Overcoming Low Back, Hip, and SI joint Pain
If you have low back, hip, and/or Sacroiliac joint pain and are frustrated having seen multiple practitioners, chiros, physical therapists, doctors and are not getting anywhere, sometimes screening the pelvic floor and abdomen can be the missing link. We see it often where back pain, hip, and SI joint pain are resolved or significantly improved when also direct treatment at the abdomen with visceral therapy or addressing any tightness/weakness in the pelvic floor muscles. Also we find we can get amazing outcomes for even really complicated cases when we can spend the whole appointment time one-on-one with your therapist- no aides or support staff. In this model we have time to truly dive into your mechanics, movement patterns, and compensation patterns while also screening all areas to figure out what is actually the main source of your pain. We can also make sure we really understand your goals and what you want to get back to doing to help us make a plan individualized for you- crossfit, yoga, pilates, surfing, snowboarding, jumping, running- the plan may look different!
Pain in these areas can be really complicated. Is it coming from disc issue in back, arthritis, facet issue, muscle/fascia tightness or weakness, poor mechanics, poor posture, sacroiliac joint hypermobility or hypomobility, foot weakness, or anywhere up or down the chain? We believe it's important to look at the whole body to understand the full picture and that way we can come up with a targeted treatment protocol.
Our goal as physical therapists is not only to improve strength, flexibility, and posture, but we want you to get back to doing what you love without restrictions due to pain.
Some common issues we see:
Rib flare causing increased stress to mid back, low back, and not allowing abdominal muscles to work as optimally. Step one: we fix posture.
Spasm and irritation of the obturator internus muscle which hangs out deep in the pelvis, commonly can mimic piriformis, sciatica, and deep buttock pain that isn’t resolving with typically orthopedic approach.
Tightness in the fascia of the abdomen which can cause pain referral to back, SI, and hip areas. Lots of attachments of structures that run through the abdomen from the surrounding joints.
Pelvic floor tightness or weakness which may not be supporting the pelvis well. For example: hypermobility in surrounding joints typically results in pelvic floor tension which can cause pain to back, hip, pelvis, or SI joint. You can’t address this by only stretching- we need good targeted strengthening for the pelvic floor to feel safe enough to “let go” if surrounding joints are “moving too much or are hypermobile”. Also combo of good manual therapy or body work is typically really important to address.
Physical Therapists in standard clinics don’t always have enough time to look at the “whole picture”. We find we can get a more thorough assessment of the problem when we have more time- we do one hour sessions with you and your PT, and our goal is to find root driver of symptoms (this can be tricky since a lot of the time there may be multiple problems going on, but we can strategize to address most important first).
During your first appointment we will look at posture, mobility in abdomen (visceral therapy), assess back/SI joint/hip/thoracic spine, feet and shoe wear if appropriate, screen for any potential pelvic health issues, abdominal and deep core/hip strength, and any other areas that may be influencing symptoms. We also will watch you move- walk, squat, lunge, lift, run, jump, sit, stand, or any activity that is limiting you to see if there is anything that we can modify. We then dive into treatment. This can consist of body work, strength and coordination training, breathe work, or functional training depending on what you need. This will vary depending on what is found during evaluation and what we believe is primary driver of symptoms that we choose to address first. Changing bad habits can be a commitment and a lot of work but can be so vital in your recovery!
If you're struggling with low back, hip, and/or SI joint pain, we want you to know there is hope out there to overcome! We also love to work with other providers and build a thorough treatment plan so you can overcome or learn to manage your symptoms so you can get your life back. Sometimes multiple disciplines are needed, especially with chronic pain, and we have a referral system built up to help find the right people for your team. Reach out if you need help.