The SIJ is the joint between the lower segments of the spine, the sacrum, and the illium bone of the pelvis. The SIJ is given structural support by strong ligaments and muscular support gives the SIJ some degree of dynamic stability. Movements of the SIJ are subtle and can be confusing; however the main movements which occur at this joint are nutation and counter-nutation. Basically speaking, nutation refers to the top end of the sacrum tilting forward relative to the Illium and counter-nutation refers to the top end of the sacrum tilting backwards relative to the Illium.
What is Pelvic Instability?
Pelvic instability refers to uncontrolled counter-nutation of the SIJ. This puts direct stretch on the long dorsal ligament which is highly innervated with nerves and can cause pain often felt in the buttock and down the leg. The combined actions of several muscles are critical to achieve stability of the SIJ, including trasverse abdominus, multifidus, pelvic floor muscles, the gluteal muscles, latissimus dorsi, obliques and erector spinae. Weakness or poor neuromuscular recruitment of these muscles can cause sustained counter-nutation of the sacrum, increasing the risk of SIJ irritation.
Treating Pelvic Instability and SIJ Pain
Assessment to determine which muscles are deficient in stabilising the pelvis is critical for the treatment of SIJ pain. For acute SIJ pain, any exercise or movement which brings the sacrum into nutation should reduce pain. This includes SIJ mobilisations, stretching the hamstrings to inhibit them from pulling the sacrum into counter-nutation, taping across the SIJ or into nutation as well as traction in line of the SIJ to reduce stretch on the long dorsal ligament. Initially to achieve further pelvic stability, exercises to improve the strength and control of transverse abdominus are key. To then achieve dynamic control of the pelvis, strengthening the other muscles which stabilise the pelvis (Most commonly gluteus maximus and latissimus dorsi) is required.
Written By Jack Hickey Exercise Physiologist at MD Health Pilates
This week in Workout Wednesday Jack and Mark demonstrate basic shoulder exercises to strengthen the stabilizing and postural muscles around the shoulder blades.
Conservative management for people with shoulder impingement normally includes exercise therapy to strengthen the rotator cuff muscles as well as scapular stabilising muscles. Research has shown that exercise therapy can be just as effective as surgical intervention for the reduction of shoulder pain in people with shoulder impingement. The goal of exercise therapy is to increase the strength, endurance and/or muscular hypertrophy of the scapula stabilising and rotator cuff muscles. Control and progression of exercise variables including intensity, duration, frequency and load are crucial to achieve this. However, most clinical research studies in exercise for shoulder impingement vary widely in their prescription of exercise and do not closely control these exercise variables. Method: A recent research study looked at the benefits of a closely controlled progressive resistance training program for people diagnosed with sub-acromial shoulder impingement. Participants in this study were assigned to either a progressive resistance training (PRT) group or a control group which performed no exercise. Participants in the PRT group participated in exercise therapy to strengthen the muscles around the shoulder twice per week for 2 months. The exercise variables in this study were closely monitored and progressed over the 2 months to optimise increases in muscle hypertrophy, strength and endurance.
– This extract was taken from Monday’s blog article ‘Progressive Resistance Training for Shoulder Impingement’ by Jack Hickey. Read it here: http://www.mdhealth.com.au/progressive-resistance-training-for-shoulder-impingement/
The shoulder complex is made up of the gleno-humeral (GH), acromio-clavicular (AC) and sterno-clavicular (SC) joints as well as the articulation between the scapula and the thorax. The GH is enclosed by a loose and shallow joint capsule which promotes a large range of movement at the cost of less joint stability. This lack of static joint stability means that the shoulder complex relies heavily on the rotator cuff muscles for dynamic joint stability as well as control of scapula-thoracic rhythm for optimal shoulder biomechanics and range of movement.
What is the Sub-Acromial Space?
The sub-acromial space refers to the space underneath the acromion of the scapula and the head of the humerus. The tendons of the supraspinatus and long head of biceps muscle pass through this joint space as well as the sub-acromial bursa.
What is Sub-Acromial Shoulder Impingement?
Sub-acromial shoulder impingement refers to the tendons of either or both of supraspinatus and long head of biceps getting compressed in the sub-acromial space. This compression causes irritation of the tendons and the sub-acromial bursa, causing inflammation and a reduction in the sub-acromial space, resulting in further shoulder impingement. This impingement usually occurs with overhead movements of the arm, resulting in pain around the tip of the shoulder and down the upper arm.
What Causes Sub-Acromial Shoulder Impingement?
Sub-acromial shoulder impingement can be caused by any one of the following factors including rotator cuff tears, GH joint instability, poor scapula-humeral rhythm, tight posterior shoulder capsule, AC joint or labral injuries, bone spurs and deficits in GH joint external rotation. These factors in isolation or in combination with each other cause a reduction in the sub-acromial space resulting in sub-acromial shoulder impingement.
Assessment and Treatment of Sub-Acromial Shoulder impingement
People with sub-acromial shoulder impingement will usually present with a positive “empty can” test. However it is important to differentiate between sub-acromial impingement and supraspinatus tears by then performing the empty can test with shoulder distraction. With distraction in the empty can test, pain should be reduced with sub-acromial impingement as the sub-acromial space is increased where as a supraspinatus tear will remain just as painful. It is crucial when assessing the shoulder to determine the cause of the reduction in the sub-acromial space leading to shoulder impingement. Once these factors have been determined, rehabilitation should focus on correcting any mechanical deficiencies that may be contributing to sub-acromial impingement such as poor scapula-humeral rhythm of lack of rotator cuff control.
MD Health Clinical Pilates – Workout Wednesday – ITB Release on Roller
In today’s workout Wednesday video, Exercise Physiologist Jack Hickey, goes through how to perform an ITB release using a foam roller. This is great particularly for knee pain due to patella-femoral knee pain. ITB release can also be important for some hip pathologies