Stabilisation des ligaments sacro-iliaque pour éliminer les douleurs musculaires généralisées

A-K. Research Paper June 1992

I.C.A.K. Seminar 1993

SUBJET SACRO-ILIAC SUPPORT Versus STRUCTURAL STABILISATION and ELIMINATION of MYALGIA.

by Gilles G. Brisson D.C.

ABSTRACT

Belting of the sacro-iliac joint will permit the stabilisation of all the musculo-squelettal structures, thus eliminating different myalgia throughout the body and giving a better muscle utilisation by the elimination of incorrect recrutement.

Reinforcement of the proper muscle related to the S.-.I. joint, and the stabilisation of the other muscles related to the pelvis will be necessary, to insure a permanent and strong support to the body structure.

INTRODUCTION

Treating many national and international athletes involved in different sports gave me the opportunity to find numerous injuries which wouldn't be that evident on the normal type of patient. The fact that their bodies are very finely tuned means that their capacity to recuperate seems to be accelerated. Using athletes to verify different therapeutic approaches is very helpful, because they can give us almost immediate feedback of the body's reaction to the intervention, by the way they feel during the performance / execution of their movement.

These unique experiences with athletes permitted me to apply the acquired knowledge to my regular patients. This research paper is just one of its applications.


DISCUSSION

Many sports or exercises demand the utilisation of the buttock muscles. It seems, however, that they are not properly solicited, because there is recruitment of, or compensation by, the synergistic muscles such as the sacro-spinalis, the quadratus lumborum, and the gluteus medius. Hypertension of the psoas, and the rectus femoris may also explain this inadequate usage of the buttock muscles.

Single or multiple trauma might be the cause of certain sacro-iliac instabilities. In the example of gymnasts who often fall on their buttocks, or the woman who has recently delivered .a baby, one observes that the pelvis opens like a butterfly and does not return to it's original position.

I quite often find patients with a complete and partial atrophy of the gluteus maximus; this being unilaterally or bilaterally.

People who must repeatedly perform lifting movements while bending their knees, put a great deal of tension on their quadriceps. This will lead the pelvis to move to an anterior position. As a result, the gluteus muscle will not be in such demand, and will start to diminish in size and power. The same principle applies to people who do not push off with their back leg when walking in order to propels themselves. To determine pelvis instability, many parameters will be used.

1-OBSERVATION

  • Gluteus maximus and medius atrophy : unilateral / bilateral.
  • Piriformis muscles weakness : bilateral.
  • Muscular hypotonicity
  • Lumbar hyperlordosis and shifting of the pelvis anteriorly
  • Hypertrophy of the sacrospinalis muscles unilaterally/bilaterally
  • Testing the Gluteus maximus -Extention of the thigh (trying to contract the gluteus maximus )
  • The leg and thigh segments move laterally.

2-PALPATION

  • Pain on the pubic bone.
  • Pain at sacro-iliac ligaments.
  • Pain in all muscles which are responsible for pelvic support and for the stabilisation of the spine anteriorly and posteriorly.
  • The pain is alleviated after performing the strain counter-strain technique, but comes back in a matter of minutes by itself, or if the patient changes positions.

3-MUSCLE TESTING.

  • Weakness of the gluteus medius bilaterally.
  • Weakness of the gluteus maximus tested normally, or 2-3 times in a row ( be careful when you bring the muscle to the testing position, that the thigh segment doesn`t go laterally- even slightly. Watch carefully for recruitment of the hamstring and gluteus medius ).
  • Adductor weakness- bilaterally, supine and/or sitting.
  • Patient prone: a strong muscle indicator will become weak upon manuel and constant pressure at the sacro-iliac joint.
  • Muscle testing verification for fascia involvement of the Psoas, Quadratus lumborum, Rectus femoris, Piriformis and adductor muscles.

4- OTHERS

  • Recurring subluxation, fixations, imbrication, disc compression.
  • Sacral and sacro-coccyx instability .
  • The patient complains of pain when he/she is maintaining the same position for a while; sitting, standing or lying down.
  • The patient has been diagnosed as having pubalgia. This problem has been found frequently in soccer players and in woman in their late phase of pregnancy or post-delivery.

If you find in your examination any of these parameters you should suspect an instability of the pelvis, due to hyperlaxity of the pelvic ligaments.

The best way to stabilize the pelvis is by the use of a belt.

PROCEDURE OF A SACRO-ILIAC SUPPORT.AND STABILISATION

A belt of 1 1/2 inches, or a thoracic band support should be utilized.

It should be worn around the hips at the level of the depression, and wrap around the buttock muscles half way between the origin and insertion .

The support should be tightened until the pain on the pubic bone disappears, and this, in the three different positions: lying, sitting, and standing. If certain signs or symptoms appear when the patient is asleep, or in the morning before getting up, the support should be worn during the night in addition to the entire day. This will give the ligaments of the sacro-iliac area time to heal and to regain their original strength.

Length of time to wear the support:

  • 23 1/2 hours a day for 10 days . -If any symptoms appear at night or in the morning when the patient is still in bed or just getting out of bed.
  • During the entire day for the following 15 days.
  • While the patient is wearing the support to stabilize the pelvis, it is necessary to get the musculo-sqelettal relationship functioning properly once again.

The muscles to be evaluated are :

RECTUS FEMORIS , ADDUCTORS , HAMSTRINGS.,

PSOAS , QUADRATUS LUMBORUM , PIRIFORMIS

These muscles should be investigated for :

STRAIN COUNTERSTRAIN, FASCIAL FLUSH, REACTIVE MUSCLE PATTERN.

Specific reinforcement exercises have to be performed for the GLUTEUS MAXIMUS, the GLUTEUS MEDIUS, PIRIFORMIS, and possibly the ABDOMINALS.

The structures to be evaluated and corrected are:

  • Category II
  • CategoryI
  • Sacral-wobble inspiration/expiration
  • Sacro-coccyx
  • Disc compression
  • Facet involvement
  • Subluxation
  • Sacro-occiput relationship
  • Associated cranial faults
  • Gait and synchronization
  • The procedure name ''ligament interlink'' as to be perform on the sacro-iliac ligaments.
  • Sacro-iliac ligament versus costal cartilage.

It is very important to rebalance the different types of affectations which you might find on the above-mentioned muscles and osseus structures. The sacro-iliac support will only help to relieve the symptoms and signs which you find in your examination.

Of course, the stabilisation of the sacro-iliac joint by means of the support will permit the ligaments to heal only if proper supplementation is given, and if the instructions as to how to wear the support are followed.

However, the mere fact that the patient is wearing the belt will not suffice, because as soon as he or she takes off the support, the same muscle pattern will start to develop again, and the same, or another problem will appear.

Different types of exercises may be used to get the Gluteus maximus muscle back into shape. In the first place, one has to evaluate the type of patient he is dealing with, whether it be an athlete whose sport requires force, resistance, and/or endurance, or a person who has to work long hours standing up or sitting down. One must then evaluate the degree of weakness associated with the atrophy of the muscle. Is it complete atrophy, or only a section of the muscle which is weak ?

There exists a wide range of specific exercises from which to choose; from isometric to isotonic, from power to resistance-type exercises, from dynamic to more passive-like exercises. The type of exercise which you will choose for your patient has to be appropriate to the type of work or the sport he is involved in.

When the sacro-iliac joint is stabilized by the reinforcement of the ligaments and muscles, the dural sheath, which, as you know, attaches at the sacral level will be supported even more, and will be able to work the way it was designed to.

Some have criticized that belting the pelvis will interfere with the normal and crucial sacro-coccygeal pump. Since the procedure is temporary, it should not cause any disturbance to the pumping effect, but rather regularize a wobbling movement of the sacrum due to the instability of the ligaments.

Of course, the tension used to belt the patient should not be such that it strangles the pelvis .

NUTRITION

As for any weakness/instability of joints due to poor ligament support, manganese and B12 / LIGAPLEX 1 should be evaluated as a supplementation to help the healing of these ligaments. Very often patients who exibit ligament laxities have been under different kinds of stress, so adrenal evaluation should be carried out. More times than not, we find an involvement of these glands related to the ligament weaknesses.

CONCLUSION

The author could have included all of the statistics that he has accumulated to classify the types of problems which have been alleviated and cured by the stabilisation of the sacro-iliac joint, but the procedure would have taken up too much space, and from experience, a very small percentage of readers would be interested in it .

After examining and treating various kinds of injuries, whether they be acute or chronic, the author found that if one does not correct, stabilise, and reinforce the pelvic area when there is an instability of the pelvis (due to poor ligament and muscle support), any attempt to correct the initial problem will bring only temporary results. Furthermore, the original problem may come back, or even move to some other area in the body; ( e.g.: going from one shoulder to mid-thoracic area, to a headache, or pain shifting from one side of the pelvis to the other etc).

Sacro-iliac instability and weakness, even atrophy of the gluteus maximus due to the laxicity of the ligaments is/are the underlying cause(s) of many injuries, as well as the occurance of myalgia which can not be specifically related to a trauma or an accident, but which appeared gradually.


For any type of problem experienced by the patient, who, after some time does not recuperate adequately or does not show improvement, an evaluation should be made for any type of sacro-iliac instability, and the procedure of treatment as explained previously should.be carried out.

In your practice, you should pay close attention to the stability of the pelvis with relation to: 1: different kinds of myalgia throughout the body. 2.: any returning fault that you have been working to eliminate, or 3.: any problem which seems to move from one area to another .


REFERENCES:

Leaf, David, D.C., D.I.C.A.K., Seminar in Advanced A.K., Montreal, Quebec, CANADA, 1990-91

Walther, David, D.C., D.I.C.A.K., Applied Kinesiology Synopsis, Systems D.C., 1988.

Spine Power Belting system, The Posture Research Foundation, 261 Davenport Road, #301, Toronto, Ontario, M5R 1K3 .

 



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