Odyssey ISG - a field report

Numerous forum entries with calls for help confirm it: Unfortunately, many triathletes have to deal with the sacroiliac joint (ISG). From June of last year, triathlon.de reader Antje Laschewski also had the questionable pleasure of dealing with this joint, which was completely foreign to her, and above all the pain it can cause. After the end of the odyssey, she is now happy to pass on her experiences to all those affected.

What does the specialist literature say?

So first of all, some information from the specialist literature. The ISG is a joint-like connection between the sacrum and the right and left ilium, secured by strong ligaments. Due to this tight connection of ligaments, it has only minimal mobility. If "disorders" occur in this highly complex structure, uncharacteristic, stabbing pains in the lumbar spine occur in the early stages, especially after long periods of sitting or lying down. In a more advanced stage, the symptoms occur in the area of ​​the sacrum and the lumbar vertebrae - both at rest and under stress. Usually they are no longer limited to the back, but can also radiate into the buttocks, the back of the thighs and the hip flexors - mostly on one side - and draw the entire muscular system into passion. It gets really bad when the joint becomes inflamed.

Chirotherapy as first aid

Of course, like all athletes, I was quite annoyed by the symptoms and initially tried to be ignorant. Unfortunately, that didn't work for long. Relatively quickly I had constant, severe pain both during training and afterwards. In order to get rid of these, I finally went to a doctor who is known for his chirotherapeutic talent. He said the problems come from blockages that can be solved quickly with a few simple steps. That worked fine at the beginning. I walked there every two to three weeks, let myself be “put in the right place” and it was good. Please don't imitate this, because the time between the doctor's appointments got shorter and shorter and I didn't feel well at first. On the contrary. The pain kept getting worse.

There is no way around sensible diagnostics

So, frustrated, I went to a new doctor. This – himself a triathlete – then explained to me that chiropractic therapy is not always the silver bullet. Rather, the ligament structure could be so loosened by the constant adjustment that it can no longer provide the necessary support.

His motto: If this form of therapy does not work after a maximum of 2-3 uses, the causes of the constant blockages must be sought. Poor posture of the spine, signs of wear and tear or shortening of the leg are all possible. No sooner said than done: I was examined in detail, X-rayed and finally an ultrasound was done. The doctor decided against a cost-intensive MRI because he was certain, based on the diagnostics already mentioned, that the SI joint was (meanwhile) inflamed. Reasons for me: Overexertion, possibly caused by a difference in leg length.

Finally numerous therapy suggestions in hand

In order to get the inflammation out of the body, I was prescribed a painkiller and rheumatism medication. He also prescribed me some muscle relaxation medication for a short period of time. In the long term, however, these drugs are not an alternative because there is a risk of dependence on painkillers. He also recommended targeted physiotherapy - manual therapy - and heat to counteract the muscle tension in the muscles involved over the long term. The therapy suggestions all led more or less quickly to success, i.e. freedom from pain.

Just as an aside: a good physiotherapist is not that easy to find. Recommendations from other athletes helped me to choose the right one.

Cause leg length discrepancy?

However, the supposed cause of the whole dilemma still remained open, in my case the leg length discrepancy. That required further investigation. A leg length difference is often observed in the ISG syndrome, but this has nothing to do with an anatomical difference in the length of the legs. Rather, it is a so-called "functional" leg length difference, caused by misalignments of the pelvic bones, the sacrum and the spine. Treating this case with an orthopedic insole with a one-sided elevation would be totally wrong and could lead to even more problems.

Highly innovative process brings facts to the table

So I went to another doctor with a recommendation to have it determined whether it was actually an anatomical leg length discrepancy or not. Only a few offer this innovative examination via a state-of-the-art process - the 3D measuring system. This is a combination of video and data technology. In the end, the fast, non-contact and radiation-free analysis enables an exact diagnosis with regard to any incorrect spinal posture, pelvic tilt and, of course, leg length difference. In any case, the aforementioned doctor, who, as a physicist by training, attached great importance to biomechanics, examined me again under a completely different light. He looked at the entire skeleton, even the jaw joints. He immediately noticed a stiffness in my feet. Then the leg length discrepancy was measured.

The result was: No anatomical leg length difference! But a slight pelvic tilt.

Motion analysis from head to toe completes the picture

Then he did a gait analysis, a pronation and barefoot measurement and a highly professional movement analysis on the treadmill. A lot came to light: pelvic and torso muscles that were too weak, incorrect rollover behavior of the foot, relatively stiff thoracic spine and the resulting incorrect loading of the hips, pelvis and SI joint.

Remedy: Further therapy suggestions

For therapy, he recommended orthopedic insoles that improve rolling behavior, osteopathy, physiotherapy and special exercises to stabilize all the muscles around the pelvis. I should also strengthen the lateral trunk muscles in particular and do exercises for whole-body mobilization, stretching and coordination. He also looked at my running shoes, but they matched my running behavior and didn't have to be replaced. Last but not least, I should improve my running style, especially my arm work.

Finally free of complaints

More than two months have passed since then. I have the insoles, haven't taken any medication for a long time, no longer have to go to physiotherapy and can walk pain-free again. I dare to do longer sessions again, even "fast" ones. I have incorporated the numerous exercises into my training program.

There is only so much I can say about this: Except for the complex ones, I was familiar with most of them anyway. You can find them in various elaborations on triathlon.de, for example

But that's not all. I now focus on functional strength training according to the motto: A good athlete works on his weaknesses. With this in mind, I wish all those affected by ISG a speedy recovery and hope that you can take some suggestions from my article and that you will soon have fun training again.