As you can imagine, much controversy surrounds manual testing for dysfunction of small joints that move as little as 2 mm. Many clinicians believe the following manual tests produce non reliable evidence of SI joint involvement in pain, but presently there are few other options.
Medically, the customary procedure for SI joint diagnosis is joint blocks via injection, but these as well have difficulty standing up to criticisms. Clearly more research needs to be devoted to the accurate diagnosis of SI joint pain.
The above, however, does not necessarily mean these tests are not clinically useful. They can provide valuable information, particularly when they are able to reproduce symptoms, and of course be used to follow up and assess changes after therapeutic interventions. Since these tests are relatively safe and easy to perform, they can be used to gather clues.
The following tests are the most customary ones, and I will not delve into more complex testing in this post, as that is better suited to a clinician’s textbook.
Side-Lying Sacral Compression
Femoral Shear Test:
To Sum Up…
It is suggested by some therapists that at least 3 out of the 5 tests above must be positive to indicate SI joint involvement, and that if all 5 tests are negative, move on to testing other areas as possible pain generators. Physical therapist Stuart Fife, reports dismal numbers with regard to reliability and accuracy of manual testing methods, and Richard DonTigny asserts that often the correction validates the diagnosis.
Based on this information, it appears that all tests may give clues, and instead of any one given test, multiple tests should be performed to accurately test for SI joint involvement in pain, and which corrective measures should be carried out for resolution.
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What does an SI belt do?
The si belt serves as an artificial locking technique through compression of the surfaces of the joints. These belts have been found in studies to reduce laxity of the sacroiliac joints and improve stability.
The theory for the use of a belt is that the surfaces of the sacroiliac joints are pressed together, which increases friction and reduces shearing forces.
Does the sacroiliac belt really work?
YES! In the video, I said that the biggest issue is whether you actually HAVE pain coming from the sacroiliac joints or not. Attaining an accurate diagnosis of pain from the SI joints isn’t that easy, simply because there isn’t an established “gold-standard” test.
Some people get significant and immediate reduction in pain once the belt is properly used, while others only have a minor reduction in pain, but often times there is some improvement in mobility or strength in the pelvic muscles. These are positive signs that you may benefit from the belt.
Is there a simple test to find out if the belt COULD work for me?
Yep! In the video above, I show a test that can be performed while lying on your back. Since the belt’s job is to compress the pelvis, we can mimic this action with a set of hands. Definitely ask someone to do this for you, which will be a much better test than attempting it on yourself.
Lay with your legs straight out. Lift your leg up from the floor in a controlled speed while assessing how it feels, both in terms of muscle strength, coordination, and pain levels. Test the other side as well.
Next, ask someone to gently compress your pelvic bones inward, toward your midline, and hold while you repeat lifting your legs. If there is improvement, then you will likely benefit from wearing the si belt.
Does it matter if I put the belt on standing vs. sitting vs. lying down?
Yes. I recommend only putting the belt on while lying on your back, AFTER doing your si joint corrective mobilizations.
How tight does the belt need to be?
Its important to understand that the emphasis should be placed on the position of the belt, NOT how tight it is. One study in particular showed that a belt with a tension of 100 N did not significantly differ from one at 50 N in terms of reducing sacroiliac motion.
More is NOT better in this case!
Which belt is the best?
They all do the same thing so its really a matter of comfort, since most people who benefit from it will wear it often. Nothing is worse than having to deal with a poorly designed belt that is constantly riding upward when you sit or move.
I personally like Serola. Now, I don’t have SI joint pain, so I can’t comment, but many of my clients like this belt.
Does relying on an SI belt make my own muscles weak?
No. Using a sacroiliac joint belt is not the same type of thing as a lumbar spine brace. SI joint instability is a ligamentous/joint problem. Since there are no muscles that directly move those joints, wearing the belt will not weaken anything. You can wear it 24/7 if you want.
That said, it does NOT mean you shouldn’t address the muscles that support the pelvis. In fact, this is the CRITICAL element. Without adequate muscle balance, strength, endurance, and coordination of the core muscles, you are very likely to have ongoing setbacks in your corrective process.
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Supporting your spine in the seated position is one of the most important back-saving habits you could possibly have. Sitting places one of the highest amounts of stress on the lower back, and slouching makes it far worse.
In the lower spine (Lumbar), there is a normal arch that occurs, and your spinal discs as well as ligaments can become quite agitated during prolonged flattening of that arch, and lead to pain.
Therefore, we must work to preserve that curve as we sit, but using our own muscles to hold ourselves up can be quite challenging, especially if you work the regular 9-5 workday. This is where having a lumbar support comes in.
Setting up the lumbar support improperly can be just as bad as not having one at all, so its important to set it up properly in order to benefit from the desired effect.
Tip 1: The Right Position
Sit with the back in full lordosis (arch), then back off approx. 10% toward neutral. This is generally where most people will need to be. Sitting like this can be very fatiguing for de-conditioned back muscles, but having the lumbar support in this position will ease the amount of muscle work.
Tip 2: Support Options
There are many different potential options for lumbar supports. Seat cushions, towel rolls, and “ergonomic chairs” often won’t get the job done because they are usually the wrong shape, and do not provide the adequate pressure needed at the right level in the lumbar spine. However, when needed, they can serve as a substitute very short term.
Tip 3: Optimal Diameter
The lumbar roll should be no more than four to five inches (about 10-13 centimeters) in diameter before being compressed. It should be filled with foam rubber of moderate density so that when compressed its diameter reduces to about 1.5 inches. (about 4 centimeters).
I highly recommend the “Mckenzie Super Roll”, which a wonderfully designed lumbar support made JUST for this purpose.
When adjusting to the new support, you may experience some ache, but it should improve fairly quickly. It all depends on how stiff you are from the get-go in the lumbar region, and of course the proper ergonomic set up.
The Lateral Tubing Walk is definitely one of my favorite exercises to use in the initial stages of my corrective programs. The one thing that I notice is how its typically instructed, which is with the knees bent, or allowing the person to bend forward at the hips. This never made sense to me, especially considering the hip abduction movement pattern is tested generally while laying down (You can find this in my 7 Movement Tests Video Course). The hip would be in a neutral position, and preferably in slight extension.
If the intention is to assist in correcting excess anterior pelvic tilt, the hips should be placed in extension during the exercise, and the range of motion limited to avoid hip-hiking.