Complaint
I have a backache. This is manifested by a soreness in the sacroiliac joints (the two nubs on either cheek, near the top, on each side of the spine), and increasing soreness up into the midback along the spine, along with sharp pains when moving between positions (i.e. sitting to standing, standing to sitting, lying down, and sometimes just turning towards something) and also when standing for long periods of time (i.e. at midnight mass, at a museum exhibit or a New Year's party). Heels are definitely uncomfortable.
Response
This is what I understand from one analysis session and two follow-up appointments:
The pain is caused by a looseness in the sacroiliac ligament, primarily on the left side. This ligament, unlike many others, doesn't have a corresponding muscle, so there is pretty much nothing to be done about it. It can't be 'tightened back up'. This ligament is in the posterior of the body and its loose state permits more than normal motion to occur between each ilium (the ilia are broad bones that form the upper part of the hips) and the sacrum (large triangular bone at the base of the spine, the bottom of which connects with the coccyx). This extra lumbar motion translates to extra spinal motion which causes aching further up the spine.
Core control will help to prevent the excess motion. It is not additional strength that is needed, but control. Of secondary importance is endurance.
History
Q. Why did it happen now? Did something trigger it? Was it loose originally or did it become loose as a result of poor core control? A. Unknown
Sensation
Q. What exactly is causing the SI discomfort? A. The excessive motion against the sheath is irritating, much like bending a finger backward, towards the top of the hand, against resistance.
Q. What is the 'smooshiness' described earlier, when there was little resistance upon pressure being applied at the hip? A. This is due to the looseness of the sheath of the join, it fails to offer a normal amount of resistance.
Q. What causes the spinal discomfort further up? I realize it is the additional motion, but what is happening to the parts of the spine? A. Overactive lumbar muscles trying to stabilize the spine. Without the help of the abs, they are overworked, overfiring and eventually, overtired.
Future approach
Why is it only abdominal control we are seeking (and only rectus, not transversus)? Do they comprise a huge percent of the core muscles and we are looking for large gains? Or is it because it is the lowest muscles in the band that we really want to control and there are no opposing muscles for the lowest abs?
Q. Is running simply a bad idea...or would it would be ok to pick up form from someone knowledgeable? A. It is ok to run, particularly if you take more and shorter steps per minute rather than long strides. Just working on ab usage is a great way to work on form.
Generally speaking, how to learn good biomechanics. How to teach to children, for example.
Exercises
In the exercises, want to achieve a posterior tilt by using the abs. Belly will be out, ‘pulling the belt buckle toward the chin’. There should be no assistance from the glutes or hams (the only other muscles that can do this). One way of assessing this is to avoid an increase in pressure from the feet to the floor.
Q. Why do I experience difficulty relaxing my neck when performing exercises? A. Even Chris gets some tension here. The idea is to continue to work to diminish the effort coming from other body parts, and this includes the neck.
Upper abs (intercostals too?) seem to be more sore. Assume it is ok since the goal is to engage the abs with as little help as possible from other muscle groups.
It is better to use the glutes and hams to start then ease them out of the helpful phase rather than achieve less pelvic tilt right off by trying to eliminate them altogether.
#4 - There should be no change in the pressure on the feet from a completely relaxed pose all the way through the exercises. Start in a rest, engage abs to cause a posterior tilt, then lift head/shoulders to compare the degree of flexation. Lift every 10 seconds. As of Jan 2: Do only three reps of 30 seconds with 15 second intervals. This is to remind yourself where the abs are before proceeding with other exercises.
#6 –. In this exercise, I want a posterior tilt but from the abs. Enough to bring a mild pressure on hands placed flat at the small of the back. There should be no change in the pressure on the feet or the small of the back, either side. Also make sure foot settles on floor before raising the other foot otherwise you’re basically executing a leg lift against which the pelvic tilt can not be maintained by the abs. Focus on the obliques here as well to keep the hips up and stationary (see oblique exercise below). Biggest issue at this point is maintaining that tilt. Be vigilant.
#18 – I am not performing this correctly; not feeling the stretch where indicated. The ‘hip pinch’, to be avoided, is about the only response I can achieve. Maybe there is another way to think about this one. This is due to not needing to stretch the glute. So don’t do it if you don’t need it. Also pull the knee up to the outside, more flush with the shoulder, not directly over the right/left breastbone.
#19 – Q. Why does lifting both legs cause back strain? This explanation likely applies to an understanding of why leg lifts are bad. Are situps also bad? A. No, situps are ok. Better to do them without pinning down the feet though. Leg lefts cause the back to arch because the abs aren’t doing the pulling as they should. According to Chris, only 1% of the population has the ab strength and control to perform these correctly. The hip flexors are big & strong and tend to do a lot of the work (also known as the ‘iliosopas’, a muscular conglomerate the thickness of a wrist?).
New Exercise for Obliques (15 each side?)(1) Lie on back and engage rectus abdominus to achieve a pelvic tilt. (I believe in addition to keeping the tilt, it's also important to keep the hips immobile while performing this exercise. In fully constricted position the hips should still be flat, no torquing should apply below the waist)
(2) Arm #1 flat out at about 45degrees from body.
(3) Arm #2 under head with lower arm perpendicular to the line of the body. This puts the arms roughly in parallel
(4) Energize obliques to bring the body on Arm #2 facing sideways.
(5) Keep in mind that obliques perform opposite function – to keep the hip from falling. Your symbol: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. Should be constricting from the lower oblique to the inner/upper oblique on the opposite side
(6) Relax relax relax, the arm, the neck
During the week and before/after each PT session, elliptical for 10”(1) Aim for a scissor kick rather than the round rolling action of an elliptical trainer
(2) Short strides
(3) Engage pelvic tilt throughout
(4) Clasp hands behind with straight arms to feel unwanted motion in the SI.
(5) Relax neck, shoulders, hands.
(6) KEEP PELVIC TILT
BridgingBridging requires that pelvic tilt too, however, it is achieved without the stomach coming out, that's not possible in this position.
Thumb on lower ribs, other four fingers together with middle finger on the hip bone. As the tilt occurs you should feel the finger and thumb distance close.
Can never truly get to a "flat bridge", because an arch inserts itself there. Come just short of that bridge.
The further the feet are from the butt, the less cramping will occur on the hamstrings. There is a property of muscles like the hamstrings that extend over more than one joint that causes them to cramp the more they constrict. (I believe that's what Chris said).
Use a mirror if you can't 'feel' the left hip moving about.
MaintenancePay particular attention to the transitions from leg to leg on opposing lifts. Anticipate the abdominal needs. Once you need it, it's too late. This particularly applies to running.
You should always feel like you're pushing the limit of doability and really have to think about it. Otherwise you're not working hard enough.
"Hook Lying Bent Leg Lift" 30 total (or 15 each side)
To increase the difficulty, bring one leg up and KEEP IT THERE. Now bring the second leg up to meet it. Now lower the second leg.
Another way to increase the difficulty is to keep more space between the knees.
Also, perform the exercise faster.
"Bridging with Leg Lefts" Arm position would be with elbows out, so upper arm is perpendicular to the body line, and forearms/hands are straight in the air. Then alternate legs as in the previous exercise. It is very easy and natural to fall out of the bridge while doing this, everything will start to sag and cede to gravity.
To increase the difficulty bring legs further away from each other. In all cases you are seeking to feel no torque on the arms.