What is SIJD and how do I know if I have it?

[Julia]

I have read other posts about SIJD and wonderf if I might have it. I once saw a registered massage therapist who told me that my pelvis is out of alignment and one leg appears to be shorter than the other due to one hip being higher than the other. Not sure if she knew what she was talking about but I thought it might be worth looking into.

Does anyone have a simple explanation of SIJD and can you suggest someone to diagnose it? Physiotherapist? Chiro? Family doctor?

Thanks.

[HerMajesty]

You do sound like you have SIJD; I did and I had a leg length discrepancy with it as well. "SIJD", Sacroiliac Joint Dysfunction, is kind of a buzzword because it is used to describe most conditions where the pelvis is out of alignment. Your Sacroiliac Joint (S-I), may or may not be the major source of the problem. Many times you will encounter literature or videos which oversimplify pelvic misalignment as a simple case of too much movement (hypermobility) in the S-I joint, leading to pain. Really if you have one leg longer than the other something is stuck (hypomobility); if you do have S-I hypermobility it would just be a compensation.
See a PT Manual Therapist; they are the PT's that manipulate joints. They do not necessarily have to have experience with pelvic floor: A lot of Sports PT's, for example, seek training in treating SIJD. The family Doctor might only be useful if (s)he is a D.O. (Doctor of Osteopathy). They get extra training on joint manipulation. MD's are totally hands-off: They want to see x-rays, which will not show SIJD in most cases as it is primarily a problem with movement and will rarely be visible in a still picture. An x-ray might show as a slightly deviated coccyx or a widened pubic symphysis, if anything at all. PT or DO, you need to see somebody who evaluates as your Massage Therapist did: Hands-on. Use caution with Chiropractors: for every one that can really do appropriate manipulations to improve SIJD, there are a few dozen that will seem confident they can help the situation, but will really cause more problems. I would say only go the Chiro route if you get a personal recommendation from a patient whose SIJD was corrected, or a Dr. whose patients' SIJD was corrected.

[birdlife]

Love your informative posts, HM . My twopenn'orth is minor but might be useful. My sports physio didn't actually mention the term SIJD but said my right hip was fractionally pulling up my leg, and the prime culprit was the quadratus lumborum muscle (QL). The pirifornis was also contracted and there was a knock-on effect. He said if you look in a mirror and one side of your hips is more curved than the other, then that's a good indication you have tight ligaments and muscles exerting an abnormal pull. Apparently the greater trochanter, the ischial tuberosity and the sacroiliac joints are three main referred pain areas from the quadratus lumborum. He worked on the triggerpoints in the QL and got it back to its normal 'resting' length.
I have a tendency for this particular one and other tp's to recur, so I just get working on them!.

[HerMajesty]

Birdlife, The situation is kind of a "which came first, the chicken or the egg" question. I got a lot of muscle work and did a lot of excercises on the philosophical basis that the behavior of joints is secondary to the behavior of muscles. That is, the philosophy that a hypomobile joint is due to muscle tension, and a hypermobile joint is due to muscle weakness. The correction was never permanent for me on that basis. When I got direct joint work, the correction was permanent: In my case muscle tension was CAUSED by traction from hypomobile joints, and muscle weakness was not the cause of hypermobility but a reflexive inhibition of muscle caused by joint dysfunction (there are mechanoreceptors within the tissues that will turn a muscle "on" or "off"). There are also neuro components, such as I am told by the Neurologist dealing with my S2 Tarlov cysts, that my piriformis muscles are still in spasm because it is enervated by S2, and my S2 nerve roots are being compressed by the cysts.
I wish things were simple but they are complicated! If you need repetitive work on one muscle group, this gives you a hint that there is an underlying cause to unearth.

[Julia]

Thanks so much for the info and discussion.

So, next question, does anyone know a PT Manual Therapist in the Toronto area??

I have been looking around for one in my area (georgetown, ontario), browsing websites etc., what kinds of things should I be looking for? What kinds of things should I stay away from? Should I ask them if they are familiar with PN, or does that not really matter? Should I tell them that I think my pelvis is misaligned, or wait and see if they come up with that on their examination?

[Julia]

Also wanted to add that I had pelvic floor physiotherapy last year, a total of 12 sessions. It was internal, myofascial release, trigger point massage. She only ever did internal work, never evaluated my posture/gait, pelvic alignment, etc. I guess I would need to see someone else for this? It seemed strange to me that she didn't consider that to be important.

[HerMajesty]

They all have different levels of training. My pelvic floor PT did external trigger point release, internal work, and joint evaluation; although she eventually referred me to a Manual Therapist to align my pelvis as my pattern of injury was too complex.
The sad thing about you ONLY getting internal work, is that I see you have bladder issues (comment in signature about IC diet), and even joint work aside, while the internal work was useless to me the external trigger point work, on my belly and inner thighs, did a world of good for my bladder. It is really just very deep tissue massage in the "belly button to knees" area, and you could probably do it yourself or get a good massage therapist to do it. I did plenty to myself at home. You lube your fingers slightly and use your 4 fingers pressed together, to kind of "dig" into the tissue. On my belly this felt like knives were stabbing me, because of all the trigger points. The PT or myself would "work" an area, concentrating on the painful spots, and then leave it alone for about half a week and work someplace else. The area will be sore and might bruise, but after a few days when it is no longer sore, you will find you can massage the same area again with much less pain because you released many of the trigger points. Some of these sessions, especially to my inner thighs which were rock hard to start with, were so painful I couldn't even speak...but when I would walk out of there my bladder felt GREAT.
As far as a good manual Therapist in your area, hold that thought...I met one from Canada that seemed very competent at a conference a year ago, but I can't remember his name or what part of Canada he was from. I will have to see if I can dig up his card. Otherwise, I will be at the International Pelvic Pain Society Conference Oct 20-23, and I will see who I meet, will keep my eye out for somebody from the Toronto area. Unfortunately I don't have any names at my fingertips.

[birdlife]

If you need repetitive work on one muscle group, this gives you a hint that there is an underlying cause to unearth.

That's given me something to think about HerMaj, the other side of the coin! Have had quite a bit of thinking to do on here of late. Thank you for making my grey cells work .

You lube your fingers slightly and use your 4 fingers pressed together, to kind of "dig" into the tissue.

HerMaj, this seems to me to be pressurepoint massage not triggerpoint massage. In TP you definitely do not dig down, you push the skin forwards and down with your thumbs, forwards and down, going a little deeper gradually each time, to move the fascia more kindly than pressurepoint massage (so as not to set up another triggerpoint!) and to move the triggerpoints out towards the end of each muscle, rather than try and annihilate the tp in one extremely painful go. And always kneed in the same direction for whichever muscle you are working on, otherwise you are shoving the tp backwards and forwards within the muscle instead of easing the waste products gradually out. A little difficult with the piriformis mind you, due to its horizontal position and so you have the choice of massaging out towards the hipbone or in towards the spine, and then its hard to eradicate the very last bits with bones in the way. Oh yes, I know EXACTLY what your thighs felt like! I'll rephrase that . I mean I had such pain with tp's in the adductors and the gracilis I was in tears for weeks till I got it down to the odd gasp.

Julia I hope you get the kind of pt you're looking for, and hope it works for you! If I were you I'd mention first off that you have sacral pain, see what they say to that. My sports physio said straight out he did not deal with the pudendal, but thenj I didn't expect him to as I was going to him for the stiffness and pain in the lumbar and buttock muscles anyhow. Good luck.

[HerMajesty]

Ok Birdlife, let's put it this way...she tortured me and beat me up good, and got away with it by calling it trigger point massage
But hey, it worked. I have seen several techniques for deep tissue massage used on youtube; I even managed to chase down something called Bindegewebsmassage, try to pronounce that! Bottom line, having my belly and thighs tortured did help my bladder, and this was apparent from the beginning, immediately post-session. My best advice for anyone trying soft tissue PT, is that physical abuse is fine if you see immediate benefit. If it isn't helping or is causing a flare, then don't be too patient waiting for a result, it's probably just plain old physical abuse

[HerMajesty]

...Julia, I have tried my best to track down the identity of the Canadian Manual Therapist I met and failed But I did Google "Toronto physiotherapy manual therapy" and got several good hits, so it looks like you will have a selection of websites to read over and pick a practitioner.