Daily Mobility Exercises by Dr. Kelly Starrett › Forums › Back › Developing a protocol for SI Dysfunction to include management, risk mitigation, and rehab.

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    • 09/19/2013 at 8:57 am #70484
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      A little about myself I have been a full time police officer for 10 years and into fitness for approx. 17 years. I have two bulging discs L3-L4 and L5-S1. They are located essentially at the top of my duty belt and below my duty belt. One explanation I received is when I wear the belt it creates a simulated fusion causing the discs to wear out. It is such an issue some states have adopted laws making it workers comp related if you have a back injury on or off duty. The other issue I have developed seems to be the bear and that is SI Dysfunction. Sitting for long hours in a cruiser or desk and the weight and poor mechanics the belt creates in the hips i’m sure was one aggravating factor. I started CrossFit approximately 3 years ago and went from barely being able to deadlift 95 pounds without feeling like I was going to explode to deadlifting 400+. I still have had several relapses which I found to be very frustrating. I’ve been to physical therapy, studied some of the causes for SI Inflammation, and looked for indicators that lead up to the relapses. Since starting a CrossFit Gym a couple years ago and diving into the community I see these injuries more and more. I would like to pitch this idea to Mobility Wod to help me in developing a protocol for the community. This is what I practice and please critique. I will say i’m not a doctor or physical therapist. I may throw out some wrong names or describe areas versus the muscles and ligaments. 

      Causes: 
      -Tight quads creating pelvic tilt which puts the si joint into a state of hyper extension. 
      -Tight piriformis which adds tightness and compression in the joint. 
      -Tight IT Band and Tensor Fascia Latea where it connects to the pelvis and pulls on the femur and creates an impingement that inflames si joint ligaments. 
      -Tight psoas and lower abdominal muscles preventing easy hip extension.
      Management: 
      Stretching to include 
      -Runners stretch with hip rotation to hit the IT Band and Tensor Fascia Latea 
      -Swan pose
      -Olympic wall stretch
      -Cobra/ Mackenzie Protocol
      Active Stretches/ Warm-up
      -Warrior 1
      -Bridges
      -Bird dogs
      -Superman
      -Glute Ham Leg Raises
      Risk Mitigation: 

    • 09/19/2013 at 8:58 am #72796
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      Sumo
      Deadlift Reading the bodies indicators:

      • First Assessment Runners
        Stretch: Indicator unable to reach normal range of motion you go through
        your stretching routine and there is no change.

      • Second Assessment Cobra
        Pose: Indicator unable to reach normal range of motion you go through
        your stretching routine and there is no change.
        Feeling of compression in the lower back.

      • Third Assessment range of
        motion: Pain bending over or walking through the movements and feeling
        unstable.

      • Fourth
        Assessment Pelvic Tilt: Check to see if the hips are like a
        bucket of water tilted forward. Will the quads free up.

       

      High
      Risk Exercises: (Any lift with heavy weight can be high risk, what I use to
      determine high risk are movements that I’ve seen commonly create
      flare ups because of poor mechanics or hyper extension. Also because of the
      immense stress it puts on the joint)

      –Thrusters

      – High Pull

      -Box Jumps landing off the box

      -Glute Ham Raises

      – Pistols 

       

    • 09/19/2013 at 8:58 am #72799
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      Understanding
      Risk versus reward and applying your body’s indicators towards scaling 

      your
      workouts.

      -Tight in the runners stretch caution with pulls from the floor.

      – Is the person rehabbing the injury or feeling 100%. Are they
      training to compete or       just to be fitter and enjoy themselves. What is
      their overall       condition and last incident.
      Swap thrusters for clean and jerk,       step down from the box, swap ghr for bridges
      paired up with light weight high       rep
      deadlift, trade pistols       for high
      box stepups.

       

      Rehab:

      Incident
      occurs:

       –Rest or cautiously roll top of glutes immediately
      after the flare up.

      -Apply Ice for 15 minutes on 15 minutes off.

      -Rest if possible

      -Following day attempt the management phase in
      the morning and afternoon. It will take a few days to get full range of motion
      back. Some movements will not be possible or the ability to hold them will be
      short.

      -Begin applying heat.

      -Conduct standing or from the knee glute ham
      raises through out the day.

      -Returning to exercise focus on basic body weight
      movements and work up to light weight movements.

      -Give your posterior chain time to rest and
      recover.

      -As you feel better increase volume and weight. 



      Sorry for the formatting issues.

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