Rotation Helps Improve SI Joint Pain: A Doctor Even Says So!

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Today’s guest post comes courtesy of Dr. Erika Mundinger1, who’s presentation on how to deal with SI joint pain (specifically how ROTATION can help!) at The Fitness Summit a few weeks ago really impressed me.

I asked if she’d be willing to help me out while I was away, and she was more than happy to oblige. 

Enjoy!

A couple of years ago, a fellow physical therapist at the clinic where I work asked with a quizzical and concerned look, “What do you think of that Jefferson deadlift everyone is doing at your gym? Lifting and twisting?” My response evoked an even more quizzical look — that in my four years coaching the Jefferson deadlift, I had yet to see someone get hurt.

Now I know that a PT saying it’s OK to lift and twist is bold and brazen. But lets be clear, I’m NOT saying this:

 

What I am saying is that I’ve seen rotational movements, when trained properly, actually help clients and spine patients get out of pain.

When I see clients and patients with a back injury that results from twisting it’s not necessarily because they were twisting in the first place. Often it’s because they were trying to twist, bend, or reach into a range of motion not available to them.

In layman’s terms, they were trying to move beyond their limits. So, my contention is that instead of avoiding rotation in training, we can find safe ways to use rotation to help get people out of back pain — and potentially prevent back pain at all.

So since we naturally move in to rotation why would we not want to train rotation?

One clear answer is because if we lack mobility we could get hurt lifting in to rotation. But does that mean we should NEVER place a client or ourselves in to these positions? Or should we start training rotation so that when they find themselves in this position again the chance of getting hurt is minimized?

I vote for the latter.

Lets back up for a moment and take a look at how the spine and pelvis move together. When you move for day-to-day functional activities, are you moving in singular, robotic motions? When you squat down to pick up something off the floor are you assuming the same back squat position you do at the gym? Typically one foot is slightly forward, one foot back, the front foot may be more flat on the floor with the other foot raised on to a toe, and there’s a slight twist in the spine and pelvis. In fact our pelvis twists with every single motion we do.

Take a look at walking, for example, as one foot is forward and one foot backward the pelvis sits forward and down on one side and up and back on the other.

The hips, pelvis, and spine move together in a three-dimensional pattern. And as a result we have a three-dimensional system that stabilizes our pelvis as our joints bend and rotate.

Posterior Sling

Posterior Longitudinal Sling

The posterior sling involves the erector spinae, multifidi, and thoraco lumbar fascia. As they contract, they tilts the sacrum forward and pull upward, locking the SI joints in to place with a vertical force vector.

Posterior Oblique Sling

Posterior Oblique Sling

The posterior oblique sling involves the glute max, glute med, biceps femoris combined with the opposite lat create a diagonal force compressing the SI joint together.

Anterior Oblique Sling

Anterior Oblique Sling

The anterior oblique sling involves the external oblique, internal oblique and transverse abdominis with the oppsite adductors compress the pubic symphysis and stabilize the anterior pelvis.

If we lack mobility, or if we have a muscle imbalance in one or more of these slings, the stabilizing force of our pelvis can neither allow for mobility when we need it, nor stabilize where we need it. This causes more load to be placed on the spine and SI joints, possibly leading to injury.

Now let’s be clear about one thing: If there is a lack of mobility at the pelvis and spine, there is also most likely a lack of mobility at the hips. It would certainly be irresponsible of us to address one area without addressing the other.

However, the beauty of training rotation is that we get to address many of the sticky spots because in a 3-D system, we can’t move one without the other.

As always, if the exercise is uncomfortable, don’t do it. Furthermore, if the exercise feels great on one side but not so great on the other — don’t be afraid to train only one side. Forcing a motion on a side that feels uncomfortable will also cause injury.

Typical question: “But won’t I be uneven?” My typical response, “You’re already uneven, which is why we are now having this little chat.”

Scoliosis

Here is an example of someone who trained Jeffersons with the intent of improving motion. Upon first attempting Jeffersons, one side felt great while the other side, well, not so much.

When looking at spine, pelvic, and hip motion we could see that an underlying scoliosis was one contributor to the problem. So he trained Jeffersons on just the side that felt comfortable. With time, as motion started to improve on that side, so did motion on the other and gradually he was able to perform the movement on both sides. The results were very impressive.

Not only did his general strength in rotational patterns improved, but so did the position of his spine. (photo reprinted curtesy https://www.dellanave.com/follow-your-body-to-better/)

So how do we do this?

Obviously if there is an imbalance, and certainly if there is a pre-existing injury, the last thing we are going to do is perform a loaded rotational movement. It is no secret that rotation places more load on the facet joints and requires more work from muscles increasing torque. But if we start with the motion itself, unloaded, or lightly loaded, with modifications were necessary, we build a solid platform on which progression can occur.

More Rotational Deadlifting

 

As Tony mentioned in a previous post, rotational deadlifts challenge the transverse plane of mobility, not to mention help fire up those oblique slings we use for diagonal stability. But what if it hurts to this, or you don’t have mobility to do this?

The above video is a great modification for beginners of this motion or those who have some trepidation in approaching this movement.

Valslide Curtsy Lunges

 

Don’t feel limited to rotational picking-up of things. Rotational lunges also provide a great opportunity to gain motion, not to mention they are a good butt burner.

After I taught this exercise at the Fitness Summit, a comment I received a lot via email/text/twitter from the attending trainers was “My clients love to hate this motion.” They love it because it feels so good, but hate it because the glutes are on fire, but then love it again because the glutes are on fire.

I have seen those with SI dysfunction quickly relieve symptoms performing this movement, even unloaded.

And Of Course the Jefferson

This is such a great exercise because it really caters to where our asymmetries in the pelvis may be.

You can stagger your stance if deadlifting with an even stance is hard. You can reduce shearing forces on the SI joint that can occur with single plane deadlifts because ALL three slings are engaging. And it reduces torque on the spine that a conventional deadlift can create because the load is directly under your center of mass, not in front of it.

David Dellanave of the Movement Minneapolis has great coaching and training tips HERE.

Summary

Ready to start twisting?

The first step is: Don’t be afraid to play around with rotational movements. Pick some exercises you already know and like, then start by staggering the stance a bit, or add even a few degrees of rotation. Follow what feels good.

Disclaimer: These are not exercises to push through, and this is not the time to pick the heaviest weight so you can look strong or boost your ego. That will lead to trouble — trust me. There are very safe ways to do this. If done mindfully, clients can gain not only improved mobility, but overall strength within that mobility. As always, listen to pain, don’t push past your current range of motion, and start where you are, and not where you want to be.

About the Author

Erika Mundinger is a licensed Physical Therapist and a board-certified orthopedic specialist working in the Twin Cities area. She practices orthopedics and sports medicine with advanced training and practice in manual therapies, corrective and functional exercises, and treatment of spinal disorders. She works at TRIA Orthopedic Center, the Twin Cities’ premier ortho clinic, treating athletes from professional to “weekend warrior” levels as well as general orthopedics and is a member of the clinic’s Spine Team, helping to better advance patient access to professionals specialized to manage care of spinal disorders and injury.

In 2002 she received her B.S. in Exercise Science from Montana State where she was involved in exercise physiology research and outdoor sports. In 2007 she received her Clinical Doctorate in Physical Therapy at the Mayo Clinic. She will receive a board certification as an Orthopedic Specialist in March 2015.

Mundinger is also an active member, coach, and physical therapist at the Movement Minneapolis and is trained in the Gym Movement Protocol. She actively applies this biofeedback training with clients and her own patients. She also works with several trainers outside of the Movement to help bridge the gap between physical rehabilitation and returning to fitness and recreation.

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  1. Fun fact about Dr. Mundinger. She was apologetic for taking so long getting this article to me because, as she explained, she was “competing in a skydiving competition last weekend.” To which I replied, “No worries at all! And chalk “competing in a skydiving competition” on the same list as “stuff I’d do AFTER french kissing a great white shark.” She’s a woman of many talents! And obviously more adventurous than myself.

Comments for This Entry

  • Katherine Nova

    Great post , I really like your post as well as the idea you want to deliver the users.I like examples you shared with us.I appreciate your approach and the points you shared. Orthopedic hospital

    June 5, 2015 at 2:15 am | Reply to this comment

  • Anne in WT

    Love love love this article and your recent one on the rotational deadlift. I think you might be a Jedi, Tony... or at least posses some sort of cosmic mind reading power. As it happens my SI joint was going funky on me last week. I was a bit hesitant in the gym and as a swimmer, my flip turns were letting me know that something was off. After a couple visits to my chiropractor/ART magician (who says he ran into you at a seminar last year and is coincidentally a fan of yours) my joint is once again fully operational. I definitely will be stealing some things from these two articles to ensure that things remain that way.

    June 5, 2015 at 2:17 pm | Reply to this comment

  • Gina

    You gave so much value with this article it is unbelievable. I highly appreciate your approach and knowledge of this subject matter - Gina http://bodyworkoutsource.com

    June 5, 2015 at 3:57 pm | Reply to this comment

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  • Shane Mclean

    My SI joint is a mess and causes me constant pain. I'm definitely going to add some rotational lower body exercises suggested here. Nice work Erika and congrats on making the articles of the week on The PTDC.

    June 7, 2015 at 10:01 am | Reply to this comment

  • Cory Neel

    "So he trained Jeffersons on just the side that felt comfortable." would you recommend the same thing for a rotational deadlift?

    June 25, 2015 at 1:40 pm | Reply to this comment

  • Bob Gorinski

    I'm late to the party with this, but could Erika or anyone comment here: When you recommend to do the comfortable side and skip the side that may feel harder and awkward, this is "feeding the dysfunction." I'm truly not saying this is wrong in this instance, but it is opposite of my usual line of thinking. It seems that feeding the dysfunction has been beneficial in your experience - why do you think this is the case?

    June 28, 2015 at 12:40 am | Reply to this comment

  • Paul Bruce

    I've been suffering from piriformis syndrome for over a year - my piriformis is tight, and compressing against my sciatic nerve. It flares up when I sit for long periods of time. And though I recently became a personal trainer, by own training has taken a hit because of the pain it causes, which can be quite intense. I tend to focus more on single-leg training as it tends to fit my goals of combat and parkour a bit better than bilateral lower body exercises - except deadlifts. Deadlifts are king. One exercise I started incorporating into my routine is a single-leg (semi-straight) crossover deadlift - a 1-leg RDL, but with the free leg crossing behind. This rotational movement always manages to loosen up my hip, and get rid of pain for a while. It's terrific.

    August 15, 2015 at 10:47 pm | Reply to this comment

    • TonyGentilcore

      Sounds like it's right on par - if not a lateral progression - to the exercise Dr. Mundinger suggests. Glad the added rotation has helped Paul!

      August 17, 2015 at 12:31 pm | Reply to this comment

      • Paul Bruce

        TONY!!! TONY!!! TOOONYYYY!!!!!! I've incorporated ALL THREE of these exercises into my program a couple months ago, deciding to balance vertical and forward movements (e.g., front squat & RDL) with lateral and rotational movements (e.g., rotational deadlift & Jefferson). I think I have effectively cured my piriformis syndrome. As long as I stay active, and continue to perform lateral and rotational movements, I feel NO pain at all! In fact, my butt just builds (my girlfriend likes that ;o ). Thanks for this article!

        September 26, 2016 at 6:35 am | Reply to this comment

      • Paul Bruce

        TONY!!! TONY!!! TOOONYYYY!!!!!! I've incorporated ALL THREE of these exercises into my program a couple months ago, deciding to balance vertical and forward movements (e.g., front squat & RDL) with lateral and rotational movements (e.g., rotational deadlift & Jefferson). I think I have effectively cured my piriformis syndrome. As long as I stay active, and continue to perform lateral and rotational movements, I feel NO pain at all! In fact, my butt just builds (my girlfriend likes that ;o ). Thanks for this article!

        September 26, 2016 at 7:35 am | Reply to this comment

  • Justin

    Can someone please answer the questions about feeding the dysfunction? Really sucks that was thrown into this article without further explanation. Its been taught to train the side that is most difficult. Is this because of the positions the body is placed into?

    August 22, 2016 at 11:41 am | Reply to this comment

    • TonyGentilcore

      Say, when someone squats they sway or gravitate towards one side (right side). This could be due to many things. You can "feed the dysfunction," use band RNT to pull them to the right, so that it gives the body some proprioceptive feedback to self correct. It's basically a way engage the nervous system to do it's job and (hopefully) clean up movement. Here, this may help explain more of what it means: https://www.youtube.com/watch?v=5LrRPIFpyjU

      August 25, 2016 at 7:59 am | Reply to this comment

      • starvin marvin

        Ok, thanks, sorry for late response, never got the notification for some reason. Makes since in the case of a squat in the sagittal plane, but what about the Jefferson deadlift? I should have added that to my original post since that's what this article was referring to and what im most curious about. The Jefferson is a more complex movement and im having trouble seeing how you could apply this method to it. I have a functional scoliosis from years of surfing similar to the one in the picture of the guy that was rehabbed using the Jefferson. I have trained my body to rotate dominantly in one direction and I think the Jefferson has the ability to improve my situation quite a bit. Ive experimented with it and it definitely seems to be helping, but im trying to figure out which side I should be working the most using this exercise since I feel strong on both sides, yet my imbalance appears rather extreme. My hips are rotated, right hip back, left hip forward. It seems my AOS, left external oblique and right internal oblique (right internal oblique really weak), along with the adductors of right leg are weak and not able to contract the way that should to place my hips in a neutral position which causes the pelvic rotation. This seems to be the main culprit behind my scoliosis.

        April 23, 2017 at 4:51 pm | Reply to this comment

      • starvin marvin

        Thanks for the response, sorry so late, didn't see the notification. I can see how this works for a sagittal plane squat movement, but what about the Jefferson deadlift? I have a functional scoliosis from surfing similar to the picture of the guy you have on this article and im trying to figure out which way to do the Jefferson. I seem strong doing it on both sides, yet my imbalance is rather extreme. My right hip is rotated back and left forward. My AOS definitely needs some work, the problem is starting from the core. Seems My right internal oblique and right hip adductors are weak and aren't contracting with the left external oblique causing my hips to rotate, which causes the scoliosis. It would seem the when doing the Jefferson lift id want to have my torso rotated to the right to get my right internal oblique and left external oblique to contract like they should?

        April 23, 2017 at 8:29 pm | Reply to this comment

        • TonyGentilcore

          I LOVE the Jefferson Deadlift and would suggest you toy around with it to see what position helps you feel the most stable and powerful and run with that.

          April 28, 2017 at 5:37 am | Reply to this comment

          • starvin marvin

            Ok thanks for your replies. I've been playing around with it and still trying to figure it out. I definitely enjoy the lift.

            May 18, 2017 at 7:26 pm

  • Justin

    Can someone please answer the questions about feeding the dysfunction? Really sucks that was thrown into this article without further explanation. Its been taught to train the side that is most difficult. Is this because of the positions the body is placed into?

    August 22, 2016 at 12:41 pm | Reply to this comment

    • TonyGentilcore

      Say, when someone squats they sway or gravitate towards one side (right side). This could be due to many things. You can "feed the dysfunction," use band RNT to pull them to the right, so that it gives the body some proprioceptive feedback to self correct. It's basically a way engage the nervous system to do it's job and (hopefully) clean up movement.

      August 25, 2016 at 8:59 am | Reply to this comment

  • Greg

    I have a congenital 8mm leg length discrepancy in my tibia that has created a huge SI problem for me. I corrected the structural issue with a 8mm shim under my weightlifting shoe. I am still a little confused, other places I have read that you need to mobilize the tight muscles and then focus on even contraction and core stability with PT exercises like deadbugs, planks, glute bridges, etc. Is it possible to just use Jeffersons to get out of this? I still don't fully understand the problem. So far i've done one heavy workout with Jeffersons using perfect form and I can't say I've got much pain relief from it and there's no noticeable hypertrophy that I can tell. Though I could have improved range of motion which would be harder to tell... Am I trying to improve range of motion or build strength? I'm guessing both. So should I be going lighter with these and my ROM will improve and then go heavy? Or should I just go heavy off the bat? It seems to me like there's two sequential components the Jefferson works through. It first improves ROM and then once the ROM is there then the weak muscles can be brought up. So would my guess is start out with high volume, high frequency, relatively low weight, and improve ROM. Then go into high frequency, low volume, and go heavy? And there's no need to mobilize beforehand with this exercise? Does the Jefferson mobilize the tissues on its own then? It just seems to me this article is a little unclear in that there are two distinct phases when using jeffersons for SI dysfunction: 1. Improving ROM 2. Strengthening weak muscles For me personally I only really plan on using Jeffersons to get out of this problem and then go back to conventional deadlifts and squats. And maybe use it as an accessory if the problem comes back. I could be entirely wrong on this. Please let know your thoughts! Thanks! -Greg

    February 13, 2017 at 12:23 pm | Reply to this comment

  • Abner.l

    if i want to work my right external oblique and my left internal oblique.Which leg should i put in front when doing jefferson deadlifts

    June 5, 2018 at 6:41 pm | Reply to this comment

  • Zeiko Technologies

    So he trained Jeffersons on just the side that felt comfortable." would you recommend the same thing for a rotational deadlift?

    December 21, 2018 at 2:29 am | Reply to this comment

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