries (http://www.acbsp.com/searching.asp) or a physical therapist trained in the McKenzie Method (http://www.mckenziemdt.org/index_us.cfm).

    Let us know how you do and feel free to ask if you have any more questions. Good luck!
    Last edited by bsdc; 06-26-2008 at 03:46 PM.

  5. #5
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    I agree 100%. I won't add much but you would do yourself a big favor to go see a physical therapist with some mechanical diagnosis experience a la McKenzie. Highly, and I do mean very highly, unlikely it's your sacroiliac joint.

  6. #6
    Wandering not Lost
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    Quote Originally Posted by Doctorsti
    I agree 100%. I won't add much but you would do yourself a big favor to go see a physical therapist with some mechanical diagnosis experience a la McKenzie. Highly, and I do mean very highly, unlikely it's your sacroiliac joint.
    I have an ongoing issue with my SI joint... and an avid SS racer.. any advice. Being that the Doc's are in..

    thanks

  7. #7
    I wasn't Kung Fu fighting
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    I've done McKenzie before

    after a bad bicycle accident... I pile drove myself into the trail at 45mph. It took time, but ultimately the PT really helped. That was definite L5/S1 pain. This feels very different... I'm no doc so it could be a different manifestation of an old injury, but it seems very different.
    Everyone has the right to be stupid, but you are abusing the priveledge.

  8. #8
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    Quote Originally Posted by bykegnurd
    after a bad bicycle accident... I pile drove myself into the trail at 45mph. It took time, but ultimately the PT really helped. That was definite L5/S1 pain. This feels very different... I'm no doc so it could be a different manifestation of an old injury, but it seems very different.
    here's the problem the literature doesn't support SI being the dx very often. Even in patients that seem to get relief from diagnostic blocks of the SI, there is speculation the medication may be diffusing to the disc or facets. If you were pregnant or recently so, younger guy that had a significant unilateral trauma (like falling from a roof and landing on one foot), or had terrible pain walking or climbing stairs I wouldn't even consider SI. Here's the other problem, there is absolutely no peer reviewed literature to support our ability "to put the SI joint back in place." Best you can do is maybe injection and stabilization with core and hip girdle strengthening. I would be highly surprised if it was not an exacerbation of previous disc injury. Could be facet joint as well but you would need to have a good mechanical evaluation to determine the classification you fall in.

  9. #9
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    Quote Originally Posted by BThor
    I have an ongoing issue with my SI joint... and an avid SS racer.. any advice. Being that the Doc's are in..

    thanks
    You may be one of the lucky ones (unlucky really) but I would need to know exactly how that was diagnosed. You may be one of a very small percentage. Try and SI belt, work on closed chain balance/stabilization in unilateral stance, work on your core (method of your choice). If that works great, if not convince a doc to give you a diagnostic block to the SI and your pain should vanish immediately. Maybe not forever but at least completely pain free for hours. Good luck.

  10. #10
    Rohloff
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    Quote Originally Posted by BThor
    I have an ongoing issue with my SI joint... and an avid SS racer.. any advice. Being that the Doc's are in..

    thanks
    Chronic SI issues are uncommon. If it is the SI, Doctorsti's advice is good. My first thought with chronic SI problems is "Am I really looking at a disc problem?" Disc problems radiate pain to the SI area. You might want to look into that.

  11. #11
    Rohloff
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    Quote Originally Posted by bykegnurd
    after a bad bicycle accident... I pile drove myself into the trail at 45mph. It took time, but ultimately the PT really helped. That was definite L5/S1 pain. This feels very different... I'm no doc so it could be a different manifestation of an old injury, but it seems very different.
    OK, now I'm disagreeing wiht Doctorsti. SI joints definitely do go out of place, are put back into place, and it's pretty common. I've seen it almost every day for 16+ years. One way to tell it's an SI joint pain is that it responds pretty quickly to adjustments.

    The SI joint may or may not be a source of your pain. Your past history of a disc injury makes me think it's more likely that it is your disc, even though it feels different. Your disc may be going through a slow degenerative process that feel different than the initial acute injury. It may be something else altogether. It's hard to diagnose over the internet. If some of the simple advice you get here is not working, I recommend finding another doctor who can do a proper examination.

  12. #12
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    I went back to the bone cruncher

    yesterday and after 2 days of ice, advil and a portable tens unit... he said my SI joint moved a little. The relief was amazing. 50% less pain in about 10 minutes. So based on your last post, that would indicate that it most likely is the SI joint.

    I guess my question is, what types of exercise or stretching would help? Doctorsti referred to core building excercises... Along with cycling I walk and do the basic litany of strength exercises on a Bowflex. Should I be doing Yoga or Pilate's or stuff like that?
    Everyone has the right to be stupid, but you are abusing the priveledge.

  13. #13
    Rohloff
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    Quote Originally Posted by bykegnurd
    yesterday and after 2 days of ice, advil and a portable tens unit... he said my SI joint moved a little. The relief was amazing. 50% less pain in about 10 minutes. So based on your last post, that would indicate that it most likely is the SI joint.

    I guess my question is, what types of exercise or stretching would help? Doctorsti referred to core building excercises... Along with cycling I walk and do the basic litany of strength exercises on a Bowflex. Should I be doing Yoga or Pilate's or stuff like that?
    Hmm ... It's interesting that he's having so much trouble moving it. The SI joint is unique in many ways. For a long time, chiropractors argued with others who thought the SI joint couldn't move. It does move but not much. It's inherently a stable joint. No major muscles cross over the joint.

    I'm making these points because these factors make it relatively easy to adjust. Muscle guarding by the patient doesn't hinder the adjusting process too much. It does take a bit of strength and skill to adjust. In addition, these factors make stabilization of the SI joint through exercises pointless. In fact, in most cases, I recommend no stretches or exercises for SI joint problems. Just rest and ice. When I have a rare patient with a truly unstable SI joint, I use a trochanter belt.

    The one exception is when I have a real difficult time getting their SI to adjust. I use a counterstrain technique. It's an asymmetrical exercise designed to slowly push the SI into place. It's fairly simple but requires an assessment to know what exercise to do and how to do it.

    Don't get me wrong. I love core exercises. I recommend them for almost everyone. I just don't think they'll help someone with an SI joint problem.

  14. #14
    mvi
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    I would like to see a double blind study of anybody that can diagnose a SI joint moving "a little". Or diagnosing a block for that matter.

  15. #15
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    my fifty cents...

    from what you have talked about, i would agree with the other peeps that the root of the problem is not likely the SI jt, although obviously it can be very inflammed and sore/painful. if it is an SI problem, they will typically respond well after a few visits. Your problem seems to be due to instability of the lumbar spine. When this happens over a long period of time, the SI joints must act to help stabilize the lumbar spine, then they become "overloaded" and become tender and painful. Now, when one is riding a bike for long periods of time/years, the lumbar spine is usually in a flexed position putting more compressive forces through the discs, and abnormal forces to the facet joints etc. Now, if you stand and extend backwards does your lower back seem to "jam up" or "pinch"? My guess is it does. When you stand and flex forward it is probably painful and even more so when you try to stand up.

    Now, what I have found with when working with MTB ers (such as myself) and (oh, did i mention I was a chiropractor?) is this. Most of the time when one gets the lumbar spine adjusted, the patient lays on the side and a "lumbar roll" type of adjustment is given. What I have found is that if the doctor has a knee-chest type table and can adjust you that way, the line of correction is different. Now, when a MTBer is on the bike and the spine goes into flexion, it can cause the spine to move in a posterior postion. The lumbar roll does not usually get all of this posterior displacement out, however, a knee chest type adjustment does. I have found time and time again, after seeing bikers such as yourself who have seen everyone, tried everything and nothing worked, usually did not have this type of adjustment. So, I hope this helps, but judging upon what you have said, I feel it should and I have seen "lots O' folks with your problem".

    anyhow, i apologize for any improper spelling, grammar etc.,

    Feel free to e-mail me.

    See ya








    Quote Originally Posted by mvi
    I would like to see a double blind study of anybody that can diagnose a SI joint moving "a little". Or diagnosing a block for that matter.

  16. #16
    Rohloff
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    Quote Originally Posted by mvi
    I would like to see a double blind study of anybody that can diagnose a SI joint moving "a little". Or diagnosing a block for that matter.
    Well, you should make your way over to www.pubmed.com and start taking a look at what's available. Here's a short list that should get you started:

    Inter- and intra-examiner reliability of single and composites of selected motion palpation and pain provocation tests for sacroiliac joint.
    Man Ther. 2008 Mar 24. [Epub ahead of print]
    PMID: 18373938 [PubMed - as supplied by publisher]2: Related Articles, LinksCattley P, Winyard J, Trevaskis J, Eaton S.

    VALIDITY AND RELIABILITY OF CLINICAL TESTS FOR THE SACROILIAC JOINT: A Review of the Literature.
    Australas Chiropr Osteopathy. 2002 Nov;10(2):100. No abstract available.
    PMID: 17987183 [PubMed - in process]3: Related Articles, LinksCattley P, Winyard J, Trevaskis J, Eaton S.

    VALIDITY AND RELIABILITY OF CLINICAL TESTS FOR THE SACROILIAC JOINT: A Review of Literature.
    Australas Chiropr Osteopathy. 2002 Nov;10(2):73-80.
    PMID: 17987177 [PubMed - in process]4: Related Articles, LinksRobinson HS, Brox JI, Robinson R, Bjelland E, Solem S, Telje T.

    The reliability of selected motion- and pain provocation tests for the sacroiliac joint.
    Man Ther. 2007 Feb;12(1):72-9. Epub 2006 Jul 12.
    PMID: 16843031 [PubMed - indexed for MEDLINE]5: Related Articles, LinksSze MJ, Mulligan MJ.

    Reliability of vacuum phenomenon in the sacroiliac joint as a sign of traumatic injury.
    Emerg Radiol. 2002 Jul;9(2):100-2. Epub 2002 Mar 21.
    PMID: 15290587 [PubMed]6: Related Articles, LinksRiddle DL, Freburger JK.

    Evaluation of the presence of sacroiliac joint region dysfunction using a combination of tests: a multicenter intertester reliability study.
    Phys Ther. 2002 Aug;82(8):772-81.
    PMID: 12147007 [PubMed - indexed for MEDLINE]7: Related Articles, LinksDamen L, Stijnen T, Roebroeck ME, Snijders CJ, Stam HJ.

    Reliability of sacroiliac joint laxity measurement with Doppler imaging of vibrations.
    Ultrasound Med Biol. 2002 Apr;28(4):407-14.
    PMID: 12049951 [PubMed - indexed for MEDLINE]8: Related Articles, Linksvan der Wurff P, Hagmeijer RH, Meyne W.

    Clinical tests of the sacroiliac joint. A systematic methodological review. Part 1: Reliability.
    Man Ther. 2000 Feb;5(1):30-6. Review.
    PMID: 10688957 [PubMed - indexed for MEDLINE]9: Related Articles, LinksFreburger JK, Riddle DL.

    Measurement of sacroiliac joint dysfunction: a multicenter intertester reliability study.
    Phys Ther. 1999 Dec;79(12):1134-41.
    PMID: 10630282 [PubMed - indexed for MEDLINE]10: Related Articles, LinksLaslett M, Williams M.

    The reliability of selected pain provocation tests for sacroiliac joint pathology.
    Spine. 1994 Jun 1;19(11):1243-9.
    PMID: 8073316 [PubMed - indexed for MEDLINE]11: Related Articles, LinksHerzog W, Read LJ, Conway PJ, Shaw LD, McEwen MC.

    Reliability of motion palpation procedures to detect sacroiliac joint fixations.
    J Manipulative Physiol Ther. 1989 Apr;12(2):86-92.
    PMID: 2715742 [PubMed - indexed for MEDLINE]12: Related Articles, LinksKeating JC Jr, Jacobs GE.

    Inter- and intraexaminer reliability of palpation for sacroiliac joint dysfunction.
    J Manipulative Physiol Ther. 1989 Apr;12(2):155-8. No abstract available.
    PMID: 2715741 [PubMed - indexed for MEDLINE]13: Related Articles, LinksHobbs D.

    Inter- and intra-examiner reliability of palpation for sacroiliac joint dysfunction.
    J Manipulative Physiol Ther. 1988 Aug;11(4):336-7. No abstract available.
    PMID: 3171420 [PubMed - indexed for MEDLINE]14: Related Articles, LinksCarmichael JP.

    Inter- and intra-examiner reliability of palpation for sacroiliac joint dysfunction.
    J Manipulative Physiol Ther. 1987 Aug;10(4):164-71.
    PMID: 3655566 [PubMed - indexed for MEDLINE]15: Related Articles, LinksPotter NA, Rothstein JM.

    Intertester reliability for selected clinical tests of the sacroiliac joint.
    Phys Ther. 1985 Nov;65(11):1671-5.
    PMID: 2932746 [PubMed - indexed for MEDLINE]

    Comments on Berthelot et al. review: "Provocative sacroiliac joint maneuvers and sacroiliac joint block are unreliable for diagnosing sacroiliac joint pain".
    Joint Bone Spine. 2007 May;74(3):306-7; author reply 307-8. Epub 2007 Mar 7. No abstract available.
    PMID: 17412631 [PubMed - indexed for MEDLINE]2: Related Articles, LinksBerthelot JM, Labat JJ, Le Goff B, Gouin F, Maugars Y.

    Provocative sacroiliac joint maneuvers and sacroiliac joint block are unreliable for diagnosing sacroiliac joint pain.
    Joint Bone Spine. 2006 Jan;73(1):17-23. Review.
    PMID: 16461204 [PubMed - indexed for MEDLINE]3: Related Articles, LinksMaigne JY, Aivaliklis A, Pfefer F.

    Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain.
    Spine. 1996 Aug 15;21(16):1889-92.
    PMID: 8875721 [PubMed - indexed for MEDLINE]4: Related Articles, LinksFrank AM, Trappe AE.

    [Are sacroiliac joint block and insertion tendinosis of the musculus erector trunici too rarely diagnosis as the etiology of failed back syndrome after intervertebral disk operation]
    Zentralbl Neurochir. 1994;55(4):193-6. German.
    PMID: 7887047 [PubMed - indexed for MEDLINE]

  17. #17
    mtbr member
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    I had mad mad SI problems and had a physical therapist tell me to do all these stretches with no relief. I lived with it for a year then went to a different one that said my SI was way to loose, My right leg would flop to the side. I wore this wide ass support belt around my hips and ass for a month all the time. + core building exercises, ALL BETTER NOW.
    There's always money in the banana stand.

  18. #18
    Rohloff
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    "wide ass support belt" = trochanter belt

    I had to use one myself over ten years ago. They're pretty uncomfortable, but not near as uncomfortable as the pain it ultimately relieved. For others reading this, I do want to point out that unstable SI joints requiring a trochanter belt are relatively rare.

  19. #19
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    All this babble made me look up "SI Joint". Didn't know it but I've apparently been giving myself a "self-chiro" adjustment for years now just cause it felt good.

    I lay on my side with the upper leg bent in and roll the upper body flat just like the chiros do pushing against the pelvis with my upper hand. Feels reaaaaaal good to get the pop and it helped when I used to get back pains. And then you sleep like a baby....

  20. #20
    I wasn't Kung Fu fighting
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    Sublux, I think you

    hit the nail on the head... While I cannot find too much information on knee/chest adjustment except for some ancient video of Palmer doing some WWF flying elbow neck adjustments, I do feel weak in the low back. My adjustment on Friday has me feeling well enough to stretch and try some core building exercises. When performing the 'superman' I am easily able to raise my chest and arms from the floor, but my legs were a battle and only a few reps left my back feeling fatigued and unstable. I was easily able to do 100 good quality crunches and 50 bicycle kicks for my abs, so I can only imagine the the difference in muscle strength is not helping.
    Everyone has the right to be stupid, but you are abusing the priveledge.

  21. #21
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    adjustment

    when watching those old video's kind of makes you think, "glad i was not a patient back then!!" anyway, what you need is a doc who practices the Gonstead technique and uses the knee chest table fairly regularly (so he or she is proficient). I am sure your current doc may be able to help you. your leg problem doing the superman excercise also indicates that what i was talking about is what you need. see, usually it is not a weakness, it is just that the neurological "juice" is not flowing correctly to the muscles. hope this helps and works out for you as i have had a lot of patients with this problem along with myself personally.








    Quote Originally Posted by bykegnurd
    hit the nail on the head... While I cannot find too much information on knee/chest adjustment except for some ancient video of Palmer doing some WWF flying elbow neck adjustments, I do feel weak in the low back. My adjustment on Friday has me feeling well enough to stretch and try some core building exercises. When performing the 'superman' I am easily able to raise my chest and arms from the floor, but my legs were a battle and only a few reps left my back feeling fatigued and unstable. I was easily able to do 100 good quality crunches and 50 bicycle kicks for my abs, so I can only imagine the the difference in muscle strength is not helping.

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