SI muscles wont heal

Question
QUESTION: I injured my sacroiliac muscles nearly three months ago in the gym. That's the diagnosis I got from the chiropractor, who I then saw once a week. Luckily there were no detected damages to bones or joints. So I started seeing the chiropractor weekly, and during this time, I was immobilized from doing much exercise, or even from prolonged standing, walking or sitting. Bending at the waist was out, and even sleeping posture was rigid. The pain and muscle spasms kept me from moving, anyway.

The chiropractor visits reduced the pain to the point that I regained a lot of mobility. The pain was still present, but no longer caused muscle spams that kept my body stiff. Most of the day, There was no pain at all. It would usually present itself after I get out of bed in the morning, or from sitting/standing for too long. The chiropractor said I could get back into the gym, perhaps try the ellipticals, and it shouldn't be a problem.

Well, it's been a few happy weeks going every day at the gym when one morning, after climbing out of bed, the pain was as bad as it was when it caused me to start seeing a chiropractor. The pain was notably pervasive throughout that day. About 3-4 days later, here I am, and the pain is still that bad.

What is going on with my SI that it's still injured, after three months? How long can I expect to be in recovery? I do not want to have to be sedentary again. What can I do to fix this once and for all?

Some more info to help: I'm female, 34, 5'2" and 130 lbs. This is the first time I've experienced SI injury.

ANSWER: Hey Claire

Thanks for your question. The reason why your SI got re-injured I believe is because you were doing too much too soon. Let me explain.

When you get back into a routine after an injury, your fitness program needs to be modified so you do not re injure the area that has been affected prior. So the rest of your body may be fine and feel great, but your newly healed area is stubborn, its not going to be as strong right away, so you need to build it back up slowly and gradually. My first clue was when you mentioned going to the gym everyday. It may be ok for your body if it wasn't for the SI muscle but now the program needs to be reduced in intensity and frequency.

When muscles go through a healing process, the injured muscle starts to heal as scar tissue. Scar tissue isn't as elastic as regular muscle and it isn't as strong. It needs to be treated with tender love and care with stretches and gradually added strength exercises so it can heal properly to get your body back to the level it once was.

So what do we do next?

I suggest you use the RICE principle of Rest Ice Compression and Elevation. Use an ice bag several times a day on the area that was injured, when the inflammation goes down and there is no pain start adding stretching areas for the low back and hamstrings and then gradual strength exercises. Also continue seeing the chiropractor or a doctor. Theyll tell you first if the activity is permitted beforehand.

Do not start exercising everyday,

You need to build that area up again. You also need to think of doing a temporary detour on the types of exercises you were once doing. Were you doing high impact exercises like running on the treadmill, badminton etc..? Perhaps you can replace this with cycling,or swimming. High impact exercises will put stress on the postural muscles and we don't want that. Avoid high impact activity for now. Also, i would be curious if the type of work you were doing is strenuous, that can also affect the area.

I would suggest 2-3x per week once your affected area stops being inflamed and in pain include a stretching routine for your SI muscles. Avoid the everyday routines for now, your SI muscle is a priority which I know it sucks but it is necessary to build it back up. Once it is healed you can start increasing the amount of time you are at the gym. I am not sure of the types of activity you were doing at the gym but one thing I would not recommend is doing weigh-training everyday even once your back is healed because it puts too much stress on your muscles.

Here are a couple exercises below at the end of this article. However continue to see your doctor and first get clearance that your safe for physical activity and continue seeing a chiropractor. If anything starts to hurt during exercise stop and avoid it and think of an alternative that won't aggravate that area.

Hope this helps and I know this was long :)

Stretches
-------------------------------------
Press up stretch 2x (20-30s)
Trunk Twist stretch 2x (on each side) (20-30s)
modified hurdler stretch 2x ( on each leg) (20-30s)
double knee to chest stretch 2x (20-30s)

Strengthening
---------------------------------
Opposite arm opposite leg spinal extension 1-2 sets (10-15 times each leg)
Wall squat  1 set(start with 5-10 seconds, build up to 1 minute)





---------- FOLLOW-UP ----------

QUESTION: Thank you for the detailed response! No need to apologize for length, I deeply appreciate that you took the time to answer my question! It's me that must apologize for the length of my questions.

Regarding my work, I'm not surprised at all if it adds to my SI injury. I work in computer tech, so it's long hours sitting hunched over a computer or mobile devices. In addition, the workplace doesn't have ergonomic chairs and tables that fit someone as short as me. I don't get chances during the day to be active outside of the chair, which I think is why I look forward to going to the gym every day. I'm worried that less frequent and less intense exercise will cause me to lose the muscle and fitness level that I have built up, while I hear that people need to walk or do some form of cardio every day to stay healthy. What might you suggest I do to prevent becoming less fit while I recover?

I've started to apply the RICE principle. I'm a little confused to the CE part. What's the proper way to compress and elevate the SI, and when and how often should that be done?

I've just about limited my cardio to ellipticals on interval speed and resistance intensities. Treadmills are out because of the high impact you mentioned, as is running outside. The ellipticals seem to cause less impact, but yesterday I tried cycling as you suggested. Sitting and leaning forward on the cycling machine seemed to aggravate the SI that day, so I went back to the ellipticals. Swimming might be my next experiment. Weight training for me is ether weight machines or low-weight dumbbells and my own body weight (squats, pushups, crunches, lunges, etc.) for resistance. I now try to alternate weight training days. I spend about an hour at the gym each time, overall.

I've also started trying the exercises and stretches you suggested at the end of your message. Thanks so much for that! Do you have a link to pictures or videos of these, so that I can be sure I've got the correct form?

I heard that taking fish oil for the omega-3 helps bring flexibility to joints. Would you recommend taking fish oil or omega-3 supplements for the SI joint to help my situation?

And lastly: how long can the average person expect to be recovering from injured SI muscles?

Answer
Hey Claire


Thank you for following my advice, I hope your SI muscles are getting better and aren't aggravating you.

So I am going to give you a bit more detail so it can perhaps give you a better understanding about your specific problem. A lot of it isn't black and white but I rather give you a whole picture then a *meh* half answered response.


1)

You are correct about work being a contributing factor to your SI muscles being out of whack.
I am not saying that it is the diagnosis but it could be one of the causes. So when you are sitting down 40 hours a week in that seated position, it has to have some effect on your posture because of the extended amount of time your posture is put in that position. The other clue that got my attention was when you said at the gym you were on the bike
"Sitting and leaning forward on the cycling machine seemed to aggravate the SI that day" . Many times in sitting motions people tend to lean forward in prolonged periods of time.

So what do we do? You can add some stretches in the office in between your work sessions, and get up from the seated chair every half an hour and walk around for a bit. Its not good being in the same position for an extended period of time. This is just some ideas to get you thinking differently about the problem going on with your SI muscles.

Stretch your shoulders- sit in your chair and putting your arms behind you, grab your wrist and raise your arms up from behind while maintaining a straight posture. ( do that for 15-30s, 2 times). Also do a chest wall stretch- lean one of your arms against a wall and stretch out the pectoral muscles ( each side twice for 15-30 s). Lastly you can do a spinal twist stretch with the wall- keep your back to the wall with your feet less then shoulder width and twist the body slowly and place your hands on the wall (hold for 15-30s, do this twice).

If you feel that these hurt you and you feel extreme pain then avoid these exercises for now.

2)As for losing your conditioning and reducing the intensity and duration- you need to remember your SI muscle the priority right now. So the types of activity you do takes a back seat to your SI muscles. You need to find an activity that will not aggravate your injury but also something you enjoy, so swimming was one I mentioned, but there are alternatives. You mentioned that biking affected your SI muscle so lets leave that one out. Continue with the elliptical since that is not bothering you from what you told me. Decrease the intensity but increase the duration is more appropriate in a scenario where there is an injury.

3) For the RICE principle and the CE part- try to do this at a time when your at home, you can lay on the couch and put an icepack with a towel on it and have it on your SI muscles for 15-20 min. Usually the CE Compression and elevation is meant more for an arm or leg so don't worry about that too much.

I do not have exercises at the moment, but I will have a personal site up and running soon  (fit2assist) and I will start including exercises the ones you mentioned, I can forward a link when its up.  I personally use Google images or youtube if i am looking up new exercises and want to make sure I am doing it correctly.

This is the take home message I want you to think about
When there is an injury to the low back there are 4 reasons why it gets injured.

1) Overuse - (too much too soon)
2)Footwear- ( shoes aren't right, or have been worn out)
3) Weakness and inflexibility- (muscle imbalances)
4) Mechanical problems- ( there is also an imbalance within muscles


From what is mentioned, I would consider in your case #3 the issue you need to look out for. I cannot diagnose an injury but from what you are telling me, I would consider the injury to be most likely related to muscle imbalance. When there is an injury to the low back muscles, many times it is due to inflexibility and a weakness in the abdominal muscles. So if your back is tight and your abdominal muscles are weak it is at greater risk for injury. With that being said if you don't do as much ab exercises, try to include some. Perhaps crunch with a med ball and aim for 20-30 reps. Also include flexibility in your exercise routine.

As for Fish oil, I cannot recommend supplements in my scope of practice that would be a dietitian/nutritionist's role  but I can comment on my personal experience with it along . I took fish oil with glucosomine after a tendonitis injury of lateral epicondylitis , I found that along with the RICE principle the pain went down a lot and pretty much disappeared within 2-3 weeks.

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