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sacroiliitis, hard massage and therapy

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Posted 5/19/2011 11:59 AM (GMT 0)
After hesitating and hesitating, I finally booked a physio appointment for my sacroiliitis and had it yesterday.  At the assessment, all the pains that I described were typical for sacroilitiis plus from the way she moved my joints, etc she could see I am pretty messed up.  She recommends orthodics and said I had inflammation not only in my SI joints but my piriformis muscles (whcih describe the shooting pains I get during flare ups).  She could tell this as I was very tender when she touched where this muscle would be.  Everything is also very rigid.

For treatment, she did some laser thing on the joint plus some weird stimulating machine, both of which are to improve circulation.  (Anyone else have this?).  She's also ordering an SI belt, lookign into orthodics and getting a prescription for some inflammation cream that they use with an ultrasound (anyone?)

This is all ok and am desperate to try anything.  One other thing she suggested is a massage as my muscles are very tight; however, she did say that it's gonna hurt like hell.  This terrifies me, and mostly terrifies me of causing a flare up with the shooting pain from my buttocks down my legs.  It's extremently painful and takes me 3 weeks to recover from such a flare up (plus I need to be able to lift my 2 year old which i cannot during flares). 

Anyone else tried "hard" therapeutic massages for sacroilitiis, or more so, issues with piriformis muscle?   If so, how was it (during and after)? 

PS - Any comments on physio treatment is also appreciated.

Posted 5/19/2011 4:35 PM (GMT 0)
I know about most of what you are describing from my own experiences. That weird stimulating machine thing...It has been used on me before. It is suppsed to increase circulation, like you said. I didnt like it at all. My experience with it was at the chiropracter, about 5 years ago. I have never had any type of laser treatment on my joints. I have also used all the braces and orthotics. With those, they are expensive and, for the most part, useless. I found that using the brace for my lower back trained my back and muscles to rely on it. If I didnt use it, I was working the muscles and therefore strenthening them. I do use my braces occasionally. If I am going grocery shopping or something that has to be done and my back doesnt want to allow me, I will wear it for extra support. I try not to make it a habit though. The last therapist I saw sounds a lot like the one you are seeing now, in terms of the way they practice. The one I see now is wonderful for me. He doesnt use machines or braces or anything other than his hands and my body. Each visit we practice stretches that target that area (to ensure that Im doing them correctly at home), he then massages for a better part of an hour (to loosen those muscles that are pulling on the joints). He doesnt do deep tissue on me. You dont need it to be deep and painful to be effective. It took me a while to learn this. At the end of the appointment, he shows me ways to strenthen the muscles that need attention in order to hold my joints up better.

I hope this helps. This is just my experience-and it doesnt have to hurt to help.
Posted 5/19/2011 4:46 PM (GMT 0)
One more thing to add:
I have had deep tissue, in that area and others. It almost always made me worse. Sometimes the pain from the massage would be so intense that I would vomit. I wouldnt go back to that if someone paid me a million bucks. Maybe you can have the therapist start with a gental massage. Im not going to act like massaging that muscle is anything close to blissful, but we work on it a little bit each time, twice a week, and then I use an epsom salt bath after and biofreeze or something similar to it and it is very tolerable. The first couple times, it will be aggrivated, but ask your therapist to start slow..real slow....like 5 minutes the first week so you can see how you are affected. Like you said, you dont have the time to be down, esp with a 2 year old.

Let me know how it works for you.
Posted 5/19/2011 10:15 PM (GMT 0)
My therapist did something called trigger point massages. She would take two fingers and gently push at certain points on my body and the muscle would just melt out of the spasms. It felt wonderful!
She would only work the muscles that were not hurting which would cause the muscles that were hurting to relax.
The stimulation machine sounds like a TENS. Sometimes it helps, sometimes not. It depends on the therapist's skill.
I've had the ultrasound therapy on my foot. I helped a lot with the scar tissue that was building up on my foot. Make sure you don't feel heat during it or you'll have a burnt bone! One guy scorced my bone and it took a week before the pain calmed down.
Posted 5/20/2011 1:51 AM (GMT 0)
Over the years I've had aqua therapy, ultra sound heat therapy and electrical stimulation both for muscle issues and also a herniated disc with sciatica.   These provided limited and temporary relief, and in some cases, actually seemed to aggravate my pain.  For the past 6 mos. I have been seeing a very good and skilled neuromuscular massage therapist and I believe I've found the most benefit from her.  I had seen another massage therapist for quite awhile before, and that was sometimes beneficial, and sometimes actually did bring on flare and/or more pain and problems.  

Like everything else, your specific areas and problems will respond in their individual way.  Be careful of therapists who think they are going to adjust you and that's that.   I also have fibromyalgia and when I first tried massage therapy it made me feel awful afterward for a few days.  I learned I better handled 30 min.sessions  more often than a less frequent hour long session.   Eventually I realized I was no longer making any progress with my last therapist and talked to lots of people before trying my current one.  She's a genius.   It's like anything else - sometimes you get lucky, sometimes not.  If I had given up after getting my very first "complimentary massage" years ago, though - which made my back hurt something awful - I'd be missing the benefits I feel I'm getting today.

With your issues and tight muscles I don't like to hear "it will hurt like hell".   I think that sounds like a red flag.  My massage therapy is not the "relaxing spa experience" that some people think or expect it to be.  It causes some moments of discomfort, *not out and out pain*, and occasionally I'm hurting a bit the next day.  But the location and severity are what supply the clues to the therapist for the next time.  I'm told to take notes and I do.  We go over the problem areas, changes, new pain, improvement, etc. at the beginning of each visit and she compares to the last visit.  She checks my SI joints each time to see if they are "stuck" again.  We plot progress.  She tells me what stretches might help, using a very individualized method. 

Also - I had several PT's, 2 massage therapists and one doctor tell me I needed orthotics.  However, the difference in leg length is only 3/8 inch and my insurance won't cover anything under an inch.  I've tried OTC inserts and finally quit trying to get it right.  Oftentimes it aggravated the pain, or so it seemed.  I have found the gel insoles (in both shoes) to be helpful, though. 

Good luck - I hope you can find some measure of relief.  Just be careful and go slow.  I probably shouldn't say this, but sometimes I think the average PT treats every body/muscle injury the same - and the same recipe just doesn't work in every scenario.  Look for somebody who understands the body, not just the method.

Posted 5/20/2011 2:25 AM (GMT 0)
I've had plenty of therapeutic massage and I do think it helps me. But I always make sure the massage therapist is very skilled and highly recommended and I do not permit them to push so hard that I cry. My long-time therapist (who moved to Spokane, darn it!) made it very clear that he would let me decide what was hard enough.

Trigger point massage is great. People with sacroileitis have a typical pattern of muscle spasms that can be addressed with massage very effectively IMO.
Posted 5/20/2011 12:02 PM (GMT 0)

Thank you all for the responses.  I realize everyone is different but it still really helps in hearing other's experience.

too young, interesting what you say about the brace (this is the SI belt?).  Glad you have a good therapist now.  To tell you the truth, I was expecting muscle strenghtening exercises and was surprised at getting the machines. I'm no dr, but don't really believe that the circulation machines will help.  I am hapyp though to try the inflammation type treatments (cream) and am hoping my insurance helps cover the orthodics.  I agree...you would think that massage doesn't have to hurt to work.  How awful that your ws so bad you got sick. 

couchtater, yes, tens sounds familiar.  She also put a heating pad on my back at the same time.  She put the stimulation pads on each SI joint and also where my piriformis muscle would be....which hurt slightly on one of the muscles (rest was ok).  Thank you for the warning of the ultrasound therapy.  that's awful you got burned.

lucysgd, that's exactly waht I'm scared of...of causing more pain and a flare up.  Thank you for the warnings.  For me, she suggested orthodics because of my lack of a foot arch.  She thought my legs were diff lengths but then measured and they're ok.  Hmmm...I do hope my insurance covers them regardless. 

kazbern, thanks. Sounds like you had a good experience.

Thank you all again for the responses.  I think I am too scared to try a massage that is goign to hurt...esp when she says a lot.  So I may skip that treatment.  Am meeting again on Wed to discuss treatment going forward.


 

Posted 5/20/2011 3:37 PM (GMT 0)
I was told it was an SI Belt. I will have to check the box when I get home.

Someone else has mentioned earlier that if they would have stopped getting massages after their first bad experience, then they wouldnt know the benefits that it provides them now. This is true. I strongly believe that joint and muscle problems go hand in hand. One causes the other or the side effects of our meds creates these issues. Regardless, please dont avoid massages completely due to fear of it being painful. Find a good therapist who's specialty is massages or something similar. Call around and ask each office if they have a history of successfully working with others with your condition. Ask friends for referrals. When you find someone who understands your condition and can read you, you will be glad you did. For example, my therapist can tell by my breathing and watching my hands if something is too hard for me. (your face is in the little hold that massage tables generally have). He says that I tend to clench my hands and hold my breath or breath shorter and quicker when something is painful. He knows to lighten up and I have never had a session with him that has caused more pain.
Posted 5/20/2011 4:05 PM (GMT 0)
I don't have the same condition, I have RA. I have only had a few massages, and the next day I hurt terribly from them, not sure why! It felt as if someone had beat me up. It could have been the person wasn't as gentle as they should have been. So I agree get someone who is skilled and has experience with your issues.
Posted 5/20/2011 5:12 PM (GMT 0)
This thearapist was quite familiar with my situation and seemed to say it was common (although they have a specific person who does massages so wouldn't be her).  too young...she also commented that the joint and muscle problems go together and it was just a matter of which came first, the chicken or the egg.
Posted 5/20/2011 6:22 PM (GMT 0)
lol. I like your analogy.
It is true though. Also, that muscle, if I understand correctly, connects to your hip bone. The tighter it is, the more it will pull your hip down. There is another muscle that connects your bottom rib to your hipbone. The tighter that one is, the more it pulls your hipbone up. Those two issues are a common problem and create sacroiliitis in many people. When your hipbones are not aligned properly, your legs tend to not be the length they should be.

Image this: someone ties a rope to the top of your right hip bone and pulls up. Your back and SI area are now misaligned and your legs are not the same length anymore. My does it hurt. Now imagine someone is using the same rope but pulling toward the ground. That hip bone is now lower than it should be and your legs are misaligned and all that jazz and it still hurts. Loosen the muscles to "normal" and it realigns. It takes time but it goes back to....not hurting as bad.

Does that make sense?
Posted 5/21/2011 12:22 AM (GMT 0)
too young...your description makes sense.  Thanks so much for explaining.  So in other words...massage should help if done correctly and it doesn't (shouldn't) be done in a painful way
Posted 5/22/2011 11:19 PM (GMT 0)
Pretty much. It can be done in a way to not cause pain. I am sometimes sore after a massage but to a point that I barely notice it.
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