Biomechanics is particularly important to release the blockage. A forward rotation of the pelvic blades is combined with an outflare of the blades and an internal rotation of the hip joints. A backward rotation of the pelvic blades is combined with an inward migration of the pelvic blades and an outward rotation of the hip. These malpositions are detected in physiotherapy by means of certain findings and can then be mobilized or manipulated. If ISG complaints/blockades occur more frequently, there is a poor muscular tension, which should be built up through specific training.
ISG blockade release
One possibility to solve an ISG blockade by yourself is the option via movement. It is important that there is no relieving posture and therefore “choppy” movements. Even if pain is present, the patient should be moved in a final step.
Sometimes the blockage is released by a sudden movement (sneezing, coughing) by itself. In the case of more severe ISG complaints, a physiotherapist can be consulted, who will find out about the blockage through specific examinations and can release it by mobilizing the pelvis. This can be done directly at the pelvis while the patient is lying on his side and the pelvic shovel can be mobilized backwards or forwards.
An indirect technique using the lever of the leg can be used in the prone or supine position to mobilize the pelvis further by rotating the hip. By releasing the tensed muscles, the ISG blockage can also be released, since the feeling of a blockage remains due to a too high tone of the muscles. Through specific mobilization exercises, the patient can move the pelvis in a targeted manner to release the blockage himself (see below).
As mentioned above, the ISG can easily block by a wrong movement. This happens especially quickly if the muscular tension is too weak. Exercises for mobilization in case the pelvis is blocked are the following: Sitting on the edge of the bed or chair: Sliding with the buttocks towards the end of the bed or chair (ham sliding) but make sure that the movement is out of the pelvis.
Supine position: Slide your legs out alternately so that the movement is felt in the pelvis. Stand at the stairs: push the affected leg to the step below so that the movement is felt in the pelvis Back position on the floor and feet against the wall: place 2 tennis balls on the pelvic shovels right and left underneath the spine, minimally perform the exercise of sliding ham Stand: turn circles with the pelvis or write eights (similar to belly dance) Sit on Pezzi ball: slide with the pelvis forward and backward, make circles (similar to pregnancy gymnastics) If there is a muscular disorder, it should be trained by appropriate muscles. In most cases, the abdominal muscles are too weak and can be strengthened by specific exercises such as forearm support, quadruped position or a Pezzi ball.
If the musculature is too short, especially the piriformis muscle or the ischiocrural muscles (rear leg muscles), it should be stretched (see below). Further mobilization exercises can be found in the articles ISG-Blockade and Mobilization Exercises.
- Sitting on the edge of the bed or chair: Slide with your buttocks towards the end of the bed or chair (ham-sliding) but make sure that the movement is out of the pelvis.
- Supine position: alternately push out the legs so that the movement can be felt in the pelvis.
- Standing at the stairs: push the affected leg to the step below so that the movement can be felt in the pelvis
- Lie supine on the floor and place your feet against the wall: place 2 tennis balls on the pelvic shovels right and left below the spine, minimally perform the ham-sliding exercise
- Stand: turn circles or write eights with the pelvis (similar to belly dance)
- Seat on Pezzi ball: slide with the pelvis forward and backward, make circles (similar to pregnancy gymnastics)
With an ISG problem, certain muscles are involved.
If the ilium is blocked to the front there is a hypertonus of the front thigh muscles and an overstretching of the back thigh muscles. It is important that only the hypertonic muscle is stretched. In addition to the active and passive stretching possibilities, stretching can also be achieved by tensing and relaxing the muscle.Thereby therapist and patient work together.
The muscle is adjusted to the maximum approach and the therapist gives resistance in the position to be stretched, the patient presses against it. Thus the range of movement can be slowly extended after a short period of tension and subsequent relaxation.
- The quadriceps femoris muscle can be stretched either passively over the prone position, where the therapist presses the heel towards the buttocks, or by active stretching in a standing position, where the patient pulls the heel towards the buttocks.
- In addition to the M. Quadriceps femoris, the M. Iiliopsoas, which runs through the groin, also belongs to the front musculature.
The patient can actively stretch this muscle in the supine position by pulling the other leg towards the body and deliberately stretching the other leg and pressing it onto the support (Thomarsche handle). A passive stretching exercise is not so easy to perform on the muscle.
- If the illium is blocked to the rear, the ischiocural muscles are shortened and the front leg muscles are too long. The rear muscles should be stretched.
In passive stretching, the patient lies in a supine position and the therapist pushes the stretched leg close to the trunk until the patient feels a significant stretch. In active stretching, the patient places the leg on a chair or similar and approaches the leg with the upper body.
- If hypertonus of Piriformis disease is present, the patient should sit in a longseat and place the affected leg on the other side next to the stretched leg and can increase the stretching with pressure on the knee.
In the case of ISG syndrome/ISG blockade and especially one that occurs more frequently, several muscle groups are crucial to train. On the one hand, good trunk stability is important, especially the abdomen and lower back muscles.
trunk: Forearm support Support is placed on both forearms and the two balls of feet under body tension (variations with feet alternately lift, or change from forearm support to hand support) Lateral support is always supported on one forearm and the same side of the outer edge of the foot to the outer side of the lower leg (Variation: Lift leg and/or raise pelvis) Quadruped stand Stand with both hands and knees on the floor, lift knees from floor (keep abdominal tension) and move forward (bear’s walk) Prone position, raise upper body (Variation; stretch and swing arms, row, lift upper body and rotate to right and left) supine position Bridging (pull your legs up to your body in alternation, slowly lift your pelvis up and down) Supine position: stretch your legs in alternation (cycling) Semi-seated position: tilt your upper body backwards and hold the position (ismoetric tension) All exercises can be varied in many ways. Further exercises can be found in the articles Exercises against a hollow back and Exercises against back pain. In addition to trunk stability, the legs should also be trained accordingly.
Depending on the tendency of the blockade, more front or back should be trained. Exercises Leg front: Leg extender: Theraband around foot in standing or sitting position and then stretch leg (alternative: leg stretcher machine) Exercises Leg back: Leg curl: Prone position, Theraband around foot and leg then bend (alternative: leg curl machine) Bridging support with both hands and heels in supine position (variation: Lift leg alternately, slowly let pelvis up and down) Prone position: lift bent leg Global exercises for the front and back: Lunge steps to the front or to the side Further exercises can be found in the article Physiotherapy exercises exercises knees.
- Forearm support support is placed on both forearms and the two balls of feet under body tension (alternate lifting with feet, or change from forearm support to hand support)
- Lateral support is always only supported on one forearm and the lateral outer edge of the foot to the outer side of the lower leg (variation with lifting the leg and/or lifting the pelvis)
- Quadruped Stand Stand with both hands and knees on the ground, lift knees off the ground (keep abdominal tension) and walk forward (bear walk)
- Prone position, lift upper body (variation; stretch and swing arms, row, lift upper body and rotate to the right and left)
- Supine position: Bridging (alternately pull your legs up to your body, slowly lift your pelvis up and down)
- Supine position: Stretch your legs alternately (riding a bicycle)
- Half seat: tilt the upper body backwards and hold the position (ismoetric tension)
- Leg stretcher: Theraband around foot in standing or sitting position and then stretch the leg (alternative: leg stretching machine)
- Leg curl: Prone position, Theraband around the foot and leg then bend (alternative: leg curl machine)
- Bridging support with both hands and heels in supine position (variation: alternately lift leg, slowly let pelvis up and down)
- Prone position: raise bent leg
- Lunges to the front or to the side
- Knee bends (buttocks pushes backwards and straight upper body bends slightly forward)
In case of an ISG blockade, many coordination exercises are especially useful to strengthen the trunk muscles very effectively.
1. exercise In the quadruped position lift the right arm and the left leg and bring them together from the extension under the body. This causes instability and thus more intensive muscle tension. Do this exercise several times in a row and then change sides.
The exercise can be increased on a spinning top, airex mat or trampoline, whereby the uneven surface increases instability. 2nd Exercise The bear walk also provides good muscle tension by moving in the unstable position. 3. exercise In the side support or lateral hand support, the muscle tension can be increased by bringing the upper arm and leg together.
4. exercise Simple coordination exercises in a standing position by bending the knees or taking a lunge and at the same time training the arms (e.g. strengthening with dumbbells or Theraband) can improve leg strength on the one hand and strengthen the torso on the other. Further exercises can be found in the article Coordination exercises. In ISG blockade, there is increased muscle tension in the lower back, buttocks, tractus illiotibialis and the rear or front leg muscles.
In order to release this tension, a direct technique can be used, in which the therapist massages the muscles. The patient himself can either use a fascial roller, in which case he can loosen the muscles himself, or he can trigger himself with the help of tennis balls by lying on the tennis ball. Otherwise, own mass grips are not as effective, since muscle tension is always involved.
