Destabilized SI Joints

Hi Grandma Joy!

I’ve been thinking about you and am so glad to hear from you, although sorry to hear you are struggling. Hope things are settling down on the home front now so you can get back to taking good care of yourself. The icy road does sound scary!

You know, in spite of the development of all this imaging technology - CT, MRI, ultrasound - most patients with pelvic girdle pain have normal findings. This suggests that the pain is not coming primarily from the skeleton or from major soft tissue changes. Like non-specific lumbar back pain, the trouble is now thought to emanate from the large, stabilizing muscles around the pelvis as well as pelvic ligaments and joint capsules.

Do you have the second edition of my book? I really can’t write out here as much as is needed to learn about the SIJs, why they are the most important joints in the body, and how they are stabilized through natural posture.

You’re intuition is probably right-on that your surgery greatly altered the large fascial sheaths underneath your back, which play a huge role in pelvic stability. I have my own version of that and for years had to work through the pain until today I am almost pain-free. It can take a very long time.

But guess what? We now have a very good postural support belt that I would highly recommend to those who are struggling with SIJ issues or who simply need a little help “tipping” into the posture. Check it out at:

www.store.wholewoman.com. The product category is Postural Support.

Lots of love to you and please don’t stay away so long next time!

Christine

Hi Jacqui,

No one knows why the hips widen and the lumbar curve flattens in the years after hysterectomy. Unfortunately, neither gynecology nor orthopedics even recognize that these profound musculoskeletal changes exist. Not one scientific paper can be found on the subject of pelvic instability after hysterectomy. Yet, post-hysterectomy changes are very real, self-evident, and obvious in any populated place, such as shopping centers, recreation areas, etc. The body shape that tends to develop after removal of the uterus is often wide across the buttocks. Because the lumbar curve flattens, a compensatory curve, or hump, develops at the base of the neck. The waist becomes very short as if the rib cage has come to rest atop the pelvis.

From Whole Woman perspective, these changes are centered around the sacroiliac joints in between the lower spine and hipbones. In normal anatomy, the sacrum is held in a horizontal position, while the rest of the spine rises vertically. This is only possible as a result of a pronounced lumbar curve. This curvature develops as soon as toddlers begin walking and expands furthest in pubertal females.

The uterus is a large, muscular organ that is flexed horizontally and positioned directly behind the lower abdominal wall. Two round ligaments come off the front of the uterus, travel down the inguinal canal on either side of the abdomen, and embed into the labia surrounding the vagina. These act as guy wires to hold the uterus in its anteverted position. Additional structures, called the uterosacral ligaments, connect the uterus to the sacrum. In this way, the sacrum is also held horizontally by an extensive visceral/ligamentous system. The broad ligaments connect the uterus to the pelvis at the side walls.

When this vast array of muscle and connective tissue is removed, the skeleton loses much of what shaped it during the developmental years. Perhaps most importantly, the sacral spine has lost the strong, muscular network that tethered it to the front of the body, therefore keeping it positioned horizontally.

By adulthood, we are committed bipedal creatures so that the entire musculoskeletal framework is shaped and programmed for upright posture. There is no doubt women are going to stand up and walk after surgery. However, it is a profound truth that our spine is “essentially horizontal” (S. Levin). This means we have the same horizontal pelvis, including the sacrum, as four-legged animals. The horizontal nature of the sacrum is kept that way in the female body by the uterus and its ligaments, as explained above.

Removal of the structures that tether the sacrum to the front of the body does not mean that women can no longer assume bipedal posture. However, it is very possible that the lumbosacral angle straightens as the top of the sacrum rises out of the pelvis to form a more vertical spine. Whole Woman hypothesis suggests that the last, or 5th, lumbar vertebrae wedges down between the hipbones and becomes permanently incarcerated there. This places great strain on the sacroiliac joints and causes them to translate to the far extent of their range of motion. The rest of the lumbar vertebrae adapt to the course established by the 5th, which causes great loss of curvature in the lumbar spine. Because human spinal curvature cannot be straightened out, the spine compensates by forming a significant hump at the base of the neck.

It is with great hope that I believe these changes to be preventable and somewhat reversible in some women. Whole Woman Posture, combined with sacroiliac compression from the outside, may offer women the chance of stabilizing the pelvis and preventing loss of natural spinal shape.

I don't know what to offer in terms of suggestions regarding PT. Diane Lee and other luminaries in her field have done a lot to separate fact from fiction regarding motion and functioning of the SIJs. However, there is an eerie silence about the post-hysterectomy woman, even as the literature would have you believe every pregnant woman has SIJ dysfunction. You know my point of view anyway - abiding in natural posture - although I totally understand the value of having a professional willing to support that effort.

I have sold my first belt to a woman who is just two months out from (needless and thrust-upon-her) hysterectomy. She was astonished to hear my theory and I will be waiting with a hopeful heart that she is able to keep her natural spinal shape. Only time will tell.

Christine