
MONTAUK COLUMNS Sacroiliac Joint Disfunction by Robert Bonavolta, LMT, NMT Any pain emanating from the low back, gluteals, or legs was usually branded as SI Joint (Sacro Iliac Joint) syndrome until an article in the New England Journal of Medicine in the 1930’s on disc lesions changed that and brought about decades of surgeries and put the blame on sciatica. There were limited clinical studies confirming SI Joint dysfunction although many manual therapists continued to treat this disorder with some success. No one could put forward a convincing theory explaining how the sacrum could become “stuck” between two hip bones. It was difficult to imagine how a joint with so little movement could cause so much pain and we manual therapists countered that it was its limited motion that was vital to spinal function. The SI joint controversy continued through the 1970’s until a manual therapeutic osteopath introduced a practical biomechanical model that clearly demonstrated normal and dysfunctional SI joint movement patterns occurring in most individuals. Sacroiliac Joint syndrome was back as a viable diagnosis for low back pain. Since most SI joints only move 2-4 millimeters during weight bearing and forward bending, the joint glides as opposed to bend as in a hinge joint like the knee. The primary function of the joint is to provide shock absorption properties for the spine. Most of the movement comes from ligament stretching of the Iliolimbar ligament, the Sacrotuberous ligament, or the Lumbosacral ligament as well as the third joint of pelvis, the Pubic symphysis. . The muscles involved encompass the entire hip girdle and attachments to the femur bone and the iliums. When functioning in perfect harmony this opening and closing of this locking system, called force closure, allows for a smooth transference of body mass from one leg to another, balancing the weight during gait whether walking or running, absorbing both upward and downward forces and maintaining both mobility and stability. It’s interesting to note that the greatest incidence of disabling back pain is between 25 and 45 years of age when the SI joint has the greatest degree of motion. As we age the joint can become stiff and permanently lock so it is important for manual therapists like Neuromuscular Therapists to recognize this and incorporate special techniques to mobilize the ligaments and muscles of the SI joint and create a more opened state and to maintain joint mobility, strengthen the stabilizer muscles, and maintain biomechanical efficiency. Since muscles move bones it is key to determine which muscles are in dysfunction, recognize the trigger points and reverse the pain patterns. Typical SI pain patterns are muscle spasms, a feeling that something is stuck, weakness, tightness and the physical appearance of being bent over or crooked. A sustained isometric contraction of a muscle along with inflammation can cause a vicious cycle reflex arc to the brain further increasing the pain patterns and pelvic instability. Proper assessment and treatment protocols during a Neuromuscular evaluation is critical to determine the hips angle of rotation and/or the possibility of a leg length discrepancy which could contribute to the SI joints instability. Also it is important to recognize not only the SI joint in a dysfunctional pattern but also the hip joint capsule. Restrictions in the hip joint, especially in sports related activities can send radiating referral pain patterns throughout the body. Once optimal hip range of motion is restored and the sacral ligaments aligned, the body’s innate ability to correct the imbalances usually flow into pain free movements. As a Neuromuscular Therapist dealing mainly in pain management and sports injuries I have come to recognize these pain patterns and the attending forces which contribute to the imbalance of the hip. This is where all movement begins. It is your center of gravity both front to back and side to side. For optimal health of the entire body the center must remain centered. Whether the pain pattern is migraine headaches, neck and shoulder pain knee or ankle pain we always look at the center. Checking gait pattern and hip flexion and extension is vital for proper assessment and treatment outline. In conclusion, pain is not something anyone wants to live with yet I here people say “I’ve had this pain for ten years and I guess I just have to live with it.” Ten years, ten days, ten minutes is too long to live with pain. With a balance of form and function, exercise and nutrition, good mental focus and outlook we should all be smiling and enjoying life to the fullest. Remember, The effectiveness of Neuromuscular Therapy lies in the efficiency of the therapist, the thoroughness of the exam and the precision of determining the muscles in dysfunction. At Atlantic Corrective Therapy & Massage we have an extensive client education video lending library for anyone who is interested in learning more about how Neuromuscular Therapy can help you in your quest to be pain free. During July 2007 we are offering free postural analysis for new clients to our new East Hampton office! The exam should take no more than 30 minutes and will be by appointment only on Tuesdays and Thursdays. Robert Bonavolta is a licensed massage therapist specializing in Neuromuscular Therapy focusing on chronic pain management and sports injuries. He is also an AFAA certified personal trainer and a certified Spinning® instructor. For more information appointments and Spinning class schedule call the Montauk Wellness Center and Atlantic Corrective Therapy and Massage at 631-668-0300 or visit the office at 6 South Elmwood Avenue along with Local Beauty with Maureen Jacob, LE, offering corrective skin care, facials, peels, waxing, spray tanning and massage as well as local arts and crafts and skin care products. And now also in East Hampton 9 N. Main St 631-764-3938. Visit us at www.montaukwellnesscenter.com
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MONTAUK COLUMNS

Sacroiliac Joint Disfunction
by Robert Bonavolta, LMT, NMT

Any pain emanating from the low back, gluteals, or legs was usually branded as SI Joint (Sacro Iliac Joint) syndrome until an article in the New England Journal of Medicine in the 1930’s on disc lesions changed that and brought about decades of surgeries and put the blame on sciatica. There were limited clinical studies confirming SI Joint dysfunction although many manual therapists continued to treat this disorder with some success. No one could put forward a convincing theory explaining how the sacrum could become “stuck” between two hip bones. It was difficult to imagine how a joint with so little movement could cause so much pain and we manual therapists countered that it was its limited motion that was vital to spinal function. The SI joint controversy continued through the 1970’s until a manual therapeutic osteopath introduced a practical biomechanical model that clearly demonstrated normal and dysfunctional SI joint movement patterns occurring in most individuals.

Sacroiliac Joint syndrome was back as a viable diagnosis for low back pain. Since most SI joints only move 2-4 millimeters during weight bearing and forward bending, the joint glides as opposed to bend as in a hinge joint like the knee. The primary function of the joint is to provide shock absorption properties for the spine. Most of the movement comes from ligament stretching of the Iliolimbar ligament, the Sacrotuberous ligament, or the Lumbosacral ligament as well as the third joint of pelvis, the Pubic symphysis. . The muscles involved encompass the entire hip girdle and attachments to the femur bone and the iliums. When functioning in perfect harmony this opening and closing of this locking system, called force closure, allows for a smooth transference of body mass from one leg to another, balancing the weight during gait whether walking or running, absorbing both upward and downward forces and maintaining both mobility and stability.

It’s interesting to note that the greatest incidence of disabling back pain is between 25 and 45 years of age when the SI joint has the greatest degree of motion. As we age the joint can become stiff and permanently lock so it is important for manual therapists like Neuromuscular Therapists to recognize this and incorporate special techniques to mobilize the ligaments and muscles of the SI joint and create a more opened state and to maintain joint mobility, strengthen the stabilizer muscles, and maintain biomechanical efficiency.

Since muscles move bones it is key to determine which muscles are in dysfunction, recognize the trigger points and reverse the pain patterns. Typical SI pain patterns are muscle spasms, a feeling that something is stuck, weakness, tightness and the physical appearance of being bent over or crooked. A sustained isometric contraction of a muscle along with inflammation can cause a vicious cycle reflex arc to the brain further increasing the pain patterns and pelvic instability. Proper assessment and treatment protocols during a Neuromuscular evaluation is critical to determine the hips angle of rotation and/or the possibility of a leg length discrepancy which could contribute to the SI joints instability. Also it is important to recognize not only the SI joint in a dysfunctional pattern but also the hip joint capsule. Restrictions in the hip joint, especially in sports related activities can send radiating referral pain patterns throughout the body. Once optimal hip range of motion is restored and the sacral ligaments aligned, the body’s innate ability to correct the imbalances usually flow into pain free movements.

As a Neuromuscular Therapist dealing mainly in pain management and sports injuries I have come to recognize these pain patterns and the attending forces which contribute to the imbalance of the hip. This is where all movement begins. It is your center of gravity both front to back and side to side. For optimal health of the entire body the center must remain centered. Whether the pain pattern is migraine headaches, neck and shoulder pain knee or ankle pain we always look at the center. Checking gait pattern and hip flexion and extension is vital for proper assessment and treatment outline.

In conclusion, pain is not something anyone wants to live with yet I here people say “I’ve had this pain for ten years and I guess I just have to live with it.” Ten years, ten days, ten minutes is too long to live with pain. With a balance of form and function, exercise and nutrition, good mental focus and outlook we should all be smiling and enjoying life to the fullest. Remember, The effectiveness of Neuromuscular Therapy lies in the efficiency of the therapist, the thoroughness of the exam and the precision of determining the muscles in dysfunction.

At Atlantic Corrective Therapy & Massage we have an extensive client education video lending library for anyone who is interested in learning more about how Neuromuscular Therapy can help you in your quest to be pain free. During July 2007 we are offering free postural analysis for new clients to our new East Hampton office! The exam should take no more than 30 minutes and will be by appointment only on Tuesdays and Thursdays.

Robert Bonavolta is a licensed massage therapist specializing in Neuromuscular Therapy focusing on chronic pain management and sports injuries. He is also an AFAA certified personal trainer and a certified Spinning® instructor. For more information appointments and Spinning class schedule call the Montauk Wellness Center and Atlantic Corrective Therapy and Massage at 631-668-0300 or visit the office at 6 South Elmwood Avenue along with Local Beauty with Maureen Jacob, LE, offering corrective skin care, facials, peels, waxing, spray tanning and massage as well as local arts and crafts and skin care products. And now also in East Hampton 9 N. Main St 631-764-3938. Visit us at www.montaukwellnesscenter.com

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MONTAUK COLUMNS

Sacroiliac Joint Disfunction by Robert Bonavolta, LMT, NMT

Sacroiliac Joint Disfunction
by Robert Bonavolta, LMT, NMT