Monday, April 30, 2012

Oh, Our Aching Backs--Part One

Congratulations to everyone who ran the Big Sur Marathon (especially Kathy!) and the Eugene Marathon yesterday. I was jealous (my second "did not start" since my injury diagnosis, a 15K, came and went on Saturday), but also very happy for all of you.

I also want to say GOOD LUCK to the four hearty (and sleepy) souls who signed up for the May Sleep Challenge with me. We have a tough road ahead of us. It's not May quite yet, but I tried to practice last night and therefore was "lights out" at 9:34 p.m. Instead of falling into blissful slumber until my alarm sounded at 5 a.m., I tossed and turned and got up to use the bathroom and adjusted my pillows until about 10:20, when I finally drifted off. Then I woke up three times in the night for no good reason, finally rising for good at 4:50. At least, given how tired I am right now, I don't think I'll have as much trouble falling asleep tonight.

This week, I have no physical therapy appointment. I'm just keeping my nose to the grindstone with my ab and glute exercises. So I asked some bloggers who I know have experienced my injury--to remind you, it's called sacro-iliac joint dysfunction and it affects your lower back, hips, bottom and hamstrings--and lived to run again to tell their stories via a Q&A.

Tara and Jessica were nice enough to get back to me. Their stories give me hope, so I'm sure they will help someone else with SI issues who might despair, thinking that once your lower back goes there's no return. Tara is now expecting her second child (she ran a half-marathon pregnant in January!) and is looking forward to a big return to PRs after he is born. Jessica, who has three small kids, just took third place in a 10K and in her most recent marathon qualified for the Boston Marathon for the first time with a huge PR.

1. What caused your SI joint issue? (If it was a combo of things, definitely share that too. My issue was mainly caused by pregnancy, but doing too much running too soon afterwards, carrying toddlers, driving a stick shift, sleeping on my stomach and doing the wrong core work exacerbated it over the ensuing five years.)

Tara: My SI issues were caused by having extremely weak, inflexible hips and weak glute muscles.  Now, if I were just sitting around all day, my weak hips and glutes probably wouldn't have been a burden to me, but I trained for three marathons in under a year and did absolutely NO strength work whatsoever.  No squats, no lunges, no hamstring work....nada.  All of that running and no strength work eventually caused my SI joint to become hyper-mobile and my glutes/hips couldn't hold the joint in place.  The joint pulled on my piriformis muscle, which caused me to have piriformis issues, which in turn pulled on my IT band and caused IT band pain. I finally had to pull out of the Chicago Marathon two weeks before.

Jessica: I think my issue was caused by two things: horrible posture habits which were made worse during pregnancy.  When I was a new mom I would carry my babies around on my hip and do a million other things at the same time (put groceries away, wash the dishes, carry the laundry basket etc) - never paying any attention to how I was holding my body.  As a result I had a weak core and my SI joint was completely out of whack.

2. Did you see a practitioner (physical therapist, chiropractor, doctor or other) to help you alleviate the problem? (I'm seeing PTs referred to by my doctor, a sports medicine specialist.)

Tara: I went to see a sports medicine doctor for my IT band pain and he sent me to a physical therapist who eventually diagnosed the root cause of my problems, which was that stupid SI joint.

Jessica: The first time I tweaked it, I went to see a chiropractor.  He was more of a "back cracker" and just adjusted me, told me to stop eating gluten, and sent me on my way.  It was frustrating.  When I was pregnant with my third baby last year one day I just went to tie my shoe and - TWEAK - I was in so much pain.  After the baby was born I found a new chiropractor who has honestly been so incredibly helpful to me.  He takes a much more holistic approach with his care - ART, chiropractic adjustments and massage.  He figures out where the imbalances are in my body and gives me exercises to do to strengthen them.  He is really wonderful and I am so thankful.

3. What sorts of exercises/adjustments/other therapy was prescribed? (For me, an SI support belt, regular adjustments and dry needling, massage and various at-home exercises have been my mainstays for eight weeks now.)

Tara: My PT had me doing at home hip exercises, squats, lunges, core work, etc.  I never knew that I had such a weak butt!!!

Jessica: I work with a theraband, do pilates exercises and foam roll every single day.  I also do strength training twice a week.  When I see my doctor (about once a month during marathon training) he will do ART on my super tight spots, STIM [electrical stimulation] and massage along with whatever chiropractic adjustments he feels are necessary at the time.

4. What factor or combo of factors finally got you over the hump with your SI problem? (I, alas, am still not really over mine. Trying to be patient.)

Jessica: Honestly, mostly just becoming so much more self aware and intentional with how I move and use my body.  I became a Pilates teacher two years ago and those exercises have changed my life.  As a busy mom of three I can forget myself easily on a daily basis and try to do too much at one time.  My SI joint will get cranky if I do that and I feel tweaks as a result.  So if I am mindful and I practice Pilates every day, it really helps.

5. Does your problem still flare up? What do you do when it does?

Tara (answering 4 and 5): I find that if I lapse on my strength work, the SI joint pain comes back.  I have learned to recognize the symptoms, which can be pain in the lower back, glute, hamstring, groin pain or a combination of all. I am currently getting ready to enter my 6th month of pregnancy and with pregnancy comes the hormone relaxin, which basically relaxes our joints, including the SI joint.  I am working with a chiropractor to keep my back "healthy" and he initially gave me the Serola SI joint belt, which I used for awhile, but I have been diligent about keeping up my strength work during pregnancy and I haven't needed the belt in the last few months.  I have a feeling that I will forever deal with the hyper-mobile SI joint. I must be diligent about strength work.

Jessica: Yes, it does on occasion.  I have not had a flare up for a year though, which is so wonderful!  If I feel things get tweaky, I will ice, rest and go see my doctor.  I bring more awareness to how I am using my body and try to slow down and pay better attention.

6. Any other advice for people who may be dealing with this? Any advice on how to prevent it happening in the first place?

Jessica: Take Pilates!  I really think it helps so much.  We ALL have imbalances in our bodies, even the strongest most fit athletes in the world.  We have to become self aware and pay attention to how we are using our bodies.  I think this is what has helped me so much.  I used to have issues with my SI on a pretty regular basis, and it was so depressing.  I would be laying on the couch afraid to move as my kids played around me.  I hated it.  I did not want to go through that again and Pilates has really saved me.  Also, find a doctor you really trust - not someone who will just adjust you and tell you to take supplements.  Find someone who wants to help you improve your quality of life.  Someone who "gets" you.  Check in with yourself throughout the day - when you're standing in the line at the grocery store - are you slouching?  Are you jutting out a hip?  Is your core engaged.  Stand tall and breathe.  Relax.  Be mindful and intentional with how you are moving.  And move every day - movement heals!!  You do not have to move fast - just move.


Thank you, Tara and Jessica! I also want to give a shout-out to Michael, who when I was initially diagnosed sent me a great article with a thorough explanation of this problem and some adjustments and exercises to help alleviate it. I've found these to be a big help in addition to my formal PT program.

In "Part II" I will give you a detailed description of my PT program as it stands right now.