Pain After Physical Therapy, Frustrated

Hi everyone,
      I'm wondering if anyone has had the same experience. I have had SI joint problems for 2 years.......sigh.....2 years. I finally got the SI joint injections in both sides last week and it didn't help as much as I thought it would, although it's only been a week. I felt a little relief this morning, but went to my first physical therapy appointment. The main PT was out for the week and a fill in was assigned to me with notes to follow. She seemed really busy and left me at times for 10minutes with nothing to do. The waiting was annoying, but then she had me do an exercise where I sit half way on a chair and stretch my hanging leg back behind me. It was really hard for me and she left me telling me to do 10 on each side. I did one on that side and stood up, then I stupidly tried it on the other side and immediately felt it injured me more. I felt immediate nerve pain all the way down to my foot and it has stayed all day. It is now still really sore and I still have the nerve pain. I'm so upset, because I feel like I was healing and the one exercise set me back. I feel it was a fault of the Physical Therapist. I decided not to go there again, but am wondering if all PT is like this? Any advice or experiences would be appreciated. Thanks!


  • So sorry to hear about your experience with PT. I'm not a real fan of PT myself, I do think it's good for rehab when something has already been fixed. It sounds like you are on the path of things to cross off the list before the inevitable.  Surgery.    Who did your shots, and have you had an MRI yet ? 
  • Hi Skysue, thanks for your reply! I got shots done by a spine and wellness center, by physician assistant. She seemed good, they used fluoroscopy, it hurt like crazy though! I've been avoiding bending for a whole year, which has helped my SI joint symptoms, but now I'm super inflexible. This is why I thought PT would help to get me back into flexibility and strength after shot. I don't know, maybe it is better just to do it on my own. I can't tell if the shots worked fully yet, I feel a bit of relief, until I stretch too far. Did you have the shots and what was your experience? 
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  • I had PT before and after surgery it didn't help me at all. You mentioned hurting after the one certain exercise reminded me of several mornings I would go in feeling good with no pain and coming out with all kinds of pain going on. I tried because the doctors know best right? I wish you luck and hope for a pain free life soon.
  • I had si joint surgery, one side in November, the other in May of this year.  I believe even after surgery you should wait until you heal completely or fuse completely before doing any type of pt.  Especially after surgery.  I started pt 3 weeks after my May surgery and went to a different facility than I did when I had my first surgery and now the side I had done in November is messed up.  I was non weight bearing on the other side.  Pain came on while doing therapy.  Now I am waiting to see what is going to happen next, maybe a revision.  
  • smartens162smartens162 Manitoba, CanadaPosts: 361
    PT - with an osteopathic approach - has made a world of difference for me in my recovery from initial herniation in March 2014 to date.  I stayed away for 12 weeks post-surgery at surgeon's recommendation, but did conservative exercise with walking and aqua exercises.  The osteopathic approach works more with nerve pressure, stretching, massage, gentle chiropractic adjustment as needed, and excellent coaching for self-maintenance.  I think you should look until you find one that fits, and stick with it.  There are times when I feel worse coming out of treatment than when I went in, but it's usually just the body reacting to the 'fixing' and in a couple of day I feel much better.  Of all the things I spend $ on to get relief, PT is the most valuable to me.
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  • kat1d1dkkat1d1d CaliforniaPosts: 2
    PT is different for everyone partly because there seems to be no universal approach to SI and related nerve pain. My first months in PT resulted in significant increases in pain. After a fair amount of research, trial and error and going back to working out (after my fourth procedure I was put on rest - don't do this!!), I had an honest conversation with my therapist. I communicated what was ineffective, what movements I felt helped me improve and, specifically, what elements were triggering and exacerbating the pain.

    This may not be true for everyone, so I encourage you to have an open dialog with your therapist or other movement professional. Static stretching without warmup or significant movement of my muscles was a pain trigger. Why? Because my SI join pain is caused by a weakened system of connective tissue and muscle wasting. This makes my joint loose (hyper-mobile). The stretching was increasing the laxity of the tissues, specifically the tendons and the surrounding muscles, making the joint even more unstable. This instability was not only causing inflammation in the joint triggering nerve pain, but also making the nerve entrapment worse.

    I reached out to other professional I know and we all decided to switch my PT (and training) protocol to focus on two things: strength and stability. More than likely, if you have had SI joint pain for a few years, you're muscles are no longer in an optimal structural state. You could be lopsided, with one side being stronger than another, you could be using the incorrect muscles to support your spine and pelvis or, in my case, your minor muscles are trying to do the work of your major muscles, causing constant pulling, spasms and even tearing.

    I'm on my second month of focusing on rebuilding the strength in my larger muscles using larger movements (e.g. squats) and strengthening my smaller muscles (glut med, piriformis) using body weight stabilization techniques.

    And, while it may seem completely counter intuitive and definitely takes practice to do it correctly, when I feel pain, I squeeze my glutes, drop my sacrum and stand up as tall as possible. I mean REALLY squeeze and focus especially on the outer muscles. I basically imagine pushing my joint inward. At first I could do this like 4 times a day. Now I'm probably up to 50-100.

    I also do it when I am sitting and driving. I pull in all the muscles on the outer glute and thigh. If you do it correctly, you should notice that your sacrum naturally feels less pressure and your pain might even go down. Also, come up with ten exercises that you can rotate throughout the week and find a form of cardio that requires you to engage your glutes without taxing your back.

    Most SI joint pain is caused by the joint moving too much or too little. Avoid exercises that would make that worse. Lots and lots of stretching will do that. As will avoiding utilizing the muscles in that area. Personally, I can't stretch out my hamstrings more than a little bit after work out. Cold stretching them causes my sciatic pain to kick in so hard that I'll be in tears within seconds. Interestingly, though, doing gentle hamstring strengthening (like a basic curl) seems to alleviate it. Nothing too hardcore. It's a sensitive area.

    Overall getting stronger and learning to control the muscles that support my SI helps considerably with managing the pain. Sometimes exercising is the only time it doesn't hurt. I wish I could say that it is a "fix" in my case, but it's not. The damage to my tissues, the nerves and the integrity of the joint is just too far gone. But, I've had friends who have adopted this approach and have many pain free days.

    Like many of you, I never thought I would be taken down by something like this. My entire life changed and I understand how frustrating, scary, depressing and painful it can be. I've lost a lot, including my profession, some friends, hobbies and physical abilities. What makes it difficult sometimes is the diagnostic and treatment system. I call the SI joint the "medical hot potato". Many doctors can treat it, but so many fail to do so or won't. I work with a team consisting of a neurologist (the person to catch the SI pain after my first Ortho missed it), a spine ortho, a rheumatologist and my PCP.

    To date, I have had:

    3 rounds of steroid injections into the right and left SI joint 
    1 PRP injection into the right SI joint and lower groin
    1 botox injection into the right piriformis muscle**
    1 round of radio frequency nerve ablation of S1-5
    Chiropractic (no bone cracking - only soft tissue work)

    I do currently use medication to manage both the joint and nerve pain. I am also on an immune suppressant to control the inflammation in the joint.

    My diagnosis:

    Bi-lateral SI Joint Disease (Dysfunction)
    Secondary piriformis syndrome (right)
    Chronic sciactic and groin pain, accompanied by occassional femeral nerve pain
    Psoriatic Arthritis

    **Personally, the botox injection left me crippled for more than 5 months and caused my SI joint, buttock and leg pain to go from unilateral to bilateral. If ever recommended to you, I urge you to seek out another opinion before you proceed.

  • kat1d1d - New to site and I just read your post and I can relate to 85% of your journey.  Have you improved in the last year?  I have had everything except the botox and PRP.    I have a great "team" of health care providers working together to manage my care.  All advise against si fusion.  Did the PRP help?  Any info on stem cell treatment?  

  • kat1d1d - New to site and I just read your post and I can relate to 85% of your journey.  Have you improved in the last year?  I have had everything except the botox and PRP.    I have a great "team" of health care providers working together to manage my care.  All advise against si fusion.  Did the PRP help?  Any info on stem cell treatment?  

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