SI Joint Pain, Hip Impingement and the Superman Exercise

Welcome to the Performance Place Sports Care podcast, where you can learn about sports injury theory, rehab, diagnosis, and how to understand the doctor lingo you didn't understand at your appointment. And now, your host, Dr. Sebastian Gonzales. Hey, thanks for joining us for the show. This is Dr. Sebastian Gonzales again. And we are going over a comment that I got on a YouTube video today. So as you can see, if you put your comments onto the YouTube channel and interact with it and really put some effort into the question or the comment, then I'll probably look at it. So this one was about a six-liner. It was on the Superman exercise video that I actually first put out because I wanted to really show my patients how to do this exercise the way I wanted them to.

Because there's a lot of references online that I didn't really like. And I really strongly believe that when you teach someone to do something, they should remember. And if they can't remember it, then I need to provide some type of resource for them to remember it. So this is, again, the Superman exercise video. But here's the question we got. And I'll read it the best I can. And I was never one of those guys that liked popcorn in school. And if you actually did, I don't know if, yeah, popcorn was that, it was that game that the teacher kind of made us speak out loud or read stuff out loud. As you can tell, I have no problem with public speaking, but man, I hate reading stuff. So here we go. Let's give it the best.

So this is, uh, was given to me a couple of days ago. So here it is. Uh, I've got sacroiliac joint pain, which I think has been brought on by a mix of lifestyle slash work. I have to drive a lot, eight hours, some, some days, and I like to run and do yoga to relax and stress from work and life that I deal with through yoga as much as possible, but not entirely successfully. I've tried your exercise or your, your, your other exercises heels together, lifting the thighs while lying on the belly, for instance, and got relief. But this is really, but this, this really pinches the nerve at the back of the hip on the left side.

I may have a labral tear there. I may have a bulging disc. I'm not sure. Any thoughts? Avoid this exercise or try to do it in a more doable form. I need to see a chiropractor, don't I? Thanks for your help in advance. And I appreciate your videos very much. So, um, first off, I want to thank you for watching all the videos and going through those is actually exactly how I want people to go through them. Experiment a little bit and kind of see what works and what doesn't work and so on, but obviously don't hurt yourself. Um, because again, the disclaimer, which you'll probably always hear from me because the law requires it is that I can't recommend directly what to do because I haven't seen you yet.

So, but we'll take this question and kind of digest it a little bit and help everybody understand the best way to go through a condition like this. So let's first talk about what it is that she says she's has and sacroiliac, sacroiliac joint pain is, uh, on the backside, almost low, low back area. Almost butt area. So if you look up on Google images and type up SI joint, the SI joint is on the backside of the pelvis and it's right around where kind of the sacrum is. If you guys don't know where the sacrum is, it's above your tailbone. And the top of the SI joint is actually, if you feel or if you've seen it on people, is when people have dimples at the low part of their back, that is the top part of the SI joint.

And there's two of them. Okay. SI joint pain is actually a really common thing that we see here. And the first question I ask people is, do you think the SI joint is tight, too tight or too loose? And they used to sit there and think about it for a second because they really don't have an answer. And I actually don't know either, but for the most part, I usually test them. And if we find that the trunk is unstable or the core is really low in strength, we can almost assume that the SI joint is probably unstable. And there are tests to do to confirm it, orthopedics tests. So one of them that I like to use is called pelvic rock, but there are some more of them.

You might not have to Google that one. I don't know if that one's public or not anywhere. But the SI joint is a really interesting joint. It's designed to move a bit, but it's also designed to stay together. And if you look at the anatomy of it, there are a lot of ligaments that go all around it, which some people will say that believe in fascia. I actually don't know if I believe in fascia yet. That's a whole other topic. We'll do a podcast on fascia. The fascia connections go from the hamstrings to the low back and through that SI joint sacral area where the ligaments are at. So anyways, the question that I pose to them about, is it too tight or too loose?

Well, mainly, I want them to think about what the remedies are going to be. If it's too loose already, I don't see any point in adjusting it further. If it's too tight, perhaps we adjust it or mobilize it and get it to work better. But if it's too loose, we should consider what are the things keeping it together. The ligaments, the muscles, the pelvic floor, the core, all these things keep it together. In case you don't know what the pelvic floor is or the muscles on the bottom part of the, let's have to describe this, the pelvis area. You can probably say, generally speaking, they're the kegel muscles, which if you were to stop your stream of urine, you would squeeze these muscles and they would stop it and so on.

A lot of people with urinary incontinence have weakness of their people that have been pregnant, women that have had babies. A lot of times they'll lose strength or tenacity of this area and it can probably create this SI joint pain. So, laxity. We have to really consider laxity as an issue. Because if it is, your remedy is going to be a lot of hard work. It's going to be a lot of core or pelvic floor training. That's not to say tissue work or even injections or adjustments won't help because they could. They can really help out with pain management. I know a lot of people with a variety of cases that when they loosen up an area or stretch it, it feels great, but it comes right back.

So, we have to consider what is the end-all goal with it. In this case, it could be laxity. Now, let me read through this a little bit more. She said she might have a labral tear there. There might be a bulging disc, which would be higher, be in the back. But she doesn't know. And I don't know either. And this is a situation that perhaps you need to consider an image on. The image that would confirm a labral tear would be an MRI arthrogram. The one that would confirm a disc injury would be an MRI. And they're both different. They both cost different amounts of money. And you'd probably have to do each one individually.

You might be able to go in and do them in a close period of time. I have no idea. I'm not an imaging specialist. But if you know what the condition is, I think, or you know if there's any structural damage there, then we know how to program better for this. And by programming, I mean rehab around it. She tried the other exercises, which I gave. That one was a prone heel squeeze, what it sounds like she's describing. That one was for hip impingement. That's only one that I give for hip impingement. But something to consider too, and I believe I did this in the other podcast that we talked about when I met Dr. Murray.

There is a need to centralize the ball and socket of the femur or of the hip. But there's also a very strong need to strengthen the muscles or get the muscles attaching to the ilium or the pelvis to work better. And what he kind of told me was that if you control the ilium, you control the hip. And the ball and socket will kind of follow or the ball will follow the socket. And the main goal with a lot of people should be to control the ilium. So it sounds like when she's doing yoga, I mean, I don't have a lot of experience with yoga, but I know there's different types. And the relaxational types, to me, it sounds like it won't be that hard.

When it comes to strength training of the abdominal area, a lot of times it's really, really hard. And yoga can be helpful for it if you find the right type. Pilates can be helpful. Gyrotonic can be helpful. Floor core exercises, which we do have some examples on YouTube, which would be actually the one that she's referencing, the Superman exercise. There's a lot of ways to do it. Which is the best way? I have no idea. And I'm being completely honest with you, mainly because sometimes not knowing what is the best route or the perfect route sometimes paralyzes people in a mental sense. Because they're like, you know, I don't know how to do it, so I'm not going to do it.

But you know what? Just doing something is better than nothing. And if it's not perfect, that's fine. You can perfect it later. And I know I've talked to some people about diet with this. They're like, you know, I don't know if the right diet's for me. And I'm like, you know what? Let's just take your worst meal. Say you do burgers every day at 12 o'clock. Take the burgers out and let's go with green salad. Let's go with a meal replacement. Let's go with something. And that's going to be enough at least to jumpstart you in the right direction. It doesn't have to be the perfect plan. It can just sometimes you have to get people to have little successes, which is really it's mentally feels good because it feels like you're getting somewhere.

Last thing I'd recommend in this case is make a list of things that work and don't work. And it sounds like she's on the right track. She figured out that one exercise works for her, but another one doesn't. And there's a lot of ones she probably hasn't tried yet. So that is the I talked about in the last podcast. It's one of the most important things I think someone can do because injuries are super frustrating, very mentally challenging. And that is the first thing that we need to address on people when they come to the office here is getting them to a better mental standpoint so they can properly digest the material we're giving them.

And they'll actually do the rehab they're supposed to do, because if they're coming in here to do rehab, the amount of times that I would require them to do it, they'd be in here at least four times a week. Because I strongly believe you can't make a change in whether it be diet or exercise or building muscle or rehab unless you're doing it a majority of the times of the week. There's seven days in a week. You've got to at least do four. And they can easily do some of it at home if they've paid attention to what's going on, what works, what doesn't work, and the library of exercises that we give them, which we post a lot of them on YouTube for the references.

But it's purely up to them. I know life is busy. My life is busy, too. But if you want something, you will have to dedicate time for it. And that's purely what it is. So I think that is the most advice I can give. Let's see. She asks, is this exercise something I should try to do, or is there something better? Yeah, I mean, she could be extending the hip a little bit too far, or she could be hyperextending the back. So maybe making it a more straight variety. Or even not using the arms or not doing the legs. There's ways to break this up into quarters. I usually have people in the office when they do the Superman progression is I have them start face down, the thighs are on the ground, the hands are on the ground, and then I have them gently lift up their knees off the ground.

And then we'll eventually get the thighs. But if they start lifting, they're hyperextending their back or creating that arch there because they're focusing so much on how far they're getting their thighs off the ground, then I'll back them down a little bit. And the same thing goes for the hand or shoulder component. Does she need to see a chiropractor? You know, this is one of the things I realized through chiropractic school is that, you know, there's great chiropractors out there. And there's about probably 10 I can think of right now who I would send my mother to. And I think of it like I call this the mother test.

Would I send my mom to my CPA, my chiropractor, my attorney, even like one of my best friends? Is there a real estate agent? Would I send my mom there? And if the answer is no, then don't send any patients there. And in regards to chiropractors, just like any other profession, people are all over the board. So do you need to see a chiropractor? Yeah, sure. If you want to see a good one, by all means. If you want to see a good PT, you can see a good PT, a good sports medicine doc. All of the people that do good work in sports rehab typically will do a lot of the same things. Or we have the same belief systems.

And there's other ones which won't do it this way. And you know what? If it helps you, by all means do it. But I don't want to seem like I'm bashing on any certain profession. But I know the way I like to practice. And I know where I'd send my mom. And when I do yoga personally, I don't do yoga. But it doesn't mean it doesn't help people. I know I have people come in all the time saying they do yoga. And by all means, if yoga helps you, I'm all about it. You know, does it strengthen you? Yeah. Does it relax you? Yeah. But if you go in and you're stressed out, then no, it doesn't relax you. It doesn't work for you.

It has to work for you. So what I would suggest to you is find someone who specializes in low backs or hips in your area. And it could be any profession. It could be a chiropractor, a physiotherapy, a physical therapist. It could be a sports medicine doctor. It could even be a strength and conditioning specialist or a strength coach. It could be a personal trainer. There are a lot of people who are really, really good at working with people with these conditions. But they might not have the credentials. And that doesn't really matter to me. I have people come in all the time to my office and they don't ask me one thing about where I came from, what my credentials are, and so on.

But I think they can, the reason they do that is they know I'm listening to them. I'm addressing their condition. And I at least sound like I know what I'm talking about. So I think that's what matters. If we can guide you in the right direction, you need to go see that person who's going to guide you in the right direction. So I hope this was helpful. If you want your question answered again, you can go on the YouTube channel. And any of the videos, you post a response, make it long, make it detailed, and I'll feature it on the show. If you want to go to the website, p2sportscare.com, you can actually use the speak pipe button right in the middle and just speak right through it.

And it will go directly to us and we'll filter through some of the best ones and feature them on air. So you can actually have your voice right on air. If you want to find our courses, and the reason why these courses were developed was because I want to create the best content. I want to categorize things so you guys can follow them easily. And I want you to self-educate. This is what will get you through majority of the sanity of your sports injury, injury, your condition. A lot of the exercises are very similar throughout what you'll find on YouTube and so on. But for some reason, they're thrown all over the place on YouTube.

And that's just the nature of the beast. It's hard to find stuff. So I'm putting it all together. I will speak you through it. I personally make the videos. And it is everything that I say to my patients here to get them to do it right and well. So you can find those courses on Performance Place HB. That is the other site that we've dedicated purely to courses. Performance Place HB. Find the courses. Go through. Take the free ones. If you like the free ones, buy the advanced ones. The advanced ones are going to be the most in-depth information you can find on those topics. And it is everything that I know that I've learned over the years of practicing through all my years of school and so on.

And I'm getting them right to you. So this is my life passion. And I really, really want you guys to learn as much as you can. So I will talk to you guys soon. And thanks for listening.