Minimally Invasive

I am always getting excellent news stories and media tidbits from you, Awesome Readers.  Today was no exception.  Elizabeth sent me (thanks Elizabeth!) a link to a story on ABC News tonight,

Minimally invasive surgery could relieve patients of back pain.

The story focuses on the 80 percent of Americans that will suffer back pain in their lifetime, and a particular type of back pain — SI Joint (sacroiliac) Syndrome.  Now I wouldn’t consider SI joint pain a “back” or spinal issue because the muscles that act upon the sacrum belong to the pelvic and hip category, but I’m not even going to be picky on this point.  I am, however, going to nit-pick the term Minimally Invasive when talking about the new surgery, SI joint fusion.

Yep.  With just a couple of rods and three incisions, your sacrum can be permanently connected to your pelvis for reduction in pain.

“The procedure works because it stops the joint from moving, and it’s only movement which brings on the pain,” says Dr. Graham Smith.

Correct me if I’m wrong, but this sounds a lot like the Hey Doc, It Hurts When I Do This, Then Don’t Do That philosophy of medicine.  Anyone else get that?

Let’s back up a second to an experience you may have had with a broken bone and cast or sprain and sling.  For those who have had rigid structures limiting their joint movement while healing, do you remember the day the cast came off and how the muscle atrophy (shrinkage) was so easy to see when comparing the “fused” and mobile appendages?  Here’s the thing with muscles,  they need movement at the joints in order to maintain tone, tissue health, and fluid content.  No joint movement, no muscle tone.

Now let’s talk about the sacroiliac joint.  This joint is supposed to have free, non-friction generating movement.  Just like movement of the knee keeps the quadriceps, hamstrings, and calves healthy, the movement of the sacrum keeps the glutes and pelvic floor healthy.  In fact, sacroiliac pain comes from unbalanced muscular-force between the glutes and pelvic floor, and the resulting pelvic floor hyper-tension on the sacrum.  The solution is restoring the function to minimize friction, not fusion.  Fusing this area will not only create core-musculature atrophy, it will cease natural motion of a body part.  Natural motion that was probably important, if your body developed a joint there.  Important movements like child birth, reproductive organ support, pelvic and abdominal support, digestion, and walking.  You know, those types of things.  Do you have SI Joint pain?  Check your butt.  Don’t see one?  Get one.  Your SI Joint will thank you.

Sooo, back to Minimally Invasive.  This term is a misnomer.  An incisions may be small, but the long-term affects of a fusion result in a progressive and accelerated degeneration of all tissues around the location of the fusion.  Most people do not clearly understand the role of the pelvic floor, sacrum, and gluteal muscles in supporting practically ALL human body function.  If they did, they would not be so quick to fuse this area, creating a “limp” in the core muscles that lasts FOREVER.  Minimally Invasive my butt.  My strong butt at that.

Dr. Graham is not incorrect when he says that movement brings on the pain, but not moving is not an option for those of us who know that our body is a self-winding clock.  Fuse a joint, limit your time.  Pain with movement is a signal to be heeded.  The signal is saying, The way you are moving is doing you harmThe muscles on your frame are not supporting you.  You can fix the way you move, or, you can just lie down now.  Which makes more sense?

14 Comments

  1. Jodi says:

    Very interesting points. You should send this link to the newspaper to challenge them to print a rebuttal and show another side to the piece!

  2. [...] This post was mentioned on Twitter by Shannon Boyle and Kim Vopni, Katy Bowman. Katy Bowman said: SI Joint Pain anyone? How 'bout a fusion…NOT! http://fb.me/EDcqKTcr [...]

  3. Great post! I remember when the SI joint debate was does it move or not, or does it move enough to cause a problem? We have come along way but now we are going in reverse. It moves, and it moves for a reason! J

    • Katy says:

      That’s hilarious — DEBATING does it move or not? Nutation and counter-nutation (the motions of the sacrum) are well demonstrated by many world-wide populations, so the debate seems to be more, because we (Westerners) don’t have the motion, is it really necessary? Because wouldn’t WE have it if it was necessary? – Katy

  4. Karie says:

    “fix the way you move or just lie down” LOVE IT! Too many it seems always want the ‘just lie down’ option.
    May I never be one of them!
    Thanks for addressing this.

  5. Beth says:

    Thanks sooo much Katy! So now my question is, is the squat series a good set to help heal SI pain, and if squats themselves are too much (and give you pain) should you just work on everything leading up to the squat and then gradually test you squat range?

    • Katy says:

      Beth,
      You, a RES, know that there are 30 or so exercises that come before a squat, right? Progress intelligently, preparing the whole body for the squat movement! – Katy

  6. Taylor says:

    Beth, to go with your question:

    When I started the squat month, I developed very severe SI pain, inflammation, and spasms like never before. I have very tight hamstrings and have been a “tucker” my whole life. So I backed off on the squats. Started more hamstring & calf stretching, more walking, and strengthening my gluts other ways. The pain is totally gone now!! I am easing back into squats.

  7. Ah, the SI. Thank you for addressing this part of the body Katy!! A “blow out” occurred in 1994 about 4 months after completing a triathalon…thought I was a strong hero. Guess NOT! For all those that see this post, diligent ham stretching (start with the chair and work into it), and double calf stretching on the dome (also starting on the chair), as well as squats with the rolled mat behind my knees (EVERY DAY) has been an fruitful journey to pain reduction (oh, and also that double leg listing while working @ my standing work station). Not yet a NO pain situation, but vast improvement on the SI blow out. The other thing us westerners and recovering athletes need to be hyper-conscious of, is, EASING into all this, and getting over being a hero; meaning-don’t go 100 % into any stretch or strengthening movement right off the bat, turn off your brain and let gravity do the work for you. Its a tuff lesson to learn, but the payoff is remarkable. Patience is a virtue, si?

  8. me again. just spent some time in New MExico where I WALKED 3 miles a day to and from my hotel to the meeting venue…and I spent hours in an airport getting to/from. Wow, the number of people who are hobbling around with 1) 4-5 inch high heels…methinks those women do not look sexy at all – won’t those heels puncture the emergency slide?, 2) walkers and canes, 3) limps and the like, 4) kyphosis and dowagers humps, 5) young women with too tight jeans and tucked pelvis-es and NO Butt, 6) men with no butt, 7) men and women with NO waist or core definition…shall I go on?…Perhaps we could create a quiet revolution and sneak in an aligned and well DVD to the communal TV monitor…now that would be something to see…the expressions on the faces of all the folks watching it !! Maybe the women would ditch those ridiculous shoes for starters.

  9. Melisa says:

    When physical therapy did not get rid of my pain, this is the surgery that my doctor said was the only other option. He also said that he wouldn’t recommend it and wouldn’t do it and didn’t know a surgeon in the area that would. I guess that was a good thing, but several years later I am still suffering. I’ll keep reading the back posts here to learn all I can!

  10. Desiree says:

    I know this is an older blog post, but I couldn’t help asking a question! A yoga site says to avoid asymetrical movements like standing on one foot. But I have been doing this regularly for over a year (as shown in your Down There DVD). For almost 2 years I have been working on my rib thrusting but I’m pretty good about having my pelvis back. I threw out my pelvis last year. My Chiropractor says that’s what it was, at least, but I was completely laid up. I’m not even 30 and this pain has been here over a year! So would the pelvic list be safe if you have SI pain? I do my squats, alignment checks, hamstring stretches, everything for over a year with no change to this pain. Do you have any other workshops or exercises to help “build a butt” in ways that will help SI pain?

    • Katy says:

      Have you watched the Build a butt webinar? It’s titled toward knees, but a butt is a butt and will help stabilize the pelvis. Walking is a single-legged activity, so if you don’t address the weakness in a controlled environment, then walking is going to be a pain for your pelvis!

Leave A Reply