Osteoarthritis Without Pain

By | February 10, 2019

3 Steps to Permanent Relief for SI Joint and Pelvic Pain

Today we are going to cover the 3 steps topermanent relief for pelvic and SI joint pain. Now what is SI joint painé The SI joint, ifyou do have SI joint pain, is pain on either side of the tailbone where the tailbone connectsto the pelvis. So this is a drawing of the pelvis. This is your tailbone. This isyour lumbar spine or your lower back, the bones in your lower back called vertebraesitting on top of your tailbone. Then on either side of that you have your right hip or yourleft hip if we are looking at a person from the front. When we see somebody with SI jointpain, they will typically have pain on that given side. 70% of the time, it is on theright side. Don't ask me why that is but

70% of the time we know it is on the right. You canalso get shooting groin pain, buttocks pain and symptoms down the outside of the leg thatis affected. It might be pain, numbness, tingling, burning. Typically, that personsuffers from a heaviness as well. It can also cause some incontinence and leaking issuesas along to effect sexual performance as well. It can be absolutely devastating ifthe pelvic problem is bad enough. Fortunately, most people just have pain on one side. Sowhat can you do about ité That person who has SI joint problems typically has troublerolling over in bed, getting in and out of a car, crossing one leg over the other. Usuallythey have trouble sitting for long periods

of time especially if it is on a couch or a softsurface. So it can be absolutely devastating. Now what are the steps to permanent relieffor thaté Number 1 is this. Most people when we seethem if they are going to try exercises on their own and they only have a little bitof SI joint pain or pelvic pain, they are doing stretches. Yes, there is a very basic stretchwhich most people show me on Day 1. It is a piriformis stretch which is where you grabthe knee and pull it up and across to the opposite shoulder. It will give the personwho suffers pelvic or SI joint problems and pain temporary relief. However, long termwe don't want to stretch. We want to

strengthen or stabilize. Why is thaté Whensomebody has an SI joint problem, so the center of gravity of your entire body is inthe center of your pelvis. That needs to move the right way and it needs to be stable whenyou are doing day to day activities. If it is not stable enough, what will happen is thejoint will move so far that it becomes stuck. So if we are looking at the tailbone, we havethe tailbone and we have the pelvis and you get a normal gliding day to day. If morestress, more force is put through the pelvis than the pelvis itself can handle, that SIjoint can handle, what will happen is you actually become stuck. Now that creates allsorts of problems for the muscle around it.

What most people do is try to stretch theirway out of it. The problem is not stretching and it is not flexibility. It is actuallya stability issue. If we want to stabilize, we need to do strengthening exercises. If you go on ourYouTube channel, on the Madden PT official YouTube channel, there is a tutorialcalled Top 3 Exercises for SI Joint and Pelvic Stability. They are very low grade, kindergartenlevelexercises where you can at least begin stabilizing the muscles that controlyour pelvis. But we don't want to stretch, we want to think stabilize. Step 2 is we want to take a look at our habits.So what are some habits that lead to

pelvic instability and problemsé Number oneis standing with the weight shifted. So if I'm standing like this with my weight shiftedside to side for long periods of time, what that does is over years and years and yearsit weakens the ligaments which are tissue that hold joints together that we can't control.Think about somebody with an ankle sprain. They sprained a ligament. They stretchedthe ligament but it is not a muscle. It is different than a muscle. There are littlehabits that we do. If I stand like this and let's say I weigh 175 pounds and if I'm standinglike this, I have 150 pounds on one side and 25 pounds on the other. Where if I'm standingbalanced, I have 87 ½ pounds on each


Osteo means “bone�, and arth refersto “arthron� which means joint, and itis means “inflammation�, so osteoarthritisis a disease involving inflammation of the bone and joint cartilage. It was once thought that the “itis� partof osteoarthritis was a misnomer, and that inflammation didn't play a role in its development,and that it was mostly a degenerative disease resulting from simple “wear and tear�. Nowadays, it's thought that inflammationdoes indeed play an important role in the development of osteoarthritis.

Alright, so a healthy joint consists of twobones, each with its own layer of articular cartilage, which is a type of connective tissuethat allows the two bones to glide against each other essentially without friction. With Osteoarthritis, we're really talkingabout one particular kind of joint which is a synovial joint. Along with articular cartilage, another importantcomponent of synovial joints, and where they get their name from, is the synovium, whichalong with the surface of the articular cartilage, forms the inner lining of the joint space.

The synovium's composed of loose connectivetissue, blood vessels, lymphatic vessels, and on the surface—�Type A� cells thatclear cellular debris and “Type B� cells that produce components of synovial fluid,which helps lubricate the two articular surfaces. One of the main issues in osteoarthritis isthe progressive loss of this articular cartilage, which means there's not much separatingthe two bones anymore, which adds a significant amount of friction between them, which thengenerates inflammation, and triggers pain through the nerve endings in this joint space. Maintaining healthy articular cartilage isthe chondrocyte's job, a specialized cell

responsible for maintaining everything cartilagerelated. The chondrocytes produce and are embeddedwithin a strong gel or extracellular matrix which contains type II collagen, a proteinthat provides structural support, as well as proteoglycans, which are aggregates ofprotein and sugar molecules like as hyaluronic acid, chondroitin sulfate, and keratin sulfate. All of these extracellular components givethe cartilage elasticity and high tensile strength, which help weightbearing jointsdistribute weight such that the underlying bone absorbs the shock and weight, and theseare joints like the knees, hips, and the lower

lumbar spine. Okay, so chondrocytes are important for thearticular cartilage, got it. That makes sense. In healthy people, chondrocytes maintain adelicate balance between breaking down old cartilage—called catabolic activity, andproducing new cartilage—called anabolic activity, through the use of both degradativeenzymes and synthetic enzymes. When something causes an increased expressionof degradative enzymes, then the balance tips toward a net loss of cartilage, via loss ofproteoglycans and collagen.

What sort of something though can cause anincreased expression of degradative enzymesé That's the million dollar question, righté And the answer isn't super straight forward. The biggest risk factor for osteoarthritisseems to be age, and often the cartilage degrades over longer periods of time, which makes itreally hard to pinpoint one single culprit. As I mentioned earlier, inflammation alsoseems to be involved, and there are a number of proinflammatory cytokines like IL1, IL6,and TNF, among others, that seem to play a role.

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