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SI pain, hypermobile or hypomobile?

Hello, 

I have a few questions regarding SI joint pain, but here is my story first. Im sorry it is so long, but thank you for reading it!

I have been dealing with bad lower right side back pain for several months. I had l5/s1 microdiscectomy in January, and since then have had constant low back pain. After my surgery i went back to see  my doctor because i was having low back pain and pain along the side of my hip, he said I had piriformis syndrome and sent me to PT. He did alot of stretching my hips and legs, and had me doing several pifiormis stretches at home. He also did ALOT of dry needling all over my low back and hip. I saw the PT for about 8 sessions and it seemed to help the pain I was having, enough that I decided to try and cut the PT out because i was feeling much better. About a week after stopping I fell down a few stairs and landed on my right butt/hip. I started having pain a few days after the fall, but it was a differnt pain, still on the right side but a differnt type, it was very deep in my low right side back, it went and moved to the side of my hip, almost felt like it was right above my butt, i was haivng alot of deep pain in my hip and down the side of my thigh also. This was 2 months ago. Since than the pain has been constant. I called my PT and went to see him right away after the fall, i explained what happened, and the pain i was having. He said it was a good thing i was there, he started the appointment,  but didn't change his exercises he did on me, nor did he give me any different exercises than when I started PT for my piriformis syndrome, he also continued to dry needle the same areas. I continued to see him for 4 weeks, twice a week, but I was getting very frustrated because the pain was not getting better, and he didn't seem to be doing anything different or have any new suggestions. I would ask him at every appt if there was something different i could be doing, and he alwyas said no what your doing should help. I started searching the Interne trying to fix myself, t and started reading about your SI joint and was convinced that was what was causing me all this pain. I asked him about it at my next PT appointment, he said, yeah that could totally be what's going on, and that was it, didnt say anything else about it. Didn't change anything yet again. I even asked him if there was anything I could do for this, and he told me I was already doing exercises for SI joint pain. I was doing a lot of stretches for pifiormis, and he was doing the same modalities/stretches. After that visit, I decided I was done with him. I called my doctor who refered me to PT and asked him if it could be my SI and he said maybe but he wanted to see me. So I went in and saw him, he did a quick assessment and said it does sound like it is my SI all of the pain in was descriping sounds like SI. He recommended I get an injection into my SI and that should fix it. I got my first injection 4 weeks ago, it seemed to help that first day, and then slightly help over the next 2 weeks, but didn't get rid of the pain completely. At the 3 week mark, I called him back beacuase the pain was back like normal. He said he wanted to do another injection. I had the second injection 6 days ago. The first 2 hours after the injection it felt good, at the 2 hour mark the pain came back and has been horrible since worse than it was before.

I dont know know what to do from here. I feel like doing 15 sessions of PT was a waste of time, I feel like the therpist didnt actaully listen to me, or asses me correctly. I dont think i got anywhere doing the PT. I also don't think the injections really worked cause I am in so much pain now. I know they say it can take a week for the steroid to set in, but I don't have much hope for that.

My questions i have are;

1. Could the PT I did, focusing on my piriformis, have made my SI hypermobile, and continuing the stretched for 3 months just made everything worse?

2. How can you tell if your SI is hypermobile or hypomobile? Sometimes it feels like I have a knife stabbing me right over top of the SI, but sometimes it it just this deep dull pain and it feels so good to stretch it out. The pain is also on my hip and goes down the side of my thigh into my knee. The pain seems to change, and it moves around. Sitting for long periods of time is horrible and I wake up at 4am in pain no matter what position I try to lay in hurts. Walking doesn't hurt, if anything that's the only time it doesn't seem to hurt. If i could tell what is causing my pain, i could do the correct exersices. 

3. What should i do next to get some relief? This is slowly taking my life over, and i am in contstant pain. any tips on how to releive this pain? I al so afraid to continue the strechtec/exersices ive been doing in case i am making it worse. I just dont know what exersices to do.

I really appreciate you reading this, and giving me any insight you can. I am just lost. 

Thank you!!!
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Comments

  • 1. Could the PT I did, focusing on my piriformis, have made my SI hypermobile, and continuing the stretched for 3 months just made everything worse?

    Unlikely unless they were already compromised or you had Ehlers Danos (sp?).  Those ligaments are EXTREMELY strong.

    2. How can you tell if your SI is hypermobile or hypomobile? Sometimes it feels like I have a knife stabbing me right over top of the SI, but sometimes it it just this deep dull pain and it feels so good to stretch it out. The pain is also on my hip and goes down the side of my thigh into my knee. The pain seems to change, and it moves around. Sitting for long periods of time is horrible and I wake up at 4am in pain no matter what position I try to lay in hurts. Walking doesn't hurt, if anything that's the only time it doesn't seem to hurt. If i could tell what is causing my pain, i could do the correct exersices. 

    I had the same question and still do.  A good manual therapist/chiro/osteo who has worked on a lot of SI joints can sense if you are hypo or hyper mobile, to a certain degree.  A surgeon told me that manual therapists CANNOT tell, but I had the sense he was very much a hammer looking to treat every problem as a nail, if you catch my drift.  Have you had your alignment checked?  Is the joint going out of alignment frequently?  Many times people who have gross instability will also feel unstable.


    3. What should i do next to get some relief? This is slowly taking my life over, and i am in contstant pain. any tips on how to releive this pain? I al so afraid to continue the strechtec/exersices ive been doing in case i am making it worse. I just dont know what exersices to do.

    I am in a similar boat.  I try to stay away from anything that kicks up the pain.  I think anything in which I am not loading the joint too much and which does not kick up pain is ok.  Mine is strange.  I think it is a tendonopathy or ligament issue as my pain is very much near the surface and super sensitive to pressure.  I do a lot of supine core work.  I also get a lot of pain with hip extension and lumbar extension.  Same with laying on either side, evn with a pillow between the legs.  Sitting is awful, standing is not much better.  It sucks and is pretty limiting.  I think lots of people with this say that walking actually feels ok.  For me, it is hit or miss.  I find exercises that I can do, along with ice and estim reduce the pain.   
  • emorganeemorgan Canton, MichiganPosts: 2
    Hi--I'm new to this forum, but after reading some of the discussions, feel quite at home!  Re: hypermobility, it is something that all of your joints have, not just one.  I'm hyper mobile, and I meet all 7 criteria (thumb back to wrist, hyperextended elbows, knees that lock further back, and I can touch the floor with my palms flat on the floor with no warm up).  My PT says my SI joint, my L4-L5 joint, and my weak hip flexors all combine to make my life miserable.  I would start on that slippery slope of narcotics.  I'd also go to a pain specialist.  I've been going there for a year, and he's given me every type of injection, and follows up.  I'm also seeing a physiatrist, who has recommended me to an awesome PT.  He really listens.  And a spine surgeon didn't want to fuse my L4-L5 because I'm hyper mobile, and the stress from L4-L5 inflexibility would shift stress to L3...and so I'd need another fusion for that...and so on.  

    I'd see a pain specialist.  It was the best thing I did. And then see a physiatrist.  Good luck.
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