Physical Rehabilitation Medicine/sijd


QUESTION: I am suffering from sijd with pubic symphsis, I am seeing a PT but do not feel like I am making any progress actually I feel worse after our sessions I am wondering if she is giving me the proper exercises to do, she had me doing press ups, back bends and some exercises where I pull resistance bands toward my body while standing, other than that all she is doing is massage.

ANSWER: Dear Eden,
You do not mention what the possible cause of the sijd is, and this can matter.  The SI joints do not move very much and less so in men then women. They do however move some, and can get off their normal axis of movement.  There are techniques to reposition them.  Many PTs use techniques that are named Muscle Energy Techniques.  They were developed by Osteopathic Physicians.  You can ask your PT if she knows how to test for altered SI joint mechanics with Muscle Energy techniques.  If she can't, you can ask if another therapist in the same office does.  If neither does, you can call around to other offices.  This is often helpful.

I find it important to evaluate the flexibility of the hips to be sure these large joints are providing the motion that's needed for comfortable sitting.  Your walking pattern should also be assessed.

The Si joints are held together by strong ligaments, so there's only so much to be gained by strengthening muscles in the region, but that can help.  You need to discuss your feeling worse after PT with your therapist.  If you are not satisfied with treatment, you can likely go elsewhere.  There can be a lot of variation in the hands on skills of different therapists.

I hope this helps you get the relief you are seeking.

---------- FOLLOW-UP ----------

QUESTION: My problem is due to loose ligaments in the si joint, it moves out of place and makes clicking and clunking noises. My right hip seems to be rotated forward and I also have pain in that hip, same side as loose si.

Dear Eden, If the problem is too loose SI ligaments, investigate the process of sclerosing injections also called prolotherapy. The injections into the ligaments cause inflammation and scarring which tightens the ligaments up. Many insurances will not cover this treatment so beware.  I have had a client negotiate for coverage with her insurance.  Doctors who do this procedure, will accept cash pay, they have had experience with insurances not covering it.  You will need to investigate to find a doctor who does this, it's a somewhat uncommon but helpful approach.

You may get help from your PT finding a doctor, go ahead and ask.


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Rachel Katz, PT, SEP


I have expertise working with recovery from car accidents, RSD/CRPS, neck and back pain and chronic pain. I can answer questions about pain that is not responding to expected patterns of recovery. I can address pain issues that are associated with traumatic events, and veteran associated pain issues. If you have had abuse or periods of significant stress in your life, your pain issues may be more complicated. I authored A Consumer Guide for Recovery from Car Accidents which discusses many aspects of injury recovery as all as specific detail about PTSD, traumatic brain injury, and protective involuntary muscle spasm. The link is: I can't answer questions regarding pain medications, or some specifics related to surgical interventions.


I have over 30 years experience as a Physical Therapy clinician. I taught swimming in Michigan and skiing in Aspen. I have experience in analyzing movement patterns and muscle control. I treat all areas of pain in the body including headaches, neck pain, back pain, shoulder injuries, plantar fasciitis, nerve compression, and knee pain. I have had personal experience with chronic pain, RSD, car accident injuries, PTSD, and traumatic brain injury (TBI). Muscle spasm and pain is a common component of injury and response to traumatic stress. Posture patterns and habits of how your body is often used can also contribute to pain. Restoration of movement and the senses that enable you to feel it are key. Rachel developed and implemented a stress reduction program for inmates within the Boulder County jail's drug and alcohol recovery program in 2005-2006 based on trauma healing principles from Dr. Peter Levine.

Rachel holds a BS in PT from the University of Colorado Health Sciences Center. She has over 30 years experience as a clinician. She has over 1500 hours of post graduate continuing education in many Manual Therapy and Exercise approaches. She completed her training in Somatic Experiencing under Dr. Peter Levine in 2000. This 3 year program trains therapists in treating traumatic stress conditions. Rachel has developed a body of work integrating her training and unique insights into complex pain issues. She is the developer and instructor for Sensory-Motor Manual Therapy, which is a State approved 2 day work shop for Massage Therapists through the Boulder College of Massage Therapy.

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