Follow the Injury Story to its Source.

I had the pleasure of working with youth elite weight lifter Ryan Baugh. Winner of the Under 20 62 kg class with an impressive 187kg total despite being only 15 years old, Ryan is a protégée of one of my long term clients, triple Olympian and triple Commonwealth Champion Michaela Breeze.  Through hard experience, Michaela knows that small changes in mobility or control lead to major implications under the big loads, so she brought Ryan to investigate some back pain that he has been experiencing.

Left sacroiliac pain, OK under weighted load but worst when the load releases has been Ryan’s problem. The best place to start? Let’s see him move.

Weight lifters are experienced squatters and are very flexible, so anything we see on this movement will be significant.

In Ryan’s case, the right ankle flagged potentially inadequate dorsiflexion by pronating excessively, and his weight subtly shifted into his left hip. 

On routine pelvic testing, his left SIJ did not self lock on single leg stance. What relationship is there between these factors?

The key lay in the left hip. Ryan has likely been shifting his weight into his left hip for some time, as he said that his right ankle had “always” been stiffer. On mobility testing, this relative stiffness was confirmed. (I say relative, because his actual range of motion would have been normal for most people, and unprecedented in a footballer). The left hip was significantly less mobile than the right hip. He needs the full range of motion in his sport, so if his hip will not flex, the SIJ is the next port of call as those forces must be channeled into motion somewhere. If it is forced into excessive motion repetitively, it can become stressed. Loading through that joint provides assisted closure via compression, so it may well feel fine when Ryan is actually supporting the weights, however, when the load suddenly releases, the joint loses that compressive support.

So, the first station on the railway line of treatment is the hip, BUT to normalise the loading and prevent recurrence, we must restore ankle mobility.

This presentation of  an seemingly “unstable” SIJ often receives glute exercises in an attempt to improve force closure.  The SIJ is however stressed by insufficient mobility elsewhere. Don’t try to solve a mobility problem with stability exercises! It is frustrating for all concerned. No matter what the “evidence” is for pelvic stability exercises in cases of sacroiliac joint instability, it cannot work if you don’t find and deal with the biomechanical cause.

To unpick this scenario, we must start with a movement. Without it, we cannot hope to get to the root of the problem.

 Original post: 4/10/2012

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