SI joint dysfunction - just walking, really?

June 11, 2018 1:30 PM

I had an acute bout of sacroiliac joint pain earlier this month including sciatica, foot numbness, and excruciating pain in my lower spine which was previously incorrectly diagnosed. I had a successful steroid injection in my SI joint in February which seems to be holding for the most part. Now the physical therapist says that all I can do for exercise is walking, and not on a treadmill - and no lifting weights. Is this really it?

This PT said no stretching, no carrying anything over 10 pounds, and that therapy manipulations won't do anything for me. The latter part I'm happy about as it's cheaper, but I'm frustrated about not being able to go to the gym. Internet sources say no cycling, no crunches or sit-ups, and no weight lifting (or golf or football, but I'm safe there).

Have you had this? Were you able to do anything besides walking outdoors? Walking just isn't cutting it for the other benefits I'm looking for, some level of higher aerobic activity and muscle tone specifically.

If it matters, I'm female, early 40s, BMI on the low end of "normal", and other than this in excellent health and prior to this quite fit in recent years. On that note- I do notice that the pain is more likely to come back slightly in the week before my period as apparently the joints loosen up due to hormones. I will happily skip those weeks if there's anything else I can get away with.

posted by mireille to Health & Fitness (11 answers total)

My sacroiliitis is caused by ankylosing spondylitis, and exercise is the best thing for it (well that and fancy drugs). Have you been screened for AS? If that quiz is making sense, I would consult a rheumatologist.
posted by hydropsyche at 1:39 PM on June 11, 2018

(footnote: doctors who were trained awhile ago were taught that only men get AS, and so many doctors don't even screen women for it even though we have it and related conditions at similar rates to men.)
posted by hydropsyche at 1:40 PM on June 11, 2018

Response by poster: Thanks for that - I took the quiz and result was 2 (unlikely). I'm sorry to hear that, I hope you're able to manage your symptoms and have minimal pain!
posted by mireille at 1:45 PM on June 11, 2018 [1 favorite]

I don't know if it will be OK but I would ask about swimming. It's generally a go-to for any "gentle on joints" stuff, but of course it will depend on your specific problems. And it definitely gets you to aerobic fitness and muscle tone.
posted by brainmouse at 1:56 PM on June 11, 2018 [1 favorite]

Best answer: I've got SI issues too, though not as severe, and got the same answer from my doc. It's been really frustrating! I did notice that sitting exacerbates it (or really anything that bends the joint) and got a standing desk for work - it's helped a lot. Once it started getting a little better, I was able to incorporate yoga to start strengthening the hips and glutes. But I'm still not 100% and back to regular workouts.
Sorry to not have a better answer, the patience has been the hardest part.
posted by PaulaSchultz at 3:09 PM on June 11, 2018

Best answer: I had a sudden sciatica event while traveling that left me unable to stand, with excruciating pain in the left side of my leg requiring steroids and muscle relaxants. I was determined not to stay on the medication, so here's what worked for me:

Walking in clogs. Walks for at least forty-five minutes each day. Not wearing clothing that constricts at the waist. Turn on the heating element in my car seat while commuting to improve blood flow. Lots of leg lifts to the side, front and back to build up the core muscles and blood flow in my legs and pelvis--I use a pole to steady myself for these exercises, and they help tremendously, more than the walking actually. Do the exercises at least forty minutes each day. Put a fan on my legs if I am sitting for a while to drive the blood back up into my body.

It took a couple of years for the sciatica to go away, but it finally did. It now only rears its ugly head if I have been sitting in a car wearing tight panty hose or stuck in meetings all day, and let me tell you it gets me right back to the leg lifts. I hope some of this works for you. Good luck.
posted by effluvia at 3:23 PM on June 11, 2018

Best answer: I’d get a second opinion from another physiotherapist, one who works with athletes vs a sedentary population (although the no lifting injunction seems reasonable). Also check out Stuart McGill’s books and website, he’s a biomechanics expert specializing in back conditions. He has one for people interested in returning to sport, as well as a more general book, which covers many orthopaedic conditions affecting the back (includes tests and suggested exercises - you could bring it to your PT).

Re muscle strength and mass - I’m no expert, but you could explore body weight movements using time under tension as a mechanism of growth. (Google that phrase for more - just means going slowly.) It’s not as efficient or effective as adding weight, but it would increase the challenge to your muscles somewhat. Would check specific exercises with your/a PT.
posted by cotton dress sock at 4:17 PM on June 11, 2018 [3 favorites]

Best answer: What was the diagnosis? Are there demonstrable mechanical problems with the area in question? Have you been in pain since the steroid injection? I am not a doctor, just a guy who studied pain science for a few years. Unless there is demonstrable mechanical damage and you're in pain, more movement is usually better than less. In that vein I'd try to find a PT who understands modern pain science for a 2nd opinion instead of listening to internet guy, not that they're necessarily easy to find.

I'll note that if you poke around askme for similar questions - where there is person with a pain issue who is looking for people who got out of similar pain states, where there isn't an obvious mechanical problem like spinal stenosis, broken bones, etc - the people who got out of pain have stories like effluvia's a few comments up. There is almost always a) a strong desire to get out of pain and b) an experimental process where the person in pain has a back-and-forth with their body about finding movements and activities that work for them. It's not the people who sit on their couch.
posted by MillMan at 8:18 PM on June 11, 2018 [1 favorite]

For me, my doctor said swimming was fine, as long as I only did kicking where my legs moved toward the front/back, never to the side. I also find water walking/jogging to be decent exercise.

I have managed to sort of do what effluvia described and can even now do some dance classes, but I have to modify a LOT so I always tell the instructor in advance. And this is YEARS of living with pain.
posted by freezer cake at 2:37 PM on June 12, 2018

Also, if you are near Reno, NV, memail me for a doctor rec.
posted by freezer cake at 2:40 PM on June 12, 2018

Response by poster: Thanks for all of the replies. MillMan - the diagnosis was determined because the steroid injection worked, apparently that's a secondary purpose of the injection (if the initial freezing works then it generally confirms that the SI joint is the source of inflammation). I'll keep at the walking (swimming is out, unfortunately) and will check out a second PT. This PT was at a facility with a sports doctor who saw me when I was in silent tears and was struggling to walk at a PT visit and pulled me aside as a fun case for her practicum student and luckily for me found the solution that made it possible to function again - but I'm not sure if sports was this PT's area specifically.

Other than that... patience it will have to be. Thanks again everyone!
posted by mireille at 3:39 PM on June 12, 2018