I have treated SI dysfunction with cross-fiber friction, with excellent
outcomes. In those cases not responding well, I also recommended an SI belt,
sometimes substituting a loan of a stretchy strap used for hot packs.
My use of cross-fiber was inspired by a teacher who said. "If you can
palpate it, you can cross-fiber friction it." I find discrete spots of
tenderness at & around the joint to friction & I friction to numbness all
such spots I find. One patient had received many manipulations of SI from a
chiro; he reported full relief only from my treatment.
But one case still puzzles me: I was substituting for a very experienced
manual therapist. The patient said she was leaving for Europe the next day &
could I please manipulate her SI the way her usual therapist did. She was in
great pain & I was not comfortable performing what would have been my first
SI manip on a real patient. I spent her entire 1/2 hour doing cross-fiber
friction on & around her SI joint. I later heard that she told everyone that
my treatment had been as effective as my colleague's.
I still wonder why.
1. Could it have been the placebo effect? I doubt it, but cannot completely
rule this out.
2. Could both treatments have broken the pain cycle by affecting the local
nociceptors, albeit in different ways?
3. Could both treatments have changed the local level of inflammation, my
colleague's by removing the stress of malposition & mine by stimulating the
body's ability to clean up the by-products of an excessive inflammation
response?
BTW, I should add that the patient repeorted that as she got off the plinth,
she could feel the bones slip back into place. Perhaps this observation
offers the real reason that both treatments worked roughly equally well, but
perhaps not.
I welcome comments and other personal accounts of treatments for SI.
Sarah Fern Striffler, PT
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