Hi. So today we're going to do a deadlift. And so this exercise is great and I really like it because it strengthens globally and it strengthens our lower back and it helps elongate the hamstrings and just helps us getting better movement globally in a functional chain. So this is what it looks like.

What we're going to do is have our hands shoulder width apart, just making sure that they're going straight down. We're hinging through our hips here. And you're not going down like a squat, but moving your hips backwards, making sure that your shoulder is nice and set, your back is straight. From here come up, hinge again at your hips and then slowly coming straight down.

And you can do this exercise, three to four sets of 10, if you're able to. If you're going at a higher weight, come down with the reps in a little bit. So about eight to 10 reps, three to four sets.

Start with nice tall posture and engage your core muscles below the belly button by drawing the lower ab muscles inward toward the spine. Then, stand on one leg and hold a stick with the butt end about 2 and a half feet away.

Bend down through the hips to touch the stick to the floor at the 9 O’Clock position like a grid on a clock. Come back up and then bend down to touch the end of the stick at the 10 O’Clock position. Repeat this until you get to the 3 O’Clock position and then reverse coming back to the 9 O’Clock position again to complete the full set.

When doing this exercise keep your knee aligned with your second toe, over your ankle and bring butt back like you are going to sit in a chair. Do 2 full sets 2 times a day on each side.

This is great exercise for developing core stability strength, balance, and control in your Sacro Iliac joint after it’s been injured. 

Place a ball underneath you between your hands. This will be the centre position for the ball as you will be moving it out to one of four positions each time and back to centre again.

Begin in a plank position and engage your lower core by trying to make yourself skinnier below your belly button at your waist line. Supporting yourself in a plank with your right side, move the ball from centre to up above, then back to centre, then from centre out to the left and then back to centre, and then from centre to below and then back to centre again.

Finally from centre out to the far right and back to centre again. Switch and plank on the left side now and move the ball with your right hand. Do 10 reps on each side daily.

You can utilize this exercise for many different sports and activities that require strong core stability for you sacro iliac joint such as baseball, volley ball, rock climbing or ultimate frisbee. 

Start in 4 point position on your hands and the forefoot or the balls of your feet with your knees greater than 90 degrees. As you place one hand forward bring your opposite foot forward as well.

Do this while you also keep the shoulder blade muscles and the core stability muscles in your low back engaged and your mid back position in neutral. Repeat this for 45 seconds 3 sets daily. 

This is a great exercise to strengthen the core stability muscles for your sacroiliac joint after straining or injuring it. 

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto, Insync Physio. He's the head boss, the boss man, the clinical director of the Vancouver office. And we're going to talk about lower back injury of the SI joint. How are you doing Wil? 

Wil: I'm doing good. Thanks Mark. 

Mark: So what kind of symptoms would somebody have when they've got that, that kind of pain right along that big bone along the bottom part of your back? 

Wil: We just had a couple of people that came in with SI joint injuries earlier this week. And it's interesting specifically, the kind of pain almost mimics, like you know, very similar other types of lower back pain. It could just appear like a lower back issue. 

So when I say lower back, it's basically, you have five vertebrae that make up your lumbar spine, basically and so in that area. When we get more specific about the SI joint or the sacred iliac joint, you know, it's basically where the, so the tailbone or the sacrum, which is a triangular shaped bone, which is basically the base that connects from the fifth vertebrae of the lumbar back to basically the sacrum and that's the L5 S1. And then that sacrum connects on to what's called the innominate or the iliac bones. And you have one on the left and one on the right. And so essentially your sacro iliac joint is combination their sacrum and your iliac bone, which makes up your pelvis, which makes it part of your lower back.

And so the symptoms are very, very similar. Like I was saying to the lower back where sometimes people point like to a specific pain, kind of just like on that sort of one side. You know be very pinpoint specific and it'll hurt, depending on how it's strained it can be painful, whether, you know, extending backwards or forwards. 

And also your typical functional movements, like just trying to put on your sock or shoe. And quite often people would complain, like it just feels like it's off or stuck kind of feeling. So the other thing too, you want to look out for, sometimes it can also cause some referring pain into like your groin and then even down a little bit into the thigh area. But it shouldn't go all the way down the leg or down to the toes or anything like that. So there's that referral pain. And that's also very common. And it's usually very mechanical. 

Mark: So what are the possible causes of this? 

Wil: Yeah, so there's different ways really looking at like how this can actually come about. But I'll give you an example of one that's very stereotypical, like an ex athlete. She used to play field hockey, competitive field player for a national team. And she basically didn't have any real major back injuries, but tweaked her lower back, you know what she thought was her lower back a few times when she used to play field hockey.

And this is like now, like a decade later after her field hockey days. And she still rides the bike a lot and developed all these imbalances now because with her cycling and then she likes to do a lot of running and a little bit of gym stuff weight lifting, but she does no recovery stuff.

And so essentially she's developed a lot of imbalance and you add that was a previous, maybe she might have you know, all that bending forward playing field hockey, you know, there could have been some kind of strain and maybe some trauma. So my guess is that she had some kind of pain and then she healed from that. And now she presents with this like sacral iliac joint issue where it's just not moving properly. 

And so just to kind of go back, her symptoms were basically, you know, she just felt like it was stuck and it was painful to bend all the way forward. And so what it presented as it was just rotated forward a little bit more and because it was rotated a little bit more forward, she didn't have that full range.

Her hips are really tight and she had a lot of imbalances, a lot of weakness in her core. Her one legged squat was really poor on that side versus the other side. And she didn't realize how weak she was on that left side. So those are the really common things that were going on with her in terms of symptoms and how it was presented.

Other ways that it can really happen, like in terms of getting this injury is that you can also like pregnancy, postpartum. Anything that stretches at the ligaments. So like I said, trauma. And then even just like sitting, if you have a job where you're sitting all day long and then you commute or you bike or whatever, you get really tight. 

So that's still trauma, but a different kind of trauma. It's a repetitive strain where things slowly start to creep. So yeah, trauma's pretty much the number one thing with that. 

Mark: So when you're diagnosing it, what's the process that you go through?

Wil: Yeah. So there really is a series of and really what helps us confirm it, gives us the validity and reliability for being able to say, yeah, this is sacral iliac joint related. These are sort of like gold standard things. So when you look at these different tests and if you have, you know, at least three out of five of them, and then you kind of look at the whole clinical presentation, You know, then you can say that this is what it is. But ultimately when you look at it that the joint isn't moving well, and you have certain of these tests are positive, then yeah that's what usually indicates it. 

And you take into consideration, you know, what they can and cannot do because sometimes it can also mask as you know, you got to rule out, okay, is this like a lower back issue? Is this a disc issue? Or is this you know, something else going on in the pelvis?

Mark: So what's your typical forms of treatment and what's the kind of recovery time? 

Wil: Well so with this individual, it was probably some trauma from her old field hockey days. And she's developed all this muscle imbalance. So basically we did some manual therapy and adjustment on her left SI joint to get it moving.

And it actually was like night and day. She had full range, no pain. Her one leg balance in her one leg squat was like basically from like a one out of three, falling all over the place, you know. Basically no balance whatsoever. To being able to do good squats and balance was perfect. Almost perfect.

But then the fatigue factor was still there. She had all this muscle compensation. So then we had to work on doing a lot of soft tissue stuff as well. And so that's the first session. And then really then it's process of building that back up in terms of the core stability strength, and really looking at the mobility, making sure that it stays mobile.

So if that's not an acute segment, then it can very well take you know, as long as you know, she wants to get back into doing more sports again. You know, a full like four to six weeks to really get that motor pattern changed and really help her get those muscles firing around that hip and that SI joint and even the core and lower back.

So initially yeah, it worked really well, and it's working really well. And like I said, after one session, but it's that ongoing process of being able to keep everything moving, reinforcing that mobility and firing those motor patterns, firing those muscles that recruit the stability in that area. And that can take anywhere from a good several weeks to a good several months of, you know, if it keeps going sort of in a fixated position. 

Mark: So, and some of that's determined by how much work they're willing, or the client is willing to put in because you give them a recovery process that they have homework, basically. 

Wil: That and how much they punish their body with just going back to playing sport because she wants to go back and play some more soccer and, you know, she gets trauma on there again, then that resets everything. And so you have all that muscle atrophy, so you need to really work on strengthening and getting that bigger again and that core strong. So that takes several months, honestly. But it doesn't mean that you can't go back to be being able to play sports, but it's a gradual process. So that's the thing. 

Mark: So if you've got an injury of any kind, especially lower back, but anywhere in your body, you want experts looking after you, call Insync Physio. You can book online at insyncphysio.com for both locations. They have a North Burnaby location, that number 604-298-4878. Or in Vancouver, 604-566-9716. Get some help. Get feeling better. Thanks Wil.

Wil: You bet.

Having great functional mobility in your hips means also having great mobility in your middle and lower back rotation. Being able to move through your whole spine will greatly help the full functional rehab of your hip injury.

Start by lunging forward with your one foot and twist your body in the same direction while reaching straight up above your head with the same arm and hand. Keep your low back in neutral position and your inner core muscles below the belly button pulled in and engaged.

When you lunge forward make sure your knee stays over your ankle and aligned with your second toe, hip and shoulder and that the low back doesn’t arch. Avoid having your knee fall into the mid line of your body or going past the front of your toes. Push back up to the start with the front forward foot while unwinding the back and bringing the arm back down. Repeat this for 10 repetitions doing 3 sets for each side.

If you’re unsure about the exercise or have uncertainty about where you’re at with your hip injury, consult your local Physiotherapist before continuing. 

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio in Vancouver, and they also have an office in Burnaby, BC, Canada. Multi award winning best physiotherapists in both locations, multi award-winning best physiotherapist in each location. And of course, today, we're going to talk about hip interior hip pain. What's interior hip pain?

Wil: Yeah. So anterior hip pain, which is pain in the front of the hip. And this is actually a quite common syndrome and dysfunction in the hip. So basically there's many causes of it. When we look at some of that comes in to the clinic that it has anterior, which is a hip pain, it can be caused by like bursitis. So bursitis is basically when you have an inflammation of the bursa SAC in the front of the hip. 

And then another common cause of that, it can be basically an overuse thing in the hip flexors of the hip. So that's more commonly called a hip flexor tendinopathy. So tendinopathy being that it's been more of a kind of a long-term thing. And so those are the two most common causes of hip pain that we see from, especially people who are really active in sports. You know, we treat a lot of sports injuries at our clinic and people were just generally active like hikers, bikers and doing a lot of field sports. 

So the other part of you know, aspect of anterior hip pain that doesn't really get looked at too much is it's something that's kind of more related to the bone and the structure of it. And so the terminology of this is called an FAI, which is femoroacetabular impingement. So basically what that is is there's a bony anomaly happening there, in one of the two bones causing impingement in that joint. And there's specific limitations associated with that on a clinical level when you assess it.

But all in all, when you either look at whether it's an FAI or if it's like a bursitis, overuse tendinopathy or even something that's more wear and tear where it could be a bit arthritic. There's usually a lot of imbalances in terms of the muscle structure around the hip. So a lot of weaknesses and a lot of stuff that's just too tight and not allowing the actual hip joint to basically move properly and optimally. 

Mark: So how do you diagnose that? 

Wil: Well, so with the bony part of it is, you know, like it's, through specific ranges and limitation, but you ultimately need to have some scans and imaging done, and that's usually not related to trauma. So it can develop sort of when you're growing in the bones and in terms of how the structure of the bone start to then get maybe a little bit thicker in certain parts of the femur or the pelvis. And then so when you look at other injuries like, so I'll give you an example. 

I had a woman that came into our clinic who went on a five day hike at the West Coast Trail. And she's also a rock climber too. So she does a lot of like, you know sort of fluxion movements where their hips and then she bikes a lot. So anyway, she went on this five day hike and then two days into it she started getting anterior hip pain. And so it's funny because she was attributing that specifically to the hike, but knowing her and the fact that she was so active. You know, this was all set up to happen before. And the other interesting thing is that as I was assessing her, I realized that she had other stuff going on too.

So it wasn't just like in her hip joint that she was having all these imbalances, but her sacroiliac joint, which is basically an adjacent joint to the hip, was really, really stiff. And you know, just in digging a little bit more about her history, she had like a snowboarding accident many, many years ago and just landed on her bum and she couldn't walk for a couple of days. And it was one of these things that she didn't even really think anything of, but I was just like probing about, have you actually injured that hip or anything like that before? Oh yeah, now that I think about it. Yeah, I used to snowboard and I had fell on it really hard once and I couldn't walk for a day or two and then she was fine. 

It turns out that after I worked on mobilizing that sacroiliac joint, that hip area adjacent to the actual hip you know, her limitation and her hip pain was completely gone. But what still remained though, was a lot of the weakness and a lot of the tightnesses in her hip flexors. So she's been having this sort of a issue with this adjacent hip proper issue with the sacroiliac joint. That then I think started building up with all these imbalances and she's very active to begin with, but a lot of her activities involve hip flection and her hip flexor muscles, even after mobilizing and getting that sacroiliac joint moving was so tight that she didn't even have neutral range into hip extension. And that was actually one of her biggest things that she was complaining about too, is that hip extension was painful, but hip flection was painful too, but after we mobilized it, you know, her movement wasn't painful anymore, but she was just stiff.

So basically what we had to do then after mobilizing the areas that were stiff, we had to actually start to loosen those muscles around there that were also really tight and binding. Because what happens and then it just causes this sort of vice grip in the joint still. And like you're still not getting optimal movement in actual hip joint.

And then as a result, because she's always used to those muscles being tight and other muscles were just super, one specifically like interior iliocapsularis, which is a muscle in the front of the hip. And then her gluteus medius, which is basically the butt muscles. And gave her some exercises start off with, but she was like, miraculously got off the table, I can walk after one session. But it doesn't end there because then the muscle imbalances need to be addressed. 

Mark: What's a typical course of treatment? How long has it take in a more normal situation to get more pain-free? 

Wil: Yeah, so anywhere between you know, depending on the kind of injury, if it's an acute injury, it can take a little longer anywhere between like four to six weeks. If it's like an acute strain in the hip flexor or maybe longer. If it's a bursitis, those things can settle down pretty quickly, but then it's really now addressing the imbalances. Because the thing is like with this client, she wants to get back to doing all of her sports and her activities. And, you know, they're at a recreational level, but she's operating not at an optimal way of moving her hip and she has to relearn how to use those muscles. And so our job is to help facilitate that and make sure that the range of motion in the adjacent segments and the joints are actually moving properly, continuing to move properly and to basically reinforce that optimal movement pattern.

Mark: Cool. You mentioned, like you had a second client who was having this kind of interior hip pain. Yeah. 

Wil: Anterior hip it. Yeah. So this person, we actually suspect that might have a little bit more of what I mentioned earlier, FAI, femoroacetabular impingement syndrome. He had no trauma. I mean, no trauma that he can recall. And he's young, like 30, I think he's 30 something, really active guy really fit, likes to ski, but like pretty adamant, no trauma, he's always been really careful and stuff. Just serve development with chronic hip pain and also I think part of his history, like he hasn't been really good at stretching and working on recovery and stuff like that.

But the thing is, as I started to test him, he had all the symptoms and all the clinical signs of femoroacetabular impingement and those ranges and those loss of ranges and the weaknesses too.  I think that's one of the biggest thing is that he developed this imbalance and so we want to try and work on fixing that. Ultimately I kinda told him, like we think it's this, we can only really know, like if we get some imaging, but that's really up to you. You haven't had any trauma.

And so he has been in a few sessions to see us and it's interesting because when he works on his exercises, he gets really good. He's pretty consistent, but then he goes in bouts where he'll go hard on mountain biking, he'll be a bit more sore for a few days. So it's really interesting, like how the muscle imbalance does play a really big factor, but then at the same time, you know, if it continues on and it's ongoing, then you want to address that a little bit more.

And one of the things that we did was we did some things to actually address the limitation of the actual hip joint proper. That actually helped a little bit, but it was obviously, if it's going to be something more structural and bone, then that's not going to really be a solution because it's going to keep pinching in on the cartilage and then causing a continued stress and strain and aggravation.

 If that's the case, then that'd be where I'd be wanting to refer them back to the family doctor and saying, yeah, let's get some imaging done. And let's just see. I know you haven't had any trauma and I know you're operating at a high level of like your sports and activities, but if you want more information and data on what's going on, then let's take a closer look at this.

Mark: Yes. Taking care of it sooner rather than later, if it's something like you don't want, like a cyst growing or arthritis, et cetera, whatever they possibly can do. 

Wil: Yeah exactly when it persists like that, and it just doesn't seem to get fully better. 

So, if you want some help with your hip pain, anterior, posterior, medial, I don't care where it is the guys to see are Insync Physio in Vancouver. You can reach them in Vancouver at 604-566-9716. Or you can book online@insyncphysio.com. They also have a Burnaby office. You can reach them at 604-298-4878. Same story. You can book online insyncphysio.com. Thanks a lot Wil. 

Thanks Mark.

Here’s a simple but effective exercise that can help with improving the rotation mobility in your spine in order to help with your sacro-iliac joint and pelvic injury rehabilitation.

Sit down on a chair with your feet flat on the floor & check your left and right arms into abduction like you’re making the letter “T”. Then check your hip and butt anchored to the chair with your hands.

Sitting with your legs wide and arms straight reach your hand down the inside of the leg to the ankle and reach your opposite hand up to the ceiling trying to create the letter “T” with your arms while your butt is anchored to the chair. Hold this position for 30 seconds doing 3 sets on each side 2x/day.

This is a great mobility exercise to do for the spine as a warm up and a warm down or for recoveries after you finished playing or training.

Do you have hip pain or stiffness? Do you play any running, cutting or lunging type of sports? If yes, then this might be a great exercise to help you improve your hip mobility.

Start by sitting down with the soles of your feet together drawing your heels as close to your body as possible. Make sure your lower back is nice and straight. Hold on to your ankles and feet with both hands and bend forward with your hips keeping the low back straight and push the knees to the floor with your elbows. Hold this for 30 seconds doing 3 sets 2x/day.

If you have pain that doesn’t feel like a stretch, or are unsure about what you’re doing consult a local physiotherapist before continuing. 

This exercise targets the activation of your gluteus medius muscles of your pelvis and hip. Have the back of your ankle and heel pushing back on the front low side of a big ball against the wall. In side lying, make sure that your torso is not too far back or bent too much forward to avoid your hip being in a flexed position.

With your spine and hip in neutral position push the back of your ankle and heel up to the top part of the ball maintaining contact on the ball the entire time.

A few key things to look for is to keep the toes pointing forward and towards your own nose so that you’re not rotating the hip and the toes upwards while you push the ball upwards. Bring the ball back down and repeat this 10 times for 3 sets on each side.

This is a great exercise to build more strength in your pelvis after a sacro-iliac joint injury. If you have any pain and problems with this exercise or are unsure about what you’re doing consult your local Physiotherapist before continuing.