A Tiger’s Tale… or rather its Sacrum!

You may have seen over the last few days the news about how Tiger Woods sacrum ‘popped out’ during the Bridgestone Championships and how it was ‘popped’ back into place, and how this quick ‘fix’ had Tiger ready for the US PGA tournament five days later, only to see him grimace and wince his way around the first two rounds looking uncomfortable and off form and eventually not making the cut.

Now in a game like golf I’m well aware there are a myriad of other reasons why a golfer doesn’t make the cut, but to me it looked like Tigers back pain was a major factor.

So was Tigers sacrum to blame and was this miracle cure of ‘putting the bone back in’ that miraculous?

Well lets not sugar coat it, of course it bloody wasn’t.

The notion of anyone’s sacrum (a key bone in your pelvis) can just ‘pop out’ is complete and utter nonsense, let alone the sacrum of a fit athletic professional male golfer without any history of trauma, previous pelvic issues or any other risk factors such as joint hypermobility, to put it simply…

SACRUMS DON’T JUST POP IN AND OUT…

I’m not alone in thinking this is nonsense and pseudo science at its worse, many have voiced their concern and dismay at this debacle, including the British Journal Of Sports Medicine, who voice their concerns extremely eloquently here.

So lets look at why this ‘story’ of Tigers sacrum popping out has happened. But first lets look at why the sacrum simply can not pop out!

For starters the pelvis is an incredibly strong and stable structure with many, many strong ligaments and muscles across it. The sacroiliac joint does have some small amount of movement, no question about that, and yes some have more or less than others, but the variation is minimal and the belief that many have in thinking that they can 1) feel this joint move 2) decide if it’s in the right or wrong position and 3) adjust it with manipulations is just complete and utter tosh based in cloud cuckoo land and is nothing more than palpation pareidolia, a phenomenon I have discussed before in a previous blog here and on the assessment of the painful SIJ here and its management here.

Now that’s not to say the SIJ doesn’t cause some people pain, or more accurately can be a source of nociception which can produce pain, and yes there are pathologies and conditions that can cause this such as sacroiliitis etc.

But despite the common belief there is no evidence that instability or lack of it, or mal alignments cause issues around the SIJ, rather it is usually simply irritated due to overload.

So next question is why did Tiger think his sacrum had ‘popped out’ well there are two possible reasons

  1. He got the wrong end of the stick from his medical team
  2. He was given the wrong information from his medical team

So did Tiger get the wrong end of the stick? Did he misinterpret what his doctors told him?

Well its very possible! It is well known and documented that patients often misinterpret what medical professionals tell them. There are many stories of miscommunication and misunderstandings that unfortunately happen, like the one Kieran O’Sullivan talks about in this podcast about a patient who was concerned that her back pain was caused by some things called ‘vertebrae’ in her back after her doctor showed them to her on an xray!

Miscommunication like this does happen often, I had a patient who was convinced she had an extra bone in her shoulder after a doctor told her she had some calcification in her rotator cuff!

So yes its very possible Tiger got the wrong end of the stick. However, this is inexcusable in my opinion, that the medical team of one of the worlds most influential and recognised sports personalities do not FULLY brief and inform him about his condition simply, honestly and correctly, they will be well aware that he will be interviewed and asked questions about his injury and so must prepare him for such.

Now it may also be possible that Tiger didn’t get the wrong end of the stick and that maybe he was actually informed by his medical team that his sacrum had ‘popped out’! It seems that there are some doctors in the US that work with professional golfers that unbelievably think that this nonsense can happen.

For example a specialist golf MD called Dr Ara was seen discussing Tigers sacrum here on TV shortly after the incident and he seems to concur that the sacrum can dislocate and a quick 20 minute fix of popping it back in, together with some anti inflammatory’s equals ‘job done’.

He also goes on to offer some other rather dubious advice on hydration during the interview as well but that’s by the by!

Now when you look at Dr Ara’s website here we can see that he is a MD who has worked hard to rise to his current position as a golf specialist and this all sounds highly admirable, but the question still begs, why would a doctor who works with professional golfers choose to believe in some pseudo science such as dislocating sacrum’s?

Well in my opinion the answer is either pressure or ego!

The pressure can be from having to be seen to be doing something! Something proactive, something advanced or high tech or cutting edge by the player, or their management and even the public when really there isn’t anything more to do with a professional athlete than there is with any other patient in the early stages of injury. That is simply to give good, clear, sensible, well reasoned and evidenced based advice and education on the injury, recommend the most appropriate management, loading and if suitable, and maybe, just maybe a little bit of light manual therapy as well.

In my experience the best physios/doctors I know simply don’t offer or promise quick fixes or miraculous cures as they know they don’t exist!

I come across this a lot in professional sport, a desire by physios and medical professionals to promise things they simply cant do or that can be done just to be seen to be ‘doing’ something, whether its prolotherapy or PRP injections, horse placenta or stem cell massages, silly electrotherapy machines, manipulations, quacupuncture, stretchy tape etc etc the list can be endless, all in an effort to be seen as getting the athlete better, quicker, faster, sooner, I have a saying when I worked in professional football that I still use today….

the hardest thing for a physio or doctor to do at times is…. NOTHING!

Now, when I say ‘nothing’ I mean apart from giving good, honest, advice, education and optimal loading/movement stratagies for the essentail mechanotherapy effects, which really isn’t nothing, in fact it can be a bloody lot more hard work for a physio to do this, taking more gumption and guts to apply this than taking the easy pseudo scientific route and giving a muscle rub, joint pop or a bit of sticky tape!

Now, if it’s not pressure making medical professionals believe in pseudo science then its thier ego!

Ego to be seen as the smartest, cleverist or most cutting edge clinican! To be seen as being able to detect and cure things that other mere mortals cannot! Again I have seen this a lot, a hell of a lot in my time in both professional sport and day to day practice, guru’s, specialists or experts and thier influential charismatic personas who believe they have some extra skill or ability that no other in their field has, that only they can fix this athlete based on some mumbo jumbo clap trap that usually costs a lot of money!

Anyway, what now for Tiger? Well I wish him all the best for his recovery, but I do sincerely hope he hasn’t been affected by this episode of terrible, shockingly bad medical advice, and I hope he hasn’t been left with any negative thoughts or beliefs that his sacrum is now vulnerable to ‘popping out’ and that he doesn’t rely on the use of regular manipulations in a belief that it is putting it back in.

Instead I would suggest Tigers needs some simple, good, honest advice from a medical professional that his back pain isnt due to popping sacrums, that in fact its more than likley due to his recent disc surgey and the true cause of the structure to blame can really never be found, and that to manage this episode, it needs some time, regular movement and perhaps some good strength and conditioning from the many excellent golf specialist physios I know!

So Tiger if you need any recommendations, I know you’re a subscriber to ‘The Sports Physio’, drop me a line and I’ll hook you up with a sports physio who doesn’t feed you bull shit about sacrums popping out!

As always thanks for reading

Adam

95 thoughts on “A Tiger’s Tale… or rather its Sacrum!

  1. Hi Adam,
    First things first.
    Thanks for the insightful blogs.
    Not only are they up to date with the latest credible evidence and offer an informed perspective, but your wit makes for a great , fun read !

    I am hooked !
    When I heard the bit about Wood’s “sacrum popping out”, I was secretly hoping it would be an error of interpretation on Tiger’s part. That a reputable member of the medical fraternity would make such a statement was simply too plain embarrassing to be believed. And still it was from the horse’s mouth, no less. A tad sad.

    Any chance of a write up on the spine ? Shall be looking forward to it.

    Thanks again,
    Tanvi

  2. Hi Adam,

    Another great blog again. I do have one question however. Even though I’m fully on your side of the fence with regards to the SIJ not “popping out”. I can only presume that the medical team did manipulate his SIJ/Lx spine and prescribed NSAID’s. Would it be fair to say that the combination of Manipulation and NSAID’s were the key to his return to play (I know your not a big fan of manips).I’m curious as to your thoughts on how tigers managed to complete 36holes without too much viable issues.

    Cheers

    Alan

    • Hi Alan

      Thanks for your comment

      Im sure Tiger had some manual therapy for his back and I guess it will have been a high velocity thrust type manoeuvre for him to think his sacrum has popped back in.

      With these types of treatments the afferent neurological effects are very high, the joint mechanoreceptors will bombard the central nervous system with rewarding information and the beliefs and expectation of a manipulation will also create the central nervous system to release its own opioids which create a sensation of reduced pain and stiffness and so allow tiger to complete 36 holes, but you say he didn’t have too much visible issues, I think he looked decidedly uncomfortable, but im no golf expert

      Cheers

      Adam

      • Hello Adam, great blog on a topic I also encounter a lot in everyday practice. The people in the village I work are really focused on MT and dislocated joints, as advocated by the many MT’s around here. I’m always looking for info on the workings of MT and I was wondering if you have or you know of any good blogs/articles on this subject. Thanks in advance!

  3. Some great points here Adam, thanks for sharing them.

    Quite rightly, sacrums don’t just pop out (nor pop back in).

    As therapists, we have a responsibility to be delivering the most evidence based treatment strategies and these often hinge around a strong therapeutic alliance. O’Sullivan uses a metaphor around treatment effects similar to using a syringe and fluid delivering an injection. The non specific treatment strategies (such as a the therapeutic alliance) are like the needle, an essential part of the delivery of the specific effects from the treatment itself. If the specific effects of the treatment (in Tiger’s case a manipulation) are given an explanation which is faulty by a therapist with whom he has a strong therapeutic alliance, (in his case as a reposition of his sacrum) these treatment effects act, instead of a placebo, like a nocebo. It fuels a sticky belief system which influences behaviours and fuels a pain cycle on many levels. In this way, as therapists we have a responsibility when we do have an effective and influential patient therapist relationship is to ensure we are facilitating the recovery process rather than hindering it. Our message acts a powerful determinant of the end point of treatment This concept has been brilliantly discussed on the BJSM podcast recently by Roy Moynihan.

    Tiger’s belief system is likely to generate a lot of fear around movement (kinesiophobia) and there is evidence in the literature to suggest that such fear of movement can generate an increase in trunk stiffness (due to muscle guarding). Which in turn could affect his golf swing and his pain.

    Having a long line of golf addicts in my family, I am well aware of the well documented troubled private life of Tiger over the past few years. I can’t help wonder what effect this level of stress and arousal has had on his sleep habits and the other associated psychoneuroimmunological repercussions on his pain response.

    My concern surrounding your post is this. I don’t think the answer for Tiger is a good honest strength and conditioning programme. Or at least not initially.

    A key part of Cognitive Functional Therapy assessment process, as pioneered by Professor Peter O’Sullivan and team, focuses on determining the pain mechanism driving the individual’s pain. This clinical reasoning process can then lead the treatment strategy.

    Tiger’s story around his pain needs to be heard. We can all hypothesize about what is driving his problem and what his rehab should entail but this is purely guesswork of course.

    Any history taking has to include a screening for all the risk factors for persistent pain issues which include early life stress, history of depression, smoking, sleep deficit etc.

    And an observation of pain behaviours that he may have adopted (I have certainly seen a few of these when watching from TV). What catastrophic thoughts is he having? Has he developed fear avoidant behaviours? It would be interesting to see how hypervigilant he is around his back. His future career is on the line.

    Body schema issues may also need to be explored. Ask him to draw a bodymap of his back and how he perceives it to look. A Physiotherapist experienced in working with mindfulness based strategies may well find something to work with here.

    Not forgetting the biomechanics of his golf swing and how his postural habits in other everyday activities as well. Never forget the bio (I 100% agree with you that one Adam).

    There are so many factors that need to be assessed and I certainly haven’t listed them all here. I am sure those trained in the CFT approach, amongst others, could continue this list almost endlessly.

    However, I do wonder, as a therapist who has used the evidence based Cognitive Functional Therapy approach as developed by Professor Peter O’Sullivan and the pain-ed team for sometime now, whether the answer to Tiger’s problems may lie in his breath. It is certainly something I include in the assessment of every back pain patient.

    Does he anticipate pain by bracing? Has he been taught the dreaded isolation of TAbs in neutral or has he adopted a pre-tensing of his abdominals automatically as a protective movement strategy? Does this then have an effect on his intra abdominal pressure increasing lumbar stiffness (we are going full circle here) and loading of pain sensitive structures in his back that have been already sensitised by a heightened nervous system arousal?

    There, I have got it off my chest now.

    Start with the breath. In his aggravating postures and positions. Dare I say make it functional?

    From spending time watching Professor Peter O’Sullivan work during his workshops in the UK, and using the CFT method in my own work, I have come to realise that it can be the most simple treatment strategies that can solve the most complex of problems. I am continually amazed how quickly change can happen using this approach. Strength and conditioning training will no doubt follow but these other factors are likely to need addressing first.

    Keep up the good work Adam.

    Helen Preston

    (twitter handle: @PrestonsHealth)

    • Hi Helen

      Thanks for taking the time to write such an awesome response

      I agree with nearly everything you say, has to be nearly, if I agreed fully it would be boring!

      You say you don’t think the answer is a good honest specific strength and conditioning program instead its the CF-CBT approach thats needed

      I say yes CBT is needed absolutely right but so is S&C, in my experience when working with professional athletes they work best together concurrently!

      Again in my experience a professional athlete doesn’t just want to be talking about the issue with a physio, most want to be doing, or unfortunately, having something done about it, so all the factors you quiet rightly mentioned need to be addressed and discussed etc but whilst doing the rehab.

      I find my best results using the CBT methods are achieved as the patient is moving as they are doing strengthening exercises, those minutes just before I ask them to do something, or even as they are doing the movement and in-between sets discussing how it felt, their concerns, fears, feelings of doing the movement are so helpful and where the athlete opens up more and it can become more evident what the issues are, and then as you say making the small changes either mentally or physically can have the greatest results, be it relaxed breathing, a change of foot position, or a change of belief just from giving reassurance and demonstrating that it is safe and painless!

      Does that make sense, athletes IMO need CBT but as they are doing S&C

      Thanks again for your great comments

      Adam

      PS if any one wants to listen to Ray Moynihans excellent podcast that Helen mentioned the link is here https://m.soundcloud.com/bmjpodcasts/overdiagnosis-in-sports-medicine-fai-for-example-the-great-ray-moynihan-selling-sickness?in=bmjpodcasts/sets/bjsm-1 as he talks about over diagnosis and over treatment in healthcare something a lot of MSK practitioners are guilty of

  4. Thanks for your reply Adam.

    I totally hear your point about athletes wanting to “do” something rather than talking but Classification based Cognitive Functional Therapy (CB-CFT) is not Cognitive Behavioural Therapy (CBT) It is not just talking.

    I would highly recommend this editorial in the BJSM as a reference point for your readers to learn more on the CB-CFT approach: http://bjsm.bmj.com/content/46/4/224.extract?sid=8f0bb2ab-ecc6-427d-b085-4c5464d4f87c

    Being married to a double Olympian myself, I have been lucky enough to observe first hand the culture around both athletes and therapists towards rehab over many years. Elite athletes often talk about mindfulness based concepts (such as being in the now) with regards to their performance, it really isn’t anything new. However, rarely do I hear of it talked about in sports injury rehab. Targeted mindfulness (as mentioned in the above text by O’Sullivan) can be a very powerful tool in facilitating movement behaviour change as well as pain.

    As you point out, sometimes the hardest thing for a physio is to do nothing. It can be even harder for the sportsperson. But maybe it is exactly what their nervous system needs. “Being” rather than “doing”. It is important that we don’t let our own bias’s get in the way of outcomes for our patients.

    CB-CFT is a behavioural approach and its use of targeted mindfulness in appropriate patients is always applied in a functional way. The beauty of it is that patients can experience change there and then. And the proof of the pudding is always in the eating. If they feel better immediately, then they get it. And having the drive that makes someone an elite sports person often means they can master it quicker than other individuals.

    I do agree that you can implement a lot of this into more traditional S and C training as you describe. My point is that sometimes we have to accept that initially it has to be learnt in a relaxed manner and with isolated focus. We have to become more comfortable as a profession with the idea of not always “doing ” something to our patients. Whether that “doing” be manual therapy or exercise.

    We have to make our treatments totally patient centric and individualised. I know we agree on that.

    Best Wishes

    Helen

    I read this today and, although not sports specific, I think provides something around the concepts of mindfulness and health for the sceptics (thanks to @painphysio for the link) http://www.independent.co.uk/voices/comment/a-pill-may-help-stave-off-death-it-doesnt-teach-you-how-to-live-9658215.html

  5. Yes this was an interesting one, was following all the tweets. On one hand, yes, it’s complete bollocks about the sacrum “popping out and pinching a nerve”. But then again on the eve of a major tournament the pressure to do something quickly with him must have been very high, it’s no excuse, but I doubt anyone was going to sit down with him and say “tiger, we need to talk about your feelings and the real reason your back is sore”. I daresay Tiger chooses his medical team and even if someone had started to dig a bit deeper into things I think they would have been sent packing pretty quick. It sounded like he wanted to hear something simple, I.e. Sacrum popped out. Reconceputalising the patient can be the hardest thing no after how much science you have behind you. Lastly the strength and conditioning theory (as in Tiger needing this)opens another can of worms , in that it implies weakness causes pain. All good fodder for discussion.

  6. Thanks for taking the time to reply Adam.
    I enjoyed the discussion in response to your blog.
    That’s one reason I look forward to reading it !

    Well, about the spine. Wouldn’t know where to ask you to start.
    It’s just that I have read such splendid pieces from you on the shoulder and the knee and all the while getting all kinds of spine pts, so just wanted to know your general approach towards a spine pt – cervical/lumbar. Because last I heard the core no longer counts for much ! So I guess its just strength and conditioning now. Along with correcting asymmetries, which again, has been questioned !
    Thanks again for your time,
    Regards,
    Tanvi

    Thanks again,
    Tanvi

  7. I must respectfully disagree. Since approximately 2008 this incorrect thought about the sacrum not being able to pop out or dislocate has been dis-proved. It is very slowly seeping through to the mainstream medical and physiotherapy world.
    Professor Begnt Struesson had published papers on it and sacrum fusion and other thechniqes
    such and ifuse and DIANA operations have been undertaken since at least 2008. There is a whole community of approx 500 patients around the world in my sacroilliact joint dysfunction (SIJD)support group who would also disagree and have been let down by years of misdiagnosis, pain and disability because the slightest mis-alignment of the sacrum can cause extreme pain (because it’s not designed to move) but does not show up on imaging. This is becuase the joint is so thick with ligaments and is like a ‘tongue and grove’ joint that it is nearlly impossible to show even a relatively large dislocation more than a new millimeters,
    with imaging. I know becuase mine was dislocated on and off for 3 years and eventually it would lock in the dislocated position. I would literally get my husband and osteopath to push on it and suddenly it would pop back in and I could miraculously walk again- and this is the experience of a lot of people with SIJD.
    There are now a handful of clinics around the world who treat it by aligning the sacrum
    ( this clinic I actually went to in the USA from Australia becuae I was getting so severe) this clinic aligned my sacrum properly and ‘popped it back in’ along with sports taping and strengthening program and I started to walk again from being in a wheelchair.
    ; There are also numerous patients who saw jerry hesch and miraculously came out of his 3 days of treatment walking becuae he aligned the sacrum and pelvis again. I have spoken to these patients personally. Jerry has also documented before and after his treatment of the sacroilliac joint on Utube. The sacrum can and does pop out in a small number of patients. Please stop having such a closed mind to this proven fact becuase it is very upsetting tonpeoplemwhonhave suffered from it for years with no recognition that they KNOW and can FEEL the joint is ‘out’ but practitioners like yourself make them feel like they are not believed and go undiagnosed for years being in pain and loosing more and more
    independence the more disfunctional the joint becomes because the longer it’s left out the more the ligaments stretch causing it to stay out for longer and longer periods of time until it’s chronic. Also this is where prolotherapy is done in conjunction with aligning the sacrum. Prolotherapy is done to tighten the ligaments while the sacrum is ALIGNED and not dislocated.
    Associate Professor dr Joanne Borg-stein of Harvard medical is an expert and also does NOT do prolotherapy unless the patient is also seeing a chiropractor or other health professional to align the sacrum while undergoing prolotherapy. I do hope information and future blogs can be a bit more open minded and medically current pertaining to issues related to alignment of the sacrum.

    • Dear Melanie

      Thank you for your comments, I’m sorry if you found my blog offensive and disrespectful, that was not my intent

      First I do NOT, nor have I ever said I dispute that the SIJ can be a source of pain for some, if you care to read my other blogs that I mentioned in this post you will learn more of my views.

      What I do dispute is the amount of people who are told the SIJ causes them pain, as the prevalence is very low compared to other more commonly encountered issues, but again as I mention in my blogs there are some, a rare few, maybe more often in those with hyper-mobility etc or with a history of severe trauma then the SIJ can cause pain, but not Tiger Woods who doesn’t fit into any of these categories at all

      What I also dispute are those that say they can feel if a sacrum has come out or moved or not because that is just not true, its beyond the realms of any plausibility, even in those with diagnosed hyper-mobility of the SIJ that can be seen on very accurate radiosteriometric measurements the average amount of displacement is 0.5 of a degree, well beyond what we can detect by palpation as shown in this recent study http://www.ncbi.nlm.nih.gov/pubmed/24602677

      What I do find is there are a lot of misguided and unscrupulous clinicians out there that mis inform patients and tell them that there SIJ is out of place and that a manipulation puts it back when it doesnt, even if it did, as soon as you move again the joint will go back to the place it wants to go regardless of the manipulation.

      Instead manipulations work on a neurological level not the structure they reward the brain with a flood of afferent signals and so produce a cascade of hormones and chemicals release that helps the pain and makes movements feel better, they do not fix the joint.

      This explanation is not as popular by most practitioners as it undermines their skill and need for the patient to return again and again for the quick fix, rather than looking for a long term solution which is usually through increased exercise as pain allows, gradually over time the body adapt and pain settles.

      So I will stand by my post and comments and say for MOST, the SIJ does not cause pain or just pop out

      Regards

      Adam

  8. Well Adam, I feel it is terrible you call your self a sports physio when in this article you have BLATANTLY ignored MEDICAL FACTS, and by doing so have offended the hundreds of thousands of people living with sacroiliac pain. MANY people suffer from sacroiliac joint dysfunction (SIJD) which is a condition involving your sacrum, Illum, and SI joint. Have you ever heard of hypermobility? Let me give you the definition: “Joint hypermobility syndrome is a condition that features joints that easily move beyond the normal range expected for a particular joint.”
    (http://www.medicinenet.com/hypermobility_syndrome/article.htm)
    So YES the SI joint (and connected muscles, ligaments and bones INCLUDING your sacrum) can move beyond what is considered “normal range of motion” and further more can absolutely be FELT and is excruciating pain. Also too little movement can cause serious problems: “Sacroiliac joint dysfunction generally refers to pain in the sacroiliac joint region that is caused by abnormal motion in the sacroiliac joint, either too much motion or too little motion. It typically results in inflammation of the sacroiliac joint, and can be debilitating.”
    http://en.wikipedia.org/wiki/Sacroiliac_joint_dysfunction
    Tell me, if nothing can really go wrong with your sacrum then why do surgeries exist to fix a problem that to you is “non existent” for example the iFuse procedure, fusion of the sacrum to the illum and more. Here are a few good reads you might consider before you go dismiss and OFFEND thousands of people who live in pain with this condition on a regular basis.

    • Dear Tara

      Thank you for your comments, again as with Melanie recent comment I’m sorry you feel offended, but you have taken the blog I wrote, mis-interpreted what I have said, twisted it and got the wrong end of the stick completely

      If you care to read my other blogs I mention in the post that I have done on SIJ as well as one on Hypermobility which I am well aware of, you will learn more of my views

      I do not dispute that the SIJ can cause pain, but its rare, very rare, and I’m afraid for most that have been told their SIJ is a problem, it simply is NOT, and no-one and I mean no-one can feel the SIJ move or not move its beyond the realms on any plausibility

      So again for the record I have never said NOTHING EVER goes wrong with the Sacrum, just that its RARE and UNLIKELY, and i’m 99.99% certain it wasn’t the issue that caused Tiger Woods some pain recently.

      Regards

      Adam

  9. ALSO why are you deleting the negative comments? Is it because all of us SIJD sufferers are proving you wrong?

    • Dear Tara, i’m not deleting any messages, again if you care to read things a bit more carefully and thoroughly you will see that ALL comments are MODERATED, to ensure the content is suitable, not rude, offensive or inappropriate

      It also allows me to remove any spam, marketing and advertising links in messages, which you will notice I have removed from yours and Melanie’s below

      Regards

      Adam

    • Tara

      I really must comment. Adam has provided a clinically sound, evidence based, polite and professional response.

      Yet still your response is rude, ill informed and based on erroneous emotive thinking.

      Why not show some respect for a professional group of people whose only aim in life is to provide the very best evidence based treatment and understanding for their patients.

      • Perhaps because if someone’s sacrum were genuinely displaced they only thing way to prevent them being bedbound for life would be would be major pelvic surgery followed by prolonged rest and physiotherapy? If you have any evidence to the contrary please post X-Rays and clinical histories.

  10. As a patient going through Sacroiliac Joint Dysfunction and almost a year of Prolotherapy I was quite flabbergasted at this article. Still in 2014 there’s this “unspoken agreement” that the sacrum cannot move and that is untrue. There are hundreds of scientific articles & studies that prove it does not dislocated like a typical joint but there can be significant movement within the joint. The sacrum & iliums do not align like a jigsaw puzzle piece, causing extreme bone on bone pain. With the right muscular and ligament circumstances the sacrum can have many patterns of nutation. This cannot be viewed on imaging and it leaves thousands of patients seeking help for a problem that can only be felt through multiple spring tests of the sacrum, checking ilium alignment and several other orthopaedic examinations. There are surgeries to help bedridden patients and Prolotherapy along with alignment & physiotherapy is the only option in Canada to help chronic SIJD like I have. Please take the time to educate yourself in regards to this blog post. It would be great to see an updated post validating us patients fighting tooth and nail to find doctors & therapists to help us through such a debilitating injury, especially in the chronic stage. Open your mind and please visit (advertising link removed) for information on SIJD. The Hesch Institute is a specific pelvic therapy clinic that focuses on sacrum nutation. Jerry Hesch offers classes all around the USA, spreading awareness through education of physio therapists. Diane Lee a pelvic health physio therapist & educator from Vancouver BC also has great information about this as well.

    All patients like us want is recognition so we have access to the rehabilitative help we require. Many travel far and spend a lot to figure chronic SIJD out and in return gain back their mobility. This can be a severely debilitating & painful condition that can no longer be disregarded because imaging shows nothing wrong.

    • Dear Carmen

      Thank you for your comments, I’m guessing you, Melanie and Tara are all advocates of this particular clinic and practitioner you all seem so keen to advertise, and as with the others I have removed any adverting links from your message I’m afraid

      I will direct you to my replies to both Melanie and Tara as I have said the same thing time and time again, you have mis-interpreted my blog about SIJ, and I suggested you all read things a little more carefully in future before you make ill informed comments

      Regards

      Adam

  11. Adam, your article is misinformed and misleading. What exactly are your qualifications which allow to speak with such authority on a subject you obviously know little about.? For decades people have suffered enormous pain and disability caused by sacroiliac joint ligament injury and sacroiliac joint dysfunction (many of them women) for which they have been unable to obtain an accurate diagnosis and treatment. Within the medical community and the physiotherapy community there has been a perpetuation of the myth that sacroiliac pain, injury and dysfunction do not exist and are not treatable. I suggest you re consult pub med with an objective view to really understand the current state of thinking wrt sacroiliac joint dysfunction. A lot has changed. To get you started in your re-education you may wish to consult the following websites: (links removed by moderator for advertising)

    So long as physiotherapists such as yourself continue to perpetuate the old wives tale that sacroiloac joint injury and dysfunction do not exist, people like myself and hundreds of others will continue to suffer without viable diagnostic and treatment options. Please, please take the time to educate yourself on the current medical knowledge before publishing articles such as this.

    I look forward to seeing an update to this blog, retracting this mis-information.

    • Dear Patti

      I’m guessing that you too are from the same SIJ fan club as Tara, Melanie and Carmen. So I will once more for you all explain that your angst, vitriol, frustration and personal attacks are mis informed, mis guided and frankly not well received!

      You seem to be mistaking my blog commenting on a fit athletic golfer with no past history of SIj issues, nor history of trauma, nor any risk factors for SIJ dysfunction means that I dont think SIJ dysfunction exsists, which is complete and utter nonsense and something I have NOT said, nor implied.

      My blog is commenting that Tiger Woods SIJ did not just pop out, as claimed, that his pain is more than likely due to his lumbar disc surgery he had a few months ago, and has as today said as such in a press conference.

      My blog does also question the diagnosis of SIJ dysfunction a lot yes, and I stand by this, I see many patients in my clinic that have been told and treated for SIJ dysfunction that clearly haven’t got SIJ dysfunction and so have been unnecessarily suffering in pain for months, years on end due to poor diagnosis and mis management with charlatan clinicians manipulating them time and time again with only temporary effects.

      When the true cause of the back pain is addressed both biologically and psychologically then can most at last get on with their lives independently and without the need for constant expensive manipulations, injections or surgery

      If you care to read my other blogs on SIJ that I clearly mention you will learn more on my approach and the evidence around SIJ dysfunction

      Next lets move onto my ‘exact qualifications’ as you asked. I am a physiotherapist, have been for well over a decade now, I have completed training and qualifcations in the assessment and management of people with back and SIJ pain, including post graduate qualifications from some of the world most respected SIJ experts. I treat daily those with back pains and have seen 1000’s of cases, and I can confidently say those with true SIJ are rare as rocking horse s**t, less than 10% in my clinic

      I understand that you as an SIJ sufferer feel hard done by and I do understand your frustration at the mis diagnosis you have probably received just as with Tara, Carmen etc etc, but remember there are also many, many more people out there who have had the excat opposite story to your’s with mis diagnosis of having SIJ dysfunction when its not and treated inapproritately!

      I wish you and the others from your fan club all the best with your treatments and I will say to you as I do now to my many other patients who have chronic pain conditions, go and live well with your pain, it does not mean your are broken…

      And again I will reiterate my message to you or any others from this group…. most who are told they have SIJ dysfunction, dont have SIJ dysfunction, this is NOT the same thing as saying it doesn’t exisit as you are wrongly accussing me.

      Regards

      Adam

  12. I would ask that you do not remove the links in my comment which direct interested readers to not for profit foundations.

  13. And furthermore, sacroiliac joint pain and dysfunction are ALOT less rare than you think. It’s these kinds of statements which do a huge injustice to those people struggling with this injury and very often chronic debilitating condition, many of whom are women!

  14. US Army vet here with documented sacral movement and nerve impingement (and subsequent retirement after three years at Walter Reed). A dozen EMGs can’t be wrong 🙂 What Tiger experienced is commonplace for many SIJD sufferers, except that we don’t ‘return to normal’ after our injury. I think that everyone is taking offense to your wording and reading it as “there is no movement of the Sacroiliac joint” (which is not true), rather than “Unlike other vertebrae in your spine, the vertebrae in your sacrum don’t move”, which it true. Whether the actual movement is from the Ilium or the Sacrum is immaterial. As a viscoelastic joint, the sacroiliac can (certainly) become dysfunctional.

    • Hi Ross

      I am uncertain as where all this is coming from, me commenting on the unlikelness of Tigers SIJ popping in or out is NOT me saying SIJ dysfunction doesnt cause pain!

      The harmful langauge used of popping in/out is nonsense and I will say again it just doesnt happen, yes there can be ‘excessive’ movement, yes there is pain, no dispute, but dislocations popping out absoultley no way…, and the SIJ isn’t a viscoelastic joint its a part synovial part fibrotic joint, with the synovial part more anterior meaning the movement can NOT be felt posteriorly by physios, doctors experts etc etc…

      Any I never said there is NO movement in the SIJ, just very very little…

      Regards

      Adam

  15. My SIJD came from pregnancy, not an accident. I went to 20 different specialists just this ignorant. When I mentioned fusion to one in paricular, he said, “isn’t the SI joint naturally fused?” *facepalm*

    Look, I don’t know these other patients, so don’t assume we’re all from one clinic. All I know is the SIJ does pop out and you’ve said in this blog that is does’t (NOT that it’s very very rare). In your replies you’ve also said it has to be trauma related. Well I woke up with it in my eighth month of pregnancy. So I guess you can add “sleeping wrong” to your list of “very very rare” traumas that can cause hyper mobility. I thank God every day for my ortho who fused my SIJ.

    • I cant even be bothered to reply anymore, this is nonsense, you are all obviously from the same SIJ fan club and your all getting your facts mixed up with your own personal experiences

      Regards

      Adam

      • Truly, it is pompus practitioners like you that make life so much harder for people like us. If you “can’t be bothered” to reply, then maybe you shouldn’t be blogging irresponsible or dismissive things.

  16. Adam – it does not appear to me that the comments of the other posters are “ill-informed”. While it is possible that some may have misinterpreted you at some point, your blog posts and overall tone suggest that there is no such problem as sacroiliac joint dysfunction. This is the part that those who are suffering from this condition are having a hard time swallowing. I find it to be somewhat medically irresponsible of you to shun those posters when there is obvious suffering on their part. If your blogs are being misinterpreted, perhaps you need to clarify your point a little more and explain exactly what you mean without disregarding the very real existence of SIJD as a true issue. In fact, many of those suffering are post-pregnancy women who are already lost in the chaos of new motherhood and an extreme lack of understanding about the pelvis and sacroiliac joints overall. I have what you might call a “loose” or “unstable” pelvis and have suffered extreme pelvic and sacro-iliac pain for years (it is FINALLY improving due to some very intense and involved Rolfing and osteopathic therapy), and I have had my sacrum “go out” to the point I could barely move or walk, and then had it “reset” by an osteopath. Sure, it can “pop out” again after that manipulation, but the idea is to find and address the other musculoskeletal issues and imbalances that could be contributing to the mis-alignment and solve for the whole body so the sacrum is less stressed overall.
    I know you think you have explained yourself in other blog posts, but my comment is that this particlar blog seems to be misinformed and alienating to those who are truly suffering. Being that this is a blog highlighting a famous athlete, people are more likely to read it and it really should be clear, within the parameters of this post alone, that SIJD is a very real problem for many – even if it isn’t a problem for Tiger Woods.

    • I really dont know how much clearer I cant make it

      Disputing the prevelenace and terminology used with Tiger Woods and his SIJ popping in/out is NOT saying I dispute the SIJ causes pain or problems for some rare cases.

      As I have said in other replies there are in my expereince many more cases the other way around, with many people being told they have SIJ dysfucntion and being treated inappropriatly and incorrectly as such

      My blog has obviouusly been posted on some SIJD webpage and people seem to be not reading it fully, jumping to conlcusions, making wild and ill informed claims and being personally rude and disprespectful, for which I will not tolerate

      Regards

      Adam

  17. I find it almost comical that you keep lumping us all together like we are out to get you. I don’t know who these people are, but what I think most of these comments are saying is that in this particular post about Tiger, you pretty much state that there is no such thing as a sacrum that moves. Perhaps you DO clarify it in other blogs, posts or comments, but once the Tiger post has been read, the damage has already been done. At this point, my interpretation is that you are being a bit smug and defensive about the whole thing, which is unfortunate. This makes me glad I am not coming to see you for assessment or help. I have been blasted, negated, belittled and mistreated by countless practitioners already, so I don’t need to be poo-poo’d by you as well. Many of the people who have suffered with this ailment have seen NUMEROUS therapists, doctors and practitioners who do not understand the SI joint or the problems that can manifest around it. It seems to me like maybe you’d be better off saying that YOU mis-spoke or misrepresented something instead of shrugging off what is actually being said here…but that is just my two cents.

    • Dear Mindy

      Apologies for my shortness or defensivness, it is the vitriol and angst of other posts together with the unnessacary personal comments that I have been having all day that has made me so, which is no excuse and so I again apologise

      With regards to my smugness I cannot see how this is so

      As you correctly say I ‘pretty much’ say that the sacrum doesn;t move, which is pretty much correct, I do NOT say it doesn’t move, nor do I say they do NOT hurt

      The SIJ doesn’t move much, even in hypermobility, even in dysfunction, yes it can hurt like a son of a bitch but again I will say it…the SIJ just doesnt move much

      This notion and harmful explinations and language used by clinicans when describing SIJ dysfunction is something I do not like or approve or agree with, its nonsense, it does nothing but paint false beliefs and ideas for the patient and makes them think things are about to come out, which can alter movement and actually create more pain, they just dont… and again before you go off on one, thats not to say they dont hurt!

      Pain and SIJ movement are completely unrelated as shown in this study on post partum SIJ pain, those with hypermobility had just as much pain as those with no hypermobility, go figure http://www.ncbi.nlm.nih.gov/pubmed/11703199

      I will also say again the number of missed SIJ dysfunctions is low compared to number of incorrect patients informed they have SIJ dyscuntions

      Thats my two cents

      Regards

      Adam

  18. Hi Adam

    Great blog

    And thanks to the comments from those above who have made me laugh and entertained me in thinking that you can disclose the SIJ, top reading following by great banter.

    There is a reason you have so many following your blog and agreeing mate.

    • It’s nice to know there are at least two more physios out there who find humor in the suffering of others. Sure, maybe you didn’t “mean it that way”, but there are real people here trying to discuss a very real problem and their disappointment in how the topic of whether the SI moves or not has been handled here. Perhaps some of us are a little sensitive, but the truth is, to get to the point where you have CORRECTLY been diagnosed with “true” SIJD is a hell of a battle. For many it takes years, and for others it may never happen. Beyond that, there are few who understand the breadth of this issue once it has been diagnosed properly. So, while Tiger may not have a true SIJD diagnosis, it is still questionable to treat the subject with such overall flippancy. Perhaps the response that we have received just solidifies why people have such a hard time finding healing with PTs, Physios and the like. Too many of you don’t listen. You are too stuck in your own head to really hear what is being said.

      It’s very disappointing that this discussion got to this point, but I am sure glad it made someone out there laugh. Thanks for taking our comments so seriously.

      • Mindy

        No one is laughing at you, or anyone else!

        Please remember that your messages were very personal and derogatory towards me as you had not read the blog fully and jumped to conclusions, when I attempted to explain more you continued with further ad hom attacks, which I’m afraid is just not on!

        I do feel sorry that you have been mis guided and mis informed about your SIJ popping in and out (which it doesn’t although i understand it may feel like it) and that you have been obviously sent around the houses looking for an answer to your pain, all i will say further on this subject is I hope your current treatment isn’t costing you a lot in ‘top ups’ or ‘maintenance’ and that you are doing some regular exercise and movement therapy as your pain allows

        Regards

        Adam

      • There is something amiss when I read anecdotes of patients fighting to be diagnosed of something they think they have…as opposed to listening to what the health practitioner might have to say about it.

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