Pick my Brain – Episode 2

Welcome to the second episode of Pick my Brain.  Our vision is to share knowledge, so we created this segment because I do get a lot of questions on social media, some that I can’t always answer, buy many that I can.  I think it’ll be nice to share some of the thoughts and answers to those questions here on the blog.   This week we talk about how to become as awesome as me!  No, really, that was a question!  Thank you to this follower who thinks I’m awesome, made me blush!  So, I give you my advice on what to do to make sure you grow your practice.  We also talk about SI joint dysfunction, and a few key elements to help manage it.

If you also want to ask me a question, send me a direct message on Instagram or Facebook, or drop your question in a comment below, and I will do my best to include it in one of the Pick my Brain episodes.  Make sure to watch the full video below!

I had an interesting question from someone who wrote in and asked « How do I become as awesome as you?  Like was there a game-changing course or book?” I thought that was pretty funny.

While there may not have been one single game-changing course or book, there certainly were game-changing people who contributed greatly to my journey.  My best advice to you to develop yourself as a professional is to surround yourself with people, quality people, competent people, who have different ways of doing things that you can learn from.  Also, keep an open mind on the stuff that you learn and reflect on how you can integrate it into your practice.  Just remember, we’re like artists.   All artists paint with the same paint or colors, they just do it their own way.  We’re all using many of the same tools and really, it’s about how you strategize and apply your tools.  Being around different people who do things differently is what helps you open your eyes to different ways of doing things and instigating change and growth for your practice.  So, stay yourself and surround yourself with good people would be my advice on how to become awesome. ????

SI JOINT DYSFUNCTION?

Another question I got was “What are your thoughts on SI joint dysfunction, specifically how to identify it and how to correct it?”

First off, “identifying” it depends on whether you are coming at it from a coach’s perspective or from a clinician’s perspective.  If you’re a clinician, there are several assessment and provocation tests that can be performed to determine whether there is dysfunction at the SI joint.

Let’s focus on a trainer’s scope of practice.  A thorough history with your client will help you determine whether there is pain related to SI joint movement and function.  The idea is for you to understand what movements trigger pain and what you can do to help improve movement and decrease pain.  People can usually identify their pain quite specifically with SI joint dysfunction.  They will point to the SI joint pretty accurately as the location of their pain.   However, dysfunction or even pathology elsewhere can also refer pain to the region of the SI joint and SI joint dysfunction can refer pain elsewhere.  We always encourage that you work collaboratively with a health care provider, clinician, or therapist and if in doubt, stay away from painful movements and areas and refer the client back to the health care provider.

That said, other ways to gain an understanding of whether pain is related to the SI joint is, as you do your history, look for mechanisms of injury such as jarring of one hip into its socket.  If there a mechanism like falling on one hip snowboarding or missing a stair, sidewalk or curb and landing too hard on one foot, those will be the type of mechanisms that might disrupt the SI joint.

A thorough assessment is certainly required to understand and identify SI dysfunction.  Typically, this is carried out by the clinician, and sometimes there will be a structural component that requires treatment for example, if there is a sacral torsion, an upslip, or a posterior rotation of the ilium.  The latter can come from a lumbar rotation.  Again, it is best to work collaboratively with a professional who can help identify and treat these factors.

From a coach’s perspective, there are some quick screens you can do to determine whether you should spend some time working on movement to mobilize and stabilize the SI joint.  This would be well within your role as a movement professional.

Perhaps the simplest test you can use is the Flamingo test, where the client is asked to simply stand on one leg, which places stress on the SI joint.  If there is discomfort there, you could consider including some SI joint mobility and stability work in your intervention.  You could take this test further by either asking the person to hop on one leg or lean back.

If you’re doing a Straight Leg Raise test as part of your assessment for soft-tissue limitations of the hamstrings or trunk stability, if someone gets pain or discomfort in the SI joint before 70 degrees of flexion, sometimes that can also be indicative of SI dysfunction.

WHAT TO DO?

As mentioned before, there might be a treatment portion to SI joint dysfunction that requires intervention from a qualified therapist.  That being said, you can help your client self-mobilize the SI joint to create a little more space and re-stabilize the SI using specific exercises, which usually helps not only to restore function, but to alleviate pain.

I always work in 3 sequences:  A MOBILIZATION sequence to create space, an ACTIVATION sequence to create awareness, and an INTEGRATION sequence to create behavior.  I talk about this strategy in my article “How to Build a Warm-up that’s Actually Useful“.

What I have found to work well in the Mobilization sequence with people who have SI joint pain or dysfunction is to give them either a traction exercise for the hip joint or an SI stretch.

In the video, I take you through an SI stretch as well as a traction exercise that can be done using a band.  These are exercises that clients can do themselves daily as self-care.

To re-stabilize the SI joint in the Activation sequence, a focus on lateral stability of the pelvis is often helpful.  Single-leg holds can work well, and if they were too difficult to tolerate, we could focus on a single-loaded hold standing on two feet to work on frontal plane stability.

In the Integration sequence, we want to layer movement on top of our Mobility-Stability work.  The goal is to promote force closure of the SI joint, which is provided by the muscles that cross the joint.  This is different from form closure, that comes from “packing” the joint via the structure.  Force closure of the SI comes from the functional back line.  In very simplified terms, think left hip crossing with the right shoulder.  For example, you could do a single-leg RDL combined with a band row to work left glute and right lats.  If the single-leg stance is not well-tolerated yet, you could simply prescribe a row from a lunge position.  The client will still use the opposite side glute to stabilize themselves to perform the row.

Make sure to watch the full video to see how these exercises are performed.

I have found that these exercises, as well as others, help people struggling with SI joint-related pain.  More than the exercises, the idea behind relieving the SI joint by mobilizing it, re-stabilizing it in the activation sequence and then working on force closure to strengthen is typically a good combination.  You can plug and play using exercises that best fit each client.  Each case will be different, but hopefully that gives you something to strategize around in the presence of SI joint dysfunction or pain.

Enjoyed this article?  Click the link on the top right-hand corner of the video to share it, we sure do appreciate it!

Mai-Linh Dovan M.SC., CAT(C)
Certified Athletic Therapist
Founder of Rehab-U