July 30, 2025 • 22 mins
Persistent back pain doesn't just appear out of nowhere. For active individuals, the sacroiliac (SI) joint often lurks as the hidden culprit behind nagging discomfort that's mistakenly attributed to hamstring strains, general back problems, or even hip issues.
The sacroiliac joint—where your sacrum (tailbone) meets your ilium (pelvis)—plays a crucial role in transferring forces between your upper body and lower extremities. Despite only moving millimeters, its proper function is vital for pain-free movement in running, lunging, and virtually all athletic activities. When muscle imbalances create asymmetrical forces across the pelvis, the SI joint can be gradually pulled into dysfunction, creating abnormal stresses and subsequent pain.
This podcast delves into the biomechanics of SI joint dysfunction, exploring how large muscle groups like the psoas, quadratus lumborum, erector spinae, and gluteal muscles influence pelvic positioning. Youth athletes with developing coordination and postpartum women affected by hormonal changes are particularly susceptible to these issues. The episode highlights a revealing case study of a 17-year-old football player whose persistent "hamstring pain" completely resolved with SI joint treatment—without ever touching the hamstring itself.
Most importantly, you'll discover why the missing link in treating SI joint dysfunction is proper manual therapy combined with targeted soft tissue work and specific corrective exercises. Many athletes suffer needlessly, missing valuable playing time while pursuing ineffective treatments that focus on symptoms rather than addressing the root biomechanical cause.
Whether you're an active individual battling persistent pain or a healthcare provider looking to better serve your athletic patients, this episode provides crucial insights that could transform your approach to back pain. Reach out to us if you're struggling with stubborn pain that conventional treatments haven't resolved—because there's no reason why healthy individuals should be sidelined by pain that has a clear biomechanical solution.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
If you're a driven, active person who wants to reach
and pursue a higher qualitylife with some ambition, then
guess what this podcast is foryou.
This is the Driven AthletePodcast.
What's up y'all?
Welcome back to the DrivenAthlete Podcast.
This one is mainly just superfocused on the sacroiliac joint,
(00:21):
the SIJ, the SI joint.
So the sacrum is the tailbone,all right, and the ilium is one
of the bones of your pelvis.
So in the back of the pelvis,against your tailbone, the ilium
articulates with the sacrum,all right, and there's a little
bit of movement there.
That's been documented heavilyin the research and literature
(00:45):
for cadaveric studies and allthe literature, studies and
research.
So there is a little bit ofmovement there.
It's millimeters, it's tiny,but it has a key.
It's a key player with takingforces through your leg with
like running and lunges andstep-ups and Bulgarian split
squats and and golf, like insports and lacrosse, like
(01:06):
everything sports.
So the sacroiliac joint, it'san articulation of the pelvis
and the tailbone and your backand it's a big source of pain.
It's a common source andculprit of a pain generating
(01:26):
area.
The pain generating source isthe sacroiliac joint and the
question is like why?
So let me explain this Do youhave a ton of.
It's a big joint.
There's big bones and bigmuscles that connect from your
hip to your pelvis to yourtailbone, from your lumbar spine
(01:48):
, just above the sacroiliacjoint, your spine, just above
your tailbone, you have a ton ofmuscles that articulate and
connect above and below and youalso have large ligaments that
also connect of your sacroiliacjoint, your sacrum, to your
pelvis and there's a lot ofinterplay of those muscles and
joints of the hip, the knee, theankle and then also above in
(02:10):
your spine.
So the sacroiliac joint is justa common pain generator source
that we have to investigate.
We wouldn't be doing our joband leave any stones unturned if
we didn't investigate thesacroiliac joint.
When somebody comes in with painin their back, all right.
When somebody comes in withpain in their back and they come
see us say, hey, doc, I got apain in my back, it's been going
(02:31):
on my swing, we're like thethree working hypotheses that we
have is is it coming from thelumbar spine, is it coming from
the sacroiliac joint, or does itcome from the hip, from the
sacroiliac joint or does it comefrom the hip?
So those three things we haveto weigh first, all right.
And then when we ask questionsand we get a good idea of what's
causing the pain and why andwhat generates it with their
(02:53):
activity, looking at theirmovement patterns, their range
of motion and palpation, allthose things combined is what
hones us into a diagnosis and inthis case, if it's a sacroiliac
joint, we're going to takeaction.
So we have to figure out whatarea, which direction is the
sacroiliac joint involved anddysfunctional, and how are we
(03:15):
going to intervene.
So the sacroiliac joint, like Isaid, there's a lot of large
muscles that connect to it.
In the front we have our psoasmuscle.
It's our iliopsoas muscle.
It connects to the lessertrochanter of your femur and it
originates from the psoas belly,from lumbar vertebrae L234.
(03:36):
And then the iliacus originatesfrom the ventral side of the
ilium and those two musclesconverge to one insertion point
at the lesser trochanter of yourfemur and that's just a major
player with like forceproduction for hip flexion and
trunk flexion.
So like maybe, like imaginedoing a V-up or a sit-up or a
crunch, the psoas is heavilyinvolved with making that action
(03:57):
happen.
Or a runner, as they run andthey're driving their knee up
for running, the psoas is a keyplayer with that, all right.
So the psoas is a key playerwith that, all right, so the
psoas is one of them.
The quadratus lumborum is oneof them.
That's a muscle in the back, onthe side, like on the lowest
lower side of your lumbar areain your back, and that connects
from your lumbar vertebrae andyour 12th rib to your iliac
(04:18):
crest.
All right, so that is anotherkey player.
Um, all the erector groupmuscles, multifidus,
longissimissimus iliacostalis,and then the spinalis also plays
a role because that connects toyour tailbone, your sacrum and
then down in the hip.
I mean you have all your glutemuscles.
There's actually six musclesthat insert onto the greater
trochanter of your femur thatoriginate from the ilium in the
(04:40):
pelvis or into the sacrum.
So I mean there's like a ton ofbig muscles that create a lot
of force production through yourhips and your pelvis and your
and your lumbar spine.
So imagine if somebody has lowback pain with split squats,
lunging, running, agility,changing directions.
(05:01):
In the demographic that'sreally's really seems to be,
it's just very commonplace isyouth athletes, because they're
still usually not as coordinated.
The stability isn't top notchlump core stability, hip
stability, pelvic stability.
It's not exactly as good as itcould be right, not a pro
(05:24):
athlete if they're 16 years old,15 years old, 18 years old,
right, and there's a lot offorce being put through their
ground, reaction forces andimpact forces through their leg
that translates up through theirpelvis and their low back and
their hip.
That repetitively accumulatesand can create issues.
All right, imagine, with thatthere's muscle activation and
(05:49):
recruitment disparities.
Some muscles can be verydominant and naturally strong
and then also in the body, othermuscles that are working just
hand in hand with them, thosemuscles can be maybe more
dormant and not as readilyrecruitable and activated.
All right, that's what would bea muscle imbalance.
When we say like muscleimbalances, that's what you mean
.
It's a neural, muscular, neuralrecruitment problem.
(06:11):
It's a neural, muscular, neuralrecruitment problem.
It's a neural problem, it's arecruitment issue is what we
would say.
It's not like a strengthproblem, because we've seen
plenty of people that squat over300 pounds, 400 pounds, and
they have SI joint pain, theyhave sacroiliac joint issues and
they're like well, you're weak,but no one likes hearing that.
(06:32):
But it's not like they're weak,it's just that they have a
disparity in recruitment ofthese muscles that are key
players in this region of yourback, your hip and your pelvis.
So imagine if an athlete, anactive person, also to
postpartum moms this is also asuper common thing sick or iliac
dysfunction, just becauseinstability is really common
(06:55):
after pregnancy and the birthingprocess is super.
It's tremendous, it'sincredible and there's a lot of
trauma that's involved.
There's traumatic changes thathappen and with that women are
already naturally a little bitmore unstable.
They're more mobile than men.
(07:20):
Men are usually stiff and tight.
Women are usually like a commonplace that they're more mobile,
so they're set up for moredysfunction in these kind of
areas, especially when they doactive activities, lifestyle
activities, and also withpregnant women, there's a
hormone relaxin that is flowingthrough to accommodate the
growth and the changes in theirjoints and their bones,
(07:40):
articulations and the muscles toallow things to expand and then
also facilitate the birthingprocess, and that just sets up
things for being reallyhypermobile.
Okay, so stability is reallyimportant for them.
So imagine you have an activeperson or a mom that they want
to exercise and they're doingtheir thing and they have back
(08:02):
pain on one side of their back,right in their tailbone, on the
right side or the left side, andit's just been progressively
getting worse and they'reputting a lot of forces through
their legs.
When they do lunges and whenthey do squats and when they jog
and they run, there's a lot offorces being placed through
their hips.
Side to side, things canaccumulate.
And if some muscles are verystrong and dominant and other
(08:25):
muscles are more dormant and notrecruitable and they're working
through those disparities inmuscle recruitment, those muscle
imbalances, what do you thinkis going to happen?
Joints are going to get tuggedon in specific directions over
and over and over again, becausethey're getting pulled in one
way and the other ones thatcounteract that aren't helping
enough.
So they're getting pulled inone direction over and over
(08:47):
again.
The sacroiliac joint, the pelvis, can get influenced to be more
asymmetrical and dysfunctional,going one direction or the other
direction.
It could be rotated a littlebit forward or anteriorly or it
could be rotated posteriorly.
The sacrum can also rotate alittle bit side to side and that
would be like sacral torsion,which we don't get into in
(09:08):
biomechanics.
On that, but just painting apicture that there's large
muscle groups that are pullingand tugging and influencing the
sacroiliac joint to be pushed ortugged in one direction or the
other over many, manyaccumulated events and that can
lead to.
I don't know what's going on.
My back hurts.
I didn't like fall or get in acar accident, but now my back's
been hurting for a couple ofweeks now and it's just getting
(09:30):
worse and I can't run orwhatever, right, so that's a
common thing we hear all thetime.
So if you're battling this pain, please don't hesitate to reach
out.
This is like this is our breadand butter man.
This is what we do.
So sacroiliac joint dysfunctioncan accumulate and it just gets
worse.
But that disparity in strengthrecruitment, that's what we have
(09:52):
to fix too.
All right, so how do you fixthis?
Let me one more time, one morething.
What does it feel like?
All right, so how do wediagnose this?
Well, we ask them a lot ofquestions.
Where is the pain located?
What does it feel like?
What makes it hurt worse?
What makes it feel better?
What does it feel like?
What makes it hurt worse?
What makes it feel better?
What does it feel like when yousleep?
Any exercises in particularmake it hurt worse.
(10:13):
Was there a time recently whereit was like that was the pain?
How's it feeling right now?
All right, let's take it througha range of motion.
When you bend over a lumbarrange of motion, hip range of
motion testing, functionalmovement testing, and we're
looking at their mechanics andwhere we're noticing our
(10:33):
compensations are at.
And then we go throughobjective orthopedic tests.
When we purposely try to shearor provoke symptoms, we can
isolate like, oh, this rules itin or rules it out, ruling in a
diagnosis versus ruling out adiagnosis, and then palpation
and all of that kind of combinedwould be a part of the, would
be the evaluation and that helpsus determine, like where the
pain is, what the problem is andthen why it's based on what
you're telling me, why itstarted, how are we going to fix
(10:55):
it and then how are we going tokeep it from coming back.
That's the recipe, all right.
That's like an evaluation.
So, based off of that isdetermining, like what we're
going to do, right.
So what do we do?
What's the recipe?
To fix a sacroiliac dysfunction?
We have to intervene manually.
To fix a sacroiliac dysfunction, we have to intervene manual.
I think the missing link ismanual therapy.
We have to fix thebiomechanical problem.
(11:16):
It's a biomechanical problemand that needs a mechanical fix,
all right.
So the mechanical fix is manualtherapy and we have to put it
back in a more symmetrical pathplane.
All right, we have to put itback in a more symmetrical way.
And then, after intervening withmanual therapy, we have to
follow up with soft tissue, withsome of the muscles that are
(11:38):
going to be really guarded andtense because of this position
change that's been going on fora couple of weeks now or months.
So imagine the sacroiliac jointthere's a position change.
What do you think the musclesare going to be like where that
are connecting to those areasthat are not lined up as much as
they could be?
Right, they're not symmetricallike they should be.
What do you think the musclesare going to be like when they
(11:58):
connect to that altered position?
They're going to be guarded, sothey're going to be tight and
guarded, or they're going to bechronically over, lengthened and
that length, tensionrelationship in the muscle
tissue and ligaments is going tocause pain and that's's part of
it too, right?
So we have to fix thatbiomechanical fault position
(12:18):
problem first with a mechanicalsolution, which is manual
therapy, and then we follow upwith soft tissue.
That's relevant, which where weat the clinicians that come and
mentor with me and for afellowship, training and stuff,
and we ask them we had.
We always act like we'regrilling them, like what is your
?
We get to back this up with abiomechanical rationale why are
you choosing this intervention?
Why would you not choose thisintervention?
(12:39):
And then to give a clear answerof a rationale, biomechanically
, of why they're choosing onething versus the other.
So we do soft tissue work afterthe joint intervention to get
the length, once the lengthtension relationship is better,
and then get the muscle guardingjust to settle down and make
(13:00):
things more pliable and withhyaluronic acid, blood flow and
getting fibers to be morealigned in parallel so they can
glide better for pliability andin blood flow right.
Dry needling can be reallyhelpful as an intervention on
that as well, with stripping andcupping.
Those are our go-tos.
Okay, all right, then we setthings up for success and we've
(13:23):
maybe positioned things from asoft tissue and a joint
standpoint better.
At this point we stand peopleup and we say let's retest the
thing, the movements that madeit hurt 15 minutes ago or 20
minutes ago when you first camein after before we did this
manual therapy stuff and theyretest and they feel better.
It's like perfect, we're on theright path.
(13:44):
So this is actually a reallycommon thing we just had.
This has happened to handmultiple times An active person
comes.
In this particular case, thisathlete was a 17-year-old
football player in a local highschool that was having chronic
hamstring strains and we werelike, did you change anything?
(14:08):
Like did you feel a pop in yourhamstring?
We're doing all these hamstringtests just to rule it out, to
do our due diligence.
And all of them were negative.
No, no, no, no.
Hamstring really wasn't in thattender to touch.
We couldn't.
If somebody pulled theirhamstring like it's going to
hurt with like resisting ahamstring curl, he had no pain.
So it's not the hamstring, butit feels like the hamstring.
(14:30):
All right, we got to investigateupstream up the kinetic chain
and anyway, going into this, myhypothesis was I bet it's going
to be sacroiliac joint.
That's my first thing, my firstworking hypothesis.
You have a 17-year-old withinsidious onset, low back
tightness and a hamstring pain.
All right, my first hypothesisand he's an athlete with
(14:51):
football, I'm like my firstworking hypothesis of diagnosis
is going to be sacroiliac joint,followed by lumbar spine
referred pain followed by alegit hamstring right.
That's my third workinghypothesis.
I don't think it's hamstring.
When he comes in, rule out it'snot hamstring.
His resisted hamstring curldidn't hurt.
(15:14):
Hamstring palpation doesn'thurt, it's just tight.
That's not right at the origin,right at the insertion, right
at the belly, all the placesthat'll be hot, not so it's not
the hamstring.
And then we start testing.
With all this being said too,we're testing his moving
patterns and his range of motionand all the stuff we mentioned
before and some special tests oforthopedics.
(15:35):
This is his SIJ.
It was his sacroiliac joint.
We intervened, manual therapyto get it more symmetrical and
positioned in a moreadvantageous position and we
didn't even touch his hamstring,we just intervened at the
sacroiliac joint of his pelvis.
We just intervened at thesacroiliac joint of his pelvis.
We stood him back up and weretested the range of motion
testing that caused it toincrease symptoms.
(15:56):
When he first came in he had nopain, he was better and we
didn't even touch the hamstringand we educated.
We're like his dad was thereand he was there.
We didn't even touch thehamstring and your hamstring
feels better.
It's because the hamstringwasn't the problem.
The hamstring was actuallychronically lengthened because
(16:18):
of the difference in length,tension, relationship,
positioning from the sacroiliacjoint, because the hamstring
attaches to the pelvis.
It doesn't attach to your femuror isn't originate from the
femur.
Only one part of a small muscleattaches from the femur of the
hamstring group and that's theshort head of the biceps and
that's not a huge key player tobegin with, but anyway, that's
beside the point.
It originates from the ischialtuberosity of your pelvis.
(16:39):
So we didn't even touch thehamstring and he felt better.
So we're accurate.
Let's continue this trajectory.
We're pretty confident.
We're confident.
This sacroiliac joint.
Now let's solidify these changeswith corrective exercises.
We have to stabilize the pelvis, the lumbopelvic region, your
hip and your glutes and yourcore, and sometimes the psoas
(17:01):
needs to be strengthened too.
It can be shortened and weak,not just lengthened and weak, or
shortened and guarded and tightand overly strong.
It could be either one of those.
We have to figure that out.
But anyway, in this particularsituation we needed to stabilize
and strengthen this lumbarpelvic region, some core
stability, and we do that withsling exercises, all right.
(17:21):
So the sacroiliac joint if youconsider all the key players
that attach to the sacroiliacjoint and the pelvis and the
tailbone, the sacrum, there'slots of muscles that span
multiple joints from multipleareas that we would call slings
and they globally stabilize thepelvis.
(17:41):
All right with translationalforces and translational
activity like sprinting andlunges and box jumps and agility
and changing directions andlateral movement stuff like that
.
So core stability and slingexercises and glute activation,
that seems to be the best recipeto fix underlying sacroiliac
joint dysfunction and pain.
(18:02):
But imagine if somebody justcame in and they were like my
hamstring hurts, and thensomebody, a clinician, just was
like oh, let's work on yourhamstring and they don't touch
the sacroiliac joint becausethat was the problem.
What does that look like?
I'd tell you exactly what itlooks like.
The athlete doesn't get better.
They just massage theirhamstring.
They're stretching the heck outof their hamstrings.
(18:25):
And stretching their hamstringsis not the problem.
It's actually alreadychronically over-lengthened, so
stretching might be making itworse.
So we didn't stretch hishamstrings at all.
You don't need to stretch andwarm up before you play, but
that's not the pathology.
Hamstring tightness isn't yourpathology.
We're going to focus ourefforts and treat other things.
But that leads to if someonejust does that and they're not
(18:46):
investigating an underlying rootcause like the sacroiliac joint
dysfunction, them not gettingbetter, an underlying root cause
like the sacroiliac jointdysfunction, them not getting
better, and they're justhobbling around, meandering
around at these practices, notbeing able to practice, not
being able to play and this iswhere we live vicariously
through our patients, and we getit.
And that's where we'repassionate about what we do is
because there's a short windowof opportunity for athletes to
(19:07):
showcase themselves and enjoythe process of playing sports
with your friends and stuff.
A lot of developmental benefitscome from sports and there's a
short window of time thatathletes can do that and if
they're hobbled and disabled bypain and an issue, it's going to
shorten that window and they'renot going to be able to play as
(19:27):
much and the opportunity isover.
I've had plenty of teammatesand athletes and my friends in
the past that they had some kindof pain that just didn't go
away and they were justlingering and meandering around
like I'm waiting for this docvisit.
I'm waiting for this image.
My trainer told me to rest thisPT that I'm seeing, told me to
ice it.
I'm stretching my hamstring.
I'm not better, I can't play.
Coach is like hey, when are yougoing to play?
Sorry coach, sorry coach, I'mnot ready yet.
(19:48):
I can't play.
Like well, it still hurts.
Well, you're up some dirt on it.
Play anyway.
It's like I want to what do youthink?
You know, all the teammates arelike hey buddy, when are you
coming back?
Hey man, we need you.
When are you coming back?
I want to, I want that's whatthat happens, and it sucks.
I've been there.
It's like I'm trying everythingI can.
That's why we're passionate andenthusiastic about what we do
(20:10):
is because we understand thatand we've been there, I
definitely have, and that's whyI like doing this there is an
answer and there is a solution.
As long as the underlyingsystemic red flags are ruled out
, then it's a neuromuscular,biomechanical problem and that's
what we do, so let's get afterit.
We have to diagnose youaccurately, and that changes the
trajectory and the lens inwhich we perceive this diagnosis
(20:31):
, changes the trajectory oftreatment and of how we're going
to fix it.
All right, and the question weasked our fellowship trained
docs of physical therapy thatcome train with me as mentees.
I asked them when you intervenelike this, are they progressing
?
And then, if they return backto their sport, is the pain
coming back?
If they were like, hey, dressout and play 100%, is the pain
(20:54):
returning?
If yes, then you didn't fix theproblem.
It was an inaccurate diagnosisand we had to fix the problem or
the interventions weren'taccurate.
Either one of those.
But let's deep dive, let'sfigure this out.
We have to dive into the matter.
But there is a solution.
And things don't just hurt forno reason.
And there's no reason why ahealthy individual who doesn't
have any other underlying redflags and systemic problems
(21:17):
should be hampered by painthat's not getting better.
It's neuromusculoskeletal andthat's the problem.
That requires a biomechanical,movement-based diagnosis to fix
it.
Combination of manual therapy,soft tissue work and corrective
exercises to fix the underlyingcompensation patterns.
And that's how they get better.
So if you have any questions,man, reach out.
We want to help you.
(21:37):
We're always open to comments,questions, concerns, conflicting
opinions.
If you have any suggestions onthis podcast, man, I'm always
open for ideas and if you'rebattling any pain or if you know
anybody, please share this.
We'd love to help them.
We can at least talk on thephone and see what's going on
and then, uh, at least maybedirect them to somewhere else.
Right, we might not be alwaysbe the right people, and we can
at least talk on the phone andgive them some insights.
(21:58):
So don't hesitate to reach out.
Call us at 5, 6, 1, 8, 9, 9, 87, 25, or email us at team, at
athlete rccom.
We're located here in West PalmBeach, right off Palm Beach
Lakes Boulevard, next to theTanger Outlet Mall, the Palm
Beach Outlet Mall, just east of95.
So we're right here, central.
So give us a shout and we'llcatch y'all next time.
If you're a driven, active person who wants to reach
and pursue a higher qualitylife with some ambition, then
guess what this podcast is foryou.
This is the Driven AthletePodcast.
What's up y'all?
Welcome back to the DrivenAthlete Podcast.
This one is mainly just superfocused on the sacroiliac joint,
(00:21):
the SIJ, the SI joint.
So the sacrum is the tailbone,all right, and the ilium is one
of the bones of your pelvis.
So in the back of the pelvis,against your tailbone, the ilium
articulates with the sacrum,all right, and there's a little
bit of movement there.
That's been documented heavilyin the research and literature
(00:45):
for cadaveric studies and allthe literature, studies and
research.
So there is a little bit ofmovement there.
It's millimeters, it's tiny,but it has a key.
It's a key player with takingforces through your leg with
like running and lunges andstep-ups and Bulgarian split
squats and and golf, like insports and lacrosse, like
(01:06):
everything sports.
So the sacroiliac joint, it'san articulation of the pelvis
and the tailbone and your backand it's a big source of pain.
It's a common source andculprit of a pain generating
(01:26):
area.
The pain generating source isthe sacroiliac joint and the
question is like why?
So let me explain this Do youhave a ton of.
It's a big joint.
There's big bones and bigmuscles that connect from your
hip to your pelvis to yourtailbone, from your lumbar spine
(01:48):
, just above the sacroiliacjoint, your spine, just above
your tailbone, you have a ton ofmuscles that articulate and
connect above and below and youalso have large ligaments that
also connect of your sacroiliacjoint, your sacrum, to your
pelvis and there's a lot ofinterplay of those muscles and
joints of the hip, the knee, theankle and then also above in
(02:10):
your spine.
So the sacroiliac joint is justa common pain generator source
that we have to investigate.
We wouldn't be doing our joband leave any stones unturned if
we didn't investigate thesacroiliac joint.
When somebody comes in with painin their back, all right.
When somebody comes in withpain in their back and they come
see us say, hey, doc, I got apain in my back, it's been going
(02:31):
on my swing, we're like thethree working hypotheses that we
have is is it coming from thelumbar spine, is it coming from
the sacroiliac joint, or does itcome from the hip, from the
sacroiliac joint or does it comefrom the hip?
So those three things we haveto weigh first, all right.
And then when we ask questionsand we get a good idea of what's
causing the pain and why andwhat generates it with their
(02:53):
activity, looking at theirmovement patterns, their range
of motion and palpation, allthose things combined is what
hones us into a diagnosis and inthis case, if it's a sacroiliac
joint, we're going to takeaction.
So we have to figure out whatarea, which direction is the
sacroiliac joint involved anddysfunctional, and how are we
(03:15):
going to intervene.
So the sacroiliac joint, like Isaid, there's a lot of large
muscles that connect to it.
In the front we have our psoasmuscle.
It's our iliopsoas muscle.
It connects to the lessertrochanter of your femur and it
originates from the psoas belly,from lumbar vertebrae L234.
(03:36):
And then the iliacus originatesfrom the ventral side of the
ilium and those two musclesconverge to one insertion point
at the lesser trochanter of yourfemur and that's just a major
player with like forceproduction for hip flexion and
trunk flexion.
So like maybe, like imaginedoing a V-up or a sit-up or a
crunch, the psoas is heavilyinvolved with making that action
(03:57):
happen.
Or a runner, as they run andthey're driving their knee up
for running, the psoas is a keyplayer with that, all right.
So the psoas is a key playerwith that, all right, so the
psoas is one of them.
The quadratus lumborum is oneof them.
That's a muscle in the back, onthe side, like on the lowest
lower side of your lumbar areain your back, and that connects
from your lumbar vertebrae andyour 12th rib to your iliac
(04:18):
crest.
All right, so that is anotherkey player.
Um, all the erector groupmuscles, multifidus,
longissimissimus iliacostalis,and then the spinalis also plays
a role because that connects toyour tailbone, your sacrum and
then down in the hip.
I mean you have all your glutemuscles.
There's actually six musclesthat insert onto the greater
trochanter of your femur thatoriginate from the ilium in the
(04:40):
pelvis or into the sacrum.
So I mean there's like a ton ofbig muscles that create a lot
of force production through yourhips and your pelvis and your
and your lumbar spine.
So imagine if somebody has lowback pain with split squats,
lunging, running, agility,changing directions.
(05:01):
In the demographic that'sreally's really seems to be,
it's just very commonplace isyouth athletes, because they're
still usually not as coordinated.
The stability isn't top notchlump core stability, hip
stability, pelvic stability.
It's not exactly as good as itcould be right, not a pro
(05:24):
athlete if they're 16 years old,15 years old, 18 years old,
right, and there's a lot offorce being put through their
ground, reaction forces andimpact forces through their leg
that translates up through theirpelvis and their low back and
their hip.
That repetitively accumulatesand can create issues.
All right, imagine, with thatthere's muscle activation and
(05:49):
recruitment disparities.
Some muscles can be verydominant and naturally strong
and then also in the body, othermuscles that are working just
hand in hand with them, thosemuscles can be maybe more
dormant and not as readilyrecruitable and activated.
All right, that's what would bea muscle imbalance.
When we say like muscleimbalances, that's what you mean
.
It's a neural, muscular, neuralrecruitment problem.
(06:11):
It's a neural, muscular, neuralrecruitment problem.
It's a neural problem, it's arecruitment issue is what we
would say.
It's not like a strengthproblem, because we've seen
plenty of people that squat over300 pounds, 400 pounds, and
they have SI joint pain, theyhave sacroiliac joint issues and
they're like well, you're weak,but no one likes hearing that.
(06:32):
But it's not like they're weak,it's just that they have a
disparity in recruitment ofthese muscles that are key
players in this region of yourback, your hip and your pelvis.
So imagine if an athlete, anactive person, also to
postpartum moms this is also asuper common thing sick or iliac
dysfunction, just becauseinstability is really common
(06:55):
after pregnancy and the birthingprocess is super.
It's tremendous, it'sincredible and there's a lot of
trauma that's involved.
There's traumatic changes thathappen and with that women are
already naturally a little bitmore unstable.
They're more mobile than men.
(07:20):
Men are usually stiff and tight.
Women are usually like a commonplace that they're more mobile,
so they're set up for moredysfunction in these kind of
areas, especially when they doactive activities, lifestyle
activities, and also withpregnant women, there's a
hormone relaxin that is flowingthrough to accommodate the
growth and the changes in theirjoints and their bones,
(07:40):
articulations and the muscles toallow things to expand and then
also facilitate the birthingprocess, and that just sets up
things for being reallyhypermobile.
Okay, so stability is reallyimportant for them.
So imagine you have an activeperson or a mom that they want
to exercise and they're doingtheir thing and they have back
(08:02):
pain on one side of their back,right in their tailbone, on the
right side or the left side, andit's just been progressively
getting worse and they'reputting a lot of forces through
their legs.
When they do lunges and whenthey do squats and when they jog
and they run, there's a lot offorces being placed through
their hips.
Side to side, things canaccumulate.
And if some muscles are verystrong and dominant and other
(08:25):
muscles are more dormant and notrecruitable and they're working
through those disparities inmuscle recruitment, those muscle
imbalances, what do you thinkis going to happen?
Joints are going to get tuggedon in specific directions over
and over and over again, becausethey're getting pulled in one
way and the other ones thatcounteract that aren't helping
enough.
So they're getting pulled inone direction over and over
(08:47):
again.
The sacroiliac joint, the pelvis, can get influenced to be more
asymmetrical and dysfunctional,going one direction or the other
direction.
It could be rotated a littlebit forward or anteriorly or it
could be rotated posteriorly.
The sacrum can also rotate alittle bit side to side and that
would be like sacral torsion,which we don't get into in
(09:08):
biomechanics.
On that, but just painting apicture that there's large
muscle groups that are pullingand tugging and influencing the
sacroiliac joint to be pushed ortugged in one direction or the
other over many, manyaccumulated events and that can
lead to.
I don't know what's going on.
My back hurts.
I didn't like fall or get in acar accident, but now my back's
been hurting for a couple ofweeks now and it's just getting
(09:30):
worse and I can't run orwhatever, right, so that's a
common thing we hear all thetime.
So if you're battling this pain, please don't hesitate to reach
out.
This is like this is our breadand butter man.
This is what we do.
So sacroiliac joint dysfunctioncan accumulate and it just gets
worse.
But that disparity in strengthrecruitment, that's what we have
(09:52):
to fix too.
All right, so how do you fixthis?
Let me one more time, one morething.
What does it feel like?
All right, so how do wediagnose this?
Well, we ask them a lot ofquestions.
Where is the pain located?
What does it feel like?
What makes it hurt worse?
What makes it feel better?
What does it feel like?
What makes it hurt worse?
What makes it feel better?
What does it feel like when yousleep?
Any exercises in particularmake it hurt worse.
(10:13):
Was there a time recently whereit was like that was the pain?
How's it feeling right now?
All right, let's take it througha range of motion.
When you bend over a lumbarrange of motion, hip range of
motion testing, functionalmovement testing, and we're
looking at their mechanics andwhere we're noticing our
(10:33):
compensations are at.
And then we go throughobjective orthopedic tests.
When we purposely try to shearor provoke symptoms, we can
isolate like, oh, this rules itin or rules it out, ruling in a
diagnosis versus ruling out adiagnosis, and then palpation
and all of that kind of combinedwould be a part of the, would
be the evaluation and that helpsus determine, like where the
pain is, what the problem is andthen why it's based on what
you're telling me, why itstarted, how are we going to fix
(10:55):
it and then how are we going tokeep it from coming back.
That's the recipe, all right.
That's like an evaluation.
So, based off of that isdetermining, like what we're
going to do, right.
So what do we do?
What's the recipe?
To fix a sacroiliac dysfunction?
We have to intervene manually.
To fix a sacroiliac dysfunction, we have to intervene manual.
I think the missing link ismanual therapy.
We have to fix thebiomechanical problem.
(11:16):
It's a biomechanical problemand that needs a mechanical fix,
all right.
So the mechanical fix is manualtherapy and we have to put it
back in a more symmetrical pathplane.
All right, we have to put itback in a more symmetrical way.
And then, after intervening withmanual therapy, we have to
follow up with soft tissue, withsome of the muscles that are
(11:38):
going to be really guarded andtense because of this position
change that's been going on fora couple of weeks now or months.
So imagine the sacroiliac jointthere's a position change.
What do you think the musclesare going to be like where that
are connecting to those areasthat are not lined up as much as
they could be?
Right, they're not symmetricallike they should be.
What do you think the musclesare going to be like when they
(11:58):
connect to that altered position?
They're going to be guarded, sothey're going to be tight and
guarded, or they're going to bechronically over, lengthened and
that length, tensionrelationship in the muscle
tissue and ligaments is going tocause pain and that's's part of
it too, right?
So we have to fix thatbiomechanical fault position
(12:18):
problem first with a mechanicalsolution, which is manual
therapy, and then we follow upwith soft tissue.
That's relevant, which where weat the clinicians that come and
mentor with me and for afellowship, training and stuff,
and we ask them we had.
We always act like we'regrilling them, like what is your
?
We get to back this up with abiomechanical rationale why are
you choosing this intervention?
Why would you not choose thisintervention?
(12:39):
And then to give a clear answerof a rationale, biomechanically
, of why they're choosing onething versus the other.
So we do soft tissue work afterthe joint intervention to get
the length, once the lengthtension relationship is better,
and then get the muscle guardingjust to settle down and make
(13:00):
things more pliable and withhyaluronic acid, blood flow and
getting fibers to be morealigned in parallel so they can
glide better for pliability andin blood flow right.
Dry needling can be reallyhelpful as an intervention on
that as well, with stripping andcupping.
Those are our go-tos.
Okay, all right, then we setthings up for success and we've
(13:23):
maybe positioned things from asoft tissue and a joint
standpoint better.
At this point we stand peopleup and we say let's retest the
thing, the movements that madeit hurt 15 minutes ago or 20
minutes ago when you first camein after before we did this
manual therapy stuff and theyretest and they feel better.
It's like perfect, we're on theright path.
(13:44):
So this is actually a reallycommon thing we just had.
This has happened to handmultiple times An active person
comes.
In this particular case, thisathlete was a 17-year-old
football player in a local highschool that was having chronic
hamstring strains and we werelike, did you change anything?
(14:08):
Like did you feel a pop in yourhamstring?
We're doing all these hamstringtests just to rule it out, to
do our due diligence.
And all of them were negative.
No, no, no, no.
Hamstring really wasn't in thattender to touch.
We couldn't.
If somebody pulled theirhamstring like it's going to
hurt with like resisting ahamstring curl, he had no pain.
So it's not the hamstring, butit feels like the hamstring.
(14:30):
All right, we got to investigateupstream up the kinetic chain
and anyway, going into this, myhypothesis was I bet it's going
to be sacroiliac joint.
That's my first thing, my firstworking hypothesis.
You have a 17-year-old withinsidious onset, low back
tightness and a hamstring pain.
All right, my first hypothesisand he's an athlete with
(14:51):
football, I'm like my firstworking hypothesis of diagnosis
is going to be sacroiliac joint,followed by lumbar spine
referred pain followed by alegit hamstring right.
That's my third workinghypothesis.
I don't think it's hamstring.
When he comes in, rule out it'snot hamstring.
His resisted hamstring curldidn't hurt.
(15:14):
Hamstring palpation doesn'thurt, it's just tight.
That's not right at the origin,right at the insertion, right
at the belly, all the placesthat'll be hot, not so it's not
the hamstring.
And then we start testing.
With all this being said too,we're testing his moving
patterns and his range of motionand all the stuff we mentioned
before and some special tests oforthopedics.
(15:35):
This is his SIJ.
It was his sacroiliac joint.
We intervened, manual therapyto get it more symmetrical and
positioned in a moreadvantageous position and we
didn't even touch his hamstring,we just intervened at the
sacroiliac joint of his pelvis.
We just intervened at thesacroiliac joint of his pelvis.
We stood him back up and weretested the range of motion
testing that caused it toincrease symptoms.
(15:56):
When he first came in he had nopain, he was better and we
didn't even touch the hamstringand we educated.
We're like his dad was thereand he was there.
We didn't even touch thehamstring and your hamstring
feels better.
It's because the hamstringwasn't the problem.
The hamstring was actuallychronically lengthened because
(16:18):
of the difference in length,tension, relationship,
positioning from the sacroiliacjoint, because the hamstring
attaches to the pelvis.
It doesn't attach to your femuror isn't originate from the
femur.
Only one part of a small muscleattaches from the femur of the
hamstring group and that's theshort head of the biceps and
that's not a huge key player tobegin with, but anyway, that's
beside the point.
It originates from the ischialtuberosity of your pelvis.
(16:39):
So we didn't even touch thehamstring and he felt better.
So we're accurate.
Let's continue this trajectory.
We're pretty confident.
We're confident.
This sacroiliac joint.
Now let's solidify these changeswith corrective exercises.
We have to stabilize the pelvis, the lumbopelvic region, your
hip and your glutes and yourcore, and sometimes the psoas
(17:01):
needs to be strengthened too.
It can be shortened and weak,not just lengthened and weak, or
shortened and guarded and tightand overly strong.
It could be either one of those.
We have to figure that out.
But anyway, in this particularsituation we needed to stabilize
and strengthen this lumbarpelvic region, some core
stability, and we do that withsling exercises, all right.
(17:21):
So the sacroiliac joint if youconsider all the key players
that attach to the sacroiliacjoint and the pelvis and the
tailbone, the sacrum, there'slots of muscles that span
multiple joints from multipleareas that we would call slings
and they globally stabilize thepelvis.
(17:41):
All right with translationalforces and translational
activity like sprinting andlunges and box jumps and agility
and changing directions andlateral movement stuff like that
.
So core stability and slingexercises and glute activation,
that seems to be the best recipeto fix underlying sacroiliac
joint dysfunction and pain.
(18:02):
But imagine if somebody justcame in and they were like my
hamstring hurts, and thensomebody, a clinician, just was
like oh, let's work on yourhamstring and they don't touch
the sacroiliac joint becausethat was the problem.
What does that look like?
I'd tell you exactly what itlooks like.
The athlete doesn't get better.
They just massage theirhamstring.
They're stretching the heck outof their hamstrings.
(18:25):
And stretching their hamstringsis not the problem.
It's actually alreadychronically over-lengthened, so
stretching might be making itworse.
So we didn't stretch hishamstrings at all.
You don't need to stretch andwarm up before you play, but
that's not the pathology.
Hamstring tightness isn't yourpathology.
We're going to focus ourefforts and treat other things.
But that leads to if someonejust does that and they're not
(18:46):
investigating an underlying rootcause like the sacroiliac joint
dysfunction, them not gettingbetter, an underlying root cause
like the sacroiliac jointdysfunction, them not getting
better, and they're justhobbling around, meandering
around at these practices, notbeing able to practice, not
being able to play and this iswhere we live vicariously
through our patients, and we getit.
And that's where we'repassionate about what we do is
because there's a short windowof opportunity for athletes to
(19:07):
showcase themselves and enjoythe process of playing sports
with your friends and stuff.
A lot of developmental benefitscome from sports and there's a
short window of time thatathletes can do that and if
they're hobbled and disabled bypain and an issue, it's going to
shorten that window and they'renot going to be able to play as
(19:27):
much and the opportunity isover.
I've had plenty of teammatesand athletes and my friends in
the past that they had some kindof pain that just didn't go
away and they were justlingering and meandering around
like I'm waiting for this docvisit.
I'm waiting for this image.
My trainer told me to rest thisPT that I'm seeing, told me to
ice it.
I'm stretching my hamstring.
I'm not better, I can't play.
Coach is like hey, when are yougoing to play?
Sorry coach, sorry coach, I'mnot ready yet.
(19:48):
I can't play.
Like well, it still hurts.
Well, you're up some dirt on it.
Play anyway.
It's like I want to what do youthink?
You know, all the teammates arelike hey buddy, when are you
coming back?
Hey man, we need you.
When are you coming back?
I want to, I want that's whatthat happens, and it sucks.
I've been there.
It's like I'm trying everythingI can.
That's why we're passionate andenthusiastic about what we do
(20:10):
is because we understand thatand we've been there, I
definitely have, and that's whyI like doing this there is an
answer and there is a solution.
As long as the underlyingsystemic red flags are ruled out
, then it's a neuromuscular,biomechanical problem and that's
what we do, so let's get afterit.
We have to diagnose youaccurately, and that changes the
trajectory and the lens inwhich we perceive this diagnosis
(20:31):
, changes the trajectory oftreatment and of how we're going
to fix it.
All right, and the question weasked our fellowship trained
docs of physical therapy thatcome train with me as mentees.
I asked them when you intervenelike this, are they progressing
?
And then, if they return backto their sport, is the pain
coming back?
If they were like, hey, dressout and play 100%, is the pain
(20:54):
returning?
If yes, then you didn't fix theproblem.
It was an inaccurate diagnosisand we had to fix the problem or
the interventions weren'taccurate.
Either one of those.
But let's deep dive, let'sfigure this out.
We have to dive into the matter.
But there is a solution.
And things don't just hurt forno reason.
And there's no reason why ahealthy individual who doesn't
have any other underlying redflags and systemic problems
(21:17):
should be hampered by painthat's not getting better.
It's neuromusculoskeletal andthat's the problem.
That requires a biomechanical,movement-based diagnosis to fix
it.
Combination of manual therapy,soft tissue work and corrective
exercises to fix the underlyingcompensation patterns.
And that's how they get better.
So if you have any questions,man, reach out.
We want to help you.
(21:37):
We're always open to comments,questions, concerns, conflicting
opinions.
If you have any suggestions onthis podcast, man, I'm always
open for ideas and if you'rebattling any pain or if you know
anybody, please share this.
We'd love to help them.
We can at least talk on thephone and see what's going on
and then, uh, at least maybedirect them to somewhere else.
Right, we might not be alwaysbe the right people, and we can
at least talk on the phone andgive them some insights.
(21:58):
So don't hesitate to reach out.
Call us at 5, 6, 1, 8, 9, 9, 87, 25, or email us at team, at
athlete rccom.
We're located here in West PalmBeach, right off Palm Beach
Lakes Boulevard, next to theTanger Outlet Mall, the Palm
Beach Outlet Mall, just east of95.
So we're right here, central.
So give us a shout and we'llcatch y'all next time.
Popular Podcasts
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
The Joe Rogan Experience
The official podcast of comedian Joe Rogan.