SI joint pain for 4 months

[tbui]

Hi Rip,

Looking for some input on an ongoing injury that’s been around for going on 4 months.

Stats
6’5”, 260 pounds. 28 years old.
250 squat, 285 deadlift, 235 bench, 145 press. I have not power cleaned since the injury, but was around 185 at my peak. These numbers are down from my near all time highs on NLP last fall - 330 squat, 415 deadlift, 235 bench, 150 press.

I have a short right leg, approximately 1cm shorter than my left.

The injury
Mid-January. Deadlifting and heard a pop in my lower back. Crap. I took about 2 weeks off. Since then, I have a persistent feeling of instability and pain around my tailbone, more often on the right side but bilaterally too. Internet research tells me it is in my SI joint area. There is pain in this tailbone region when I bend over with a straight or rounded back. It hurts to sneeze while I'm standing up. The pain stays between a 2 and a 5 in intensity depending on the day and what I'm doing.

Things I have tried that haven’t noticeably helped

• Chiropractor
• Hip, hamstring, glute, and psoas stretches and massages (Chiro said my hips were tight and might be pulling me into a pelvic tilt)
• McGill Big 3 in case of any core instability
• I have been lifting since the injury at lower weights and attempting to progress 5-10lbs per workout, including deadlifts. The feeling of instability has not gotten better as the weights have gone up.
• I work in an office and I've transitioned to a standing desk because otherwise my hip flexors get too tight and I get pretty uncomfortable.

Other things that might be relevant

• I do use a 3 inch Dominion belt for squat and deadlift.
• I lift with a 1cm heel lift in my right shoe.
• A few weeks ago, a buddy noted that I may be over extending my lumbar spine at the bottom of my squat. I’ve had a few workouts of focusing on addressing this, but have not seen improvements in the pain.
• I’ve wondered if my bed is not supporting my lower back enough. I am getting a higher firmness mattress in a few weeks.

Thank you for any input that helps get me back on the program. I’ve got PT scheduled in a few weeks, but they’ll probably tell me to stop lifting and I’m trying to avoid that.

[Oso Rojo]

I may have a similar problem with pain on the back of my hips, mainly after sitting. I think it's called the SI joint. For me stretching, Elephant Walks and Elevated Foot Hip Flexor. I do both of them each morning and had gotten some progress. After bitching enough to my chiropractor, she is has also start making progress on it, note: she has another title, SWMBO, She Who Must Be Obeyed, my wife, hahahaha.

I'm a lot older than you so mine could be different.

Who ever you have look at it, make sure they understand working with athletes, most doctors don't. I'm lucky in that my gym has a PT in it and my wife worked on IFBB body builders. So both know that "Stop Lifting" is not an option.

Good luck in your search for a solution.

[J.D. Shipley]

Tbui, a 1cm heel lift in one shoe only? Why? Please give more info.

[Mark Rippetoe]

Leg Length Discrepancy | Mark Rippetoe

[J.D. Shipley]

Leg Length Discrepancy | Mark Rippetoe

Trying to figure out if this is for me or the OP. A shimmed shoe and a persistent low back pain jump out at me as I’ve seen this come up too many times where someone shims unnecessarily. Of course there’s also form issues and being 260lb at 6’5”. My low back didn’t stop bugging me until I gained more weight even with shitty form, getting over 260lb at 6’3”. This post would also be more appropriate for the Managing Injuries section of the forum.

I guess the better question to ask the OP is can you get in to see a coach somewhere close to you?

[Mark Rippetoe]

For the OP. If you shim your heel, your plantar angles are different, which introduces asymmetry in the attempt to restore symmetry.

[J.D. Shipley]

I completely missed that it was a heel lift too.

[tbui]

Thank you all for the input. Some responses.

Oso: I am more and more suspicious that the pain and perceived instability is related to the tightness in my hip/groin region that my stretches and massages are not addressing. This discomfort when driving/sitting roughly coincided with the onset of the back/tailbone pain - I assumed it was correlated but not causal. Perhaps this is something the PT (who I intentionally chose based on his work in Sports Medicine) will be able to comment on. I will add your exercises to my morning stretching/mobility regimen.

JD: Unfortunately I'm about 3 hours away from the nearest coach or gym. I am not so arrogant as to say my form hasn't drifted from ideal - I will reread the blue book and see if I'm enlightened once again about anything that has broken down in my form. Re: my height/weight - my PRs for squat/pull on NLP were done last summer at 250 lbs. Not to say higher body weight will not help (I have experienced those benefits since being <200lbs a few years ago), just that I am not in uncharted waters for this body weight and the weight on the bar.

Rip: Two comments on the shim

• I have used the shim in and out of the gym for roughly 4 years and not had a problem. That's not to say the shim is not the problem, just that it has not been a problem to this point, including through my NLP run last summer up to a 350 squat/430 deadlift. I could understand if this is a culmination of years of a redistributed-but-not-fixed asymmetry, and that now I am unexpectedly paying the price.
• I have also used an insertable sole, which is the same 1cm height at the heel but adds maybe half a centimeter to the forefoot as well. This would be closer to correcting the difference in plantar angle, though still not the gold standard of shimming the whole shoe sole. I will look into what can be done here.

Thank you all again for your responses.

[Mark Rippetoe]

I have also used an insertable sole, which is the same 1cm height at the heel but adds maybe half a centimeter to the forefoot as well. This would be closer to correcting the difference in plantar angle, though still not the gold standard of shimming the whole shoe sole. I will look into what can be done here.

You can just stand on a shim. Piece of rubber mat or plywood. Right?

[tbui]

That would be too easy, wouldn't it?

You're right. I'll give that a shot.