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How Does Balance Effect My SI Joint?

April 7, 2016

I was recently having a conversation with a physical therapy

assistant who works in a local well meaning, yet very

“conventional,” physical therapy practice. Since coming to work

with us as a patient, we have had many conversations discussing

the principles, strategies, and techniques behind treatment, based

on an Applied Functional Science approach(which all of our

therapists are Fellows of Applied Functional Science). One

such discussion

occurred recently when she asked, “Can you help me understand

why ‘balance / stability training’ was included as part of the

treatment plan for my SI pain Diagnosis?” The discussion that

followed highlighted some of the misconceptions surrounding

balance rehabilitation and training, and hopefully helped provide

a better understanding of balance as an integral part of all

function. Our patient had become accustomed to seeing static

testing on the ground, or on a less stable surface, as a common

way to determine whether or not an individual had “good

balance.” Unfortunately, someone who may do well standing on

one foot with their eyes closed for a predetermined period of time

may stumble or fall when turning to look at who just called his / her

name while he / she was walking. Though commonly used, these

static balance

traditional, static tests

provide limited information when the

fundamental truths about balance are understood. Balance is

dynamic and three dimensional. It is our body’s ability to integrate

the information from all of our body systems during a functional

task and use that information to displace our center of gravity. The

system must then decelerate that motion and either bring the body

back or, more likely, move in a completely different direction. Three

of the main systems that feed the body information are the

vestibular system, the visual system, and the proprioceptive

system. Though there is a minimal amount of information

generated to those systems in a static position, it is motion

that truly “turns on” and feeds these systems the information

required for function. Balance requires the ability of the

neurological system to successfully receive information, process

that information, and then convey an appropriate motor plan for

task completion – all while controlling the center of mass against

gravity. Balance requires range of motion and strength.

If a body segment lacks motion, then not only do accommodations

of additional motion in other areas need to be made to complete a

task, but proper muscular loading and exploding at the restricted

joint cannot occur. Balance can be impaired if the surrounding

musculature is unable to control movement into

that motion (unstable), even when full passive range of motion is


slipping on ice

Most importantly, balance requirements are determined by the

functional task the body is being asked to perform. In order to

insure successful task completion, the individual should be able to

control three dimensional motion beyond that required of the

functional task. Balance rehabilitation and training programs

should reflect that goal. The physical therapy assistant that was

currently being treated happened to be an avid walker and was

unable to do so due to her SI pain.  As it turns out she had been

receiving traditional physical therapy for almost 9 months focusing

on hip alignment and core strength.  The real dysfunction was

down in her right foot.

The foot had created so much stability due

to her poor balance that it “locked up”.  Well the locked up foot was

transmitting way to much force up to her hip and causing hip

alignment issues and ultimately SI pain.  If we did not address the

stability after the mobility she would end up having a locked up

foot again.  So this was a great experience for her and us as we

were able to spread the new innovative information as it relates to

Applied Functional Science.  If you are interested in hearing more

about how stability and balance effect our SI joint and lower back

please check out our next workshop by clicking here for more

details .

P.S. I also wrote an ebook called "The Truth About Low Back Pain- The Hidden Culprits" and you can have it free by clicking here

truth about lower back pain


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