By Marc Heller, DC
So many of our patients have chronic sacroiliac dysfunction. I have written several times about this problem, from several perspectives. This article will describe the work of Richard DonTigny, a physical therapist from Havre, Mont.
DonTigny has developed a home program, a set of basic exercises to reset the patient's sacroiliac (SI) joint, as well as a simplified form of mobilization for the SI joint. DonTigny's work all goes in one direction, taking the anteriorly
Many of our low back pain patients return to the office with a recurrence of posterior or anterior innominate
DonTigny's basic indicator is tenderness. He checks the medial aspect of the upper PSIS
Sacroiliac Self-Correction Exercises
What are the basic exercises that reset the SI? The first one will look familiar to those of you familiar with post-isometric relaxation or muscle energy technique. I have reproduced a whole series of pictures, showing different positions in which to do the same basic exercise. The basic routine is to have the patient bring the leg up to the chest, grasp the leg with both arms, and push outward with the leg against resistance. DonTigny recommends pushing outward hard for five to 10 seconds, then alternating legs, doing each side three to five times. Note that this can be done supine, sitting, standing using a chair, or in a doorway.
The second type of exercise is performed supine, with one knee bent, pushing the knee directly along the line of the femur. As you do this, the pelvis will lift on that side, slightly off the surface. You can get a little better motion into the pelvis by wrapping a long belt or strap around the knee, and pushing the knee into the strap (not pictured). Note the sagittal plane torque this is trying to produce in the pelvis. Do this three times on each side, holding for five to 10 seconds at the top. I find that on the involved side, it will feel much stiffer, and it is harder to lift the pelvis freely.
The third set of exercises involves flexing the hip as far as you can, simultaneously pulling it out to the side of the body. A second variation of this is done using a chair or bench and bending forward on the bent- leg side. I would have patients who have possible disc issues, especially those sensitive to flexion, be careful with these by keeping the spine in neutral, or avoiding these exercises altogether.
I recognize this is a different model of the SI than most of us use. I recommend you read DonTingny's articles for a deeper understanding of his view of the biomechanics and pathomechanics of the SI joint.
Keep an open mind - this is probably nothing like what you usually do to correct the SI joint. I have found these procedures quite effective for selected patients. These techniques seem to work best for the patient with an anterior rotated ilium, found usually on the right, when the right SI also is fixated.
Link to Original Article: http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=50535