By Katie on Tuesday, July 17, 2001 - 06:51 pm:

Does anyone know how you can tell if you have a ligament laxity problem around the sacroiliac joint before you even start to have prolo?

Also, has anyone ended up with more pain and more problems that they had before because of the prolotherapy?

By Park Griffin on Wednesday, July 18, 2001 - 12:30 pm:

My wife has had 11 prolo sessions with no adverse effects for SIJD. Ligaments play such an important role in the functioning of the SIJ's. If you are unable to hold a correction, it is almost a guarantee that there is some ligament involvement. The brunt of the injury to the SI affects the long and short posterior SI ligaments. Sometimes there is damage to the anterior joint capsule also. Most other dysfunction is secondary to the SI insult.

To be perfectly honest with you. If you have SIJD, and can not hold a correction, prolotherapy should be standard of care. However, only have the long and short posterior SI ligaments injected because if you inject the other ligaments, especially if you have a subluxed SIJ, it can make it harder for your therapist to correct the subluxation.

The most important thing, though, is if you do not have a physical therapist who truely understands SIJD, no treatment or procedure is going to work.

A great resource to better understand SIJD and the importance of maintaining a correction is to visit www.kalindra.com

Good Luck! Park Griffin

By K on Wednesday, July 18, 2001 - 03:52 pm:

To Park Griffin,

Thanks for your reply. Could you just explain what you mean by "not able to hold a correction".

Also, can you make a recommendation on a prolo doctor who also has an excellent physical therapist they work with.

Many Thanks K

By Park Griffin on Thursday, July 19, 2001 - 04:44 pm:

The lumbopelvic area is a complex system of force couples/articulations. When you bend over, walk , lift, etc...; the pelvic bones and sacrum work independently of each other, but have to work in exact unison with each other for pain free locomotion and work. The top three sacral segments S1-S2-S3 match up with the innominate bone of the pelvis. These mating surfaces are the SI Joint. S4-S5 and the coccyx are suspended and slung together by ligaments. The structural angulation of S1-S2-S3 is very critical. This angulation can be compromised by a subluxation (minor dislocation of the SI Joint. Even a minor subluxation causes major problems. The two sacral segments that typically sublax are S1 and S3. Typically this happens when you are doing something like lifting, falling down, bending etc...

Let's use bending over for an example: When you bend over your lumbar back rests against your abdominal muscles, the innominate bones (pelvis) rotate anteriorly, S1-S2-S3's job is to perfectly track with the rotation of the innominate bones. S4-S5 and the coccyx move posteriorly in relation to the innominate bones. There is a bunch of ligaments attached between the lumbar back and the pelvis, and, the sacrum and the pelvis. Most of them act as levers and pulleys. The objective of "self-bracing" is that as you bend over your innominate bones are drawn in tight by the sacrotuberous ligaments to squeeze against the sacrum, which is designed to keep S1-S2-S3 in alignment with the pelvis as it rotates.

At some point this mechanism can fail and your pelvis over rotates and dislocates your sacrum (the force of the pelvis rotation over comes it's ability to squeeze against the sacrum) and you end up with a subluxation. This is referred to as Anterior Sacroiliac Joint Dysfuntion. Thism is not good!!! Your self-bracing mechanism fails to work when the SI is sublaxed, which causes PAIN and DYSFUNCTION.

In order for relief the subluxation NEEDS CORRECTED TO THE SELF BRACING POSITION. This is what is referred to as a CORRECTION. If you have a hypermobile joint, you will never get better unless you can hold the correction. Many people slip back out of alignment and the self-bracing mechanism no longer works properly. It can be a viscious circle for many people.

Obtaining a correction is not easy because many therapists don't understand that the pelvis was in rotation when things popped out of place. Many times therapists are able to move the pelvis back in line with the sacrum which sets S1 in place. Your legs appear even to them and they say yup your in!!!... WRONG!!! Not only does the pelvis have to go back, it has to be rotated counterclockwise and back!!! If done properly, it will line up S1-S2-S3. This is referred to as: getting A FULL CORRECTION TO THE SELF BRACING POSITION.

Enough for now: if you want to research more go to www.kalindra.com and read critical analysis of the pathological failure of the self-bracing position. Also read manual therapy rounds which are home corrective exercises you can do at home to keep yourself corrected (S1-S2-S3) in alignment with your pelvis.

One thing to keep in mind: Any body that does any manual therapy from the prone position will mess you up worse!!! Rather than moving the pelvis back, this tries to move the sacrum forward. When the sacrum moves forward this makes your pelvic bones rotate even further clockwise out of alignment. This will always make the problem worse. When a therapist uses manual therapy on you from a sidelying position, this moves the pelvis back, but does not rotate it counterclockwise and back. The only real effective way of sliding the pelvis back and rotating it counterclockwise in the process, is to have manual therpay procedures that place you in the supine position, whic means you are lying on your back when the corrective exercises are performed. There is a slew of corrective exercises you can try at home by reading "Manual Therapy Rounds" by Richard Dontigny on the www.kalindra.com website. Good Luck!!!!

By MichelleT on Friday, July 20, 2001 - 05:22 pm:

Wow. What a great website, Park! It is very informative. Thanks for the info.