Issue link: https://www.massageandbodyworkdigital.com/i/87297
MYOFASCIAL TECHNIQUES 1. If the less mobile side is more painful, work to loosen that same side, using the techniques discussed here, or others. This usually provides immediate relief, and when incorporated into ongoing work and complementary activities, such as stretching and habit modification, will give lasting results. 2. If the more mobile side is also more painful, release the less mobile side, but do much less work (if any) on the hypermobile, painful joint. Work any soreness in gluteals and hip muscles on the hypermobile side (since they're likely working to compensate for the lack of ligament stability), but don't work directly on the hypermobile joint, at least at this stage. Ask your client to track any changes in his discomfort in the days after the session. If there is less pain, you're on track and have probably relieved the strain on the hypermobile side by spreading the demands of adaptability across both joints, and/or by hydrating irritated joint tissues. Continue working in this way until the irritation subsides. 3. If your hypermobile client reports no change or a worsening of symptoms after working on just the less mobile, less painful side, you may want to discuss the option of working with the hypermobile side directly. Although conventional wisdom says that working directly with inflamed tissues can further aggravate them, I (and many others) have observed marked improvements in SIJ comfort after working directly with a hypermobile, painful joint. Occasionally, there can be a worsening of symptoms in the day or two after the session and, more rarely, for several days. Even in these cases, once the immediate aggravation has settled, there is almost always less pain and aggravation. This higher-risk, higher-reward approach is appropriate only if both you and your client are informed and comfortable with its implications. Consider factors such as your level of experience, access to supervision, and referral practitioners, as well as your client's history, stability, and the potential impact on her life or livelihood. If you, or your client, are uncomfortable with the prospect of the symptoms perhaps worsening afterward, take the cautious route of direct work only on the asymptomatic side, and lighter, indirect work on the symptomatic side. 4. If SI pain persists, referral to a complementary specialist is indicated. Success in dealing with SI pain has been reported by users of physical therapy, Rolfing and structural integration, osteopathy, chiropractic, rehab and functional medicine, and prolotherapy or sclerotherapy (tightening of loose ligaments by therapeutic scarring), as well as fluoroscopic injections and fusion surgery. If you have your client's permission, ask her other practitioners about how your work can support and complement their goals. This is a great way to educate yourself and further help your client. Keep in mind that a worsening of SI symptoms after using the techniques described here is quite rare. Performed properly, these techniques are nonintrusive and have been successfully used by the thousands of practitioners who have trained with us. Whether you use these techniques to begin a session, address SI pain, or close and integrate, your clients will appreciate your gentle, precise work with their SIJs. Notes 1. G.l. Smidt et al., "Sacroiliac Motion for extreme Hip Positions. A Fresh Cadaver Study," Spine 22, no. 18 (1997): 2,073–82. in addition to 4–8 millimeters of posterior superior iliac spine translation, this and other studies cite up to 17 degrees of angular motion at the sacroiliac joints. 2. l. Damen et al., "The Prognostic Value of Asymmetric laxity of the Sacroiliac Joints in Pregnancy-related Pelvic Pain," Spine 27, no. 24 (2002): 2,820–24. 3. T.n. Bernard et al., "recognizing Specific Characteristics of nonspecific low Back Pain," Clinical Orthopaedics and Related Research 217 (1987): 266–280. 4. Diane lee, The Pelvic Girdle (Philadelphia: Churchill livingstone, 2004). Watch Til Luchau's technique videos and read his past Myofascial Techniques articles in Massage & Bodywork's digital edition. The link is available at Massageandbodywork.com, at ABMP.com, and on Advanced-Trainings.com's Facebook page. 8 Sacroiliac Wedge Technique, performed bilaterally. Image courtesy Advanced- Trainings.com. Used by permission. Til Luchau is a member of the Advanced-Trainings. com faculty, which offers distance learning and in- person seminars throughout the United States and abroad. He is also a Certified Advanced Rolfer and has taught for the Rolf Institute of Structural Integration for 22 years. Contact him via info@ advanced-trainings. com and Advanced- Trainings.com's Facebook page. ABMPtv.com "Working with the Sacroiliac Joints" www.abmp.com. See what benefits await you. 117