| Age / Sex | 50-year-old female |
| Occupation | Pilates instructor and studio owner |
| Primary Complaint | Right-sided sacroiliac joint pain with referral into the buttock and posterior thigh, worse after teaching and prolonged standing |
| Duration of Symptoms | 3 years |
| Previous Treatments | SI joint belt, Pilates-based core strengthening, chiropractic adjustments (intermittent), yoga, SI joint injection (1x) |
| Diagnosis | Sacroiliac joint dysfunction secondary to pelvic asymmetry, poor deep core stabilization, and habitual movement pattern compensation |
Background
This 50-year-old Pilates instructor found herself in an ironic position: she spent her career teaching people to strengthen their cores and stabilize their bodies, yet her own sacroiliac joint pain had become so persistent that she was modifying her own demonstrations and limiting the classes she could teach. The pain started three years ago after a particularly intense reformer session and never fully resolved. It would fluctuate, sometimes manageable for weeks, then flaring with certain movements or after long days of teaching.
She had tried her own Pilates-based protocols, worn an SI joint belt, and received periodic chiropractic adjustments that helped temporarily. A cortisone injection into the SI joint gave her two months of relief before the pain returned. What frustrated her most was that she understood anatomy and movement, yet she could not figure out why her own body was not responding to the principles she taught daily.
Assessment Findings
Provocative testing confirmed right SI joint dysfunction, but the root cause was in her stabilization strategy. Despite being a Pilates instructor with excellent superficial core strength, her DNS assessment revealed a fundamental gap: she was stabilizing with her rectus abdominis and obliques while her diaphragm, pelvic floor, and deep multifidus were not engaging in a coordinated pattern. She had what we call “outer unit dominance,” where the muscles you can see in the mirror are strong, but the deep stabilizing system that actually controls joint position is not doing its job.
Her pelvis showed a persistent rotational asymmetry, with the right innominate in a slightly anterior and outflared position. This was not just a bony alignment issue that could be cracked back into place. It was being maintained by a motor control pattern that her traditional core work was reinforcing rather than correcting. Her breathing pattern, while appearing adequate on the surface, was heavily apical with minimal lateral rib expansion, meaning her diaphragm was not descending fully to create the intra-abdominal pressure needed for true pelvic stability.
Treatment Protocol
Phase 1 Weeks 1-2 | Chiropractic correction of pelvic rotational asymmetry. DNS breathing retraining with emphasis on 360-degree rib expansion and diaphragmatic descent. Inhibition of the overactive superficial core pattern. Education on why her current Pilates approach was reinforcing the dysfunction. |
Phase 2 Weeks 2-4 | DNS developmental position progressions to retrain deep core stabilization from the ground up. Pelvic floor integration with breathing. Chiropractic maintenance of pelvic alignment as motor patterns changed. Modified teaching cues to incorporate DNS principles into her own Pilates practice. |
Phase 3 Weeks 4-6 | Progressive loading through standing and dynamic positions. Full return to teaching all class formats. Integration of DNS-informed cueing into her teaching methodology. Independent maintenance program. |
Progress Timeline
| Years 1–3 (Pre-Treatment) | Managed symptoms with an SI joint belt and her own Pilates-based core strengthening. Tried intermittent chiropractic adjustments and yoga. Received one SI joint injection — temporary relief only. Despite 3 years of effort and professional movement knowledge, pain persisted and worsened with teaching demands. |
| ▸ Treatment at City Integrative Rehabilitation | |
| Week 1 | Pelvic alignment corrected. Breathing retraining produced an immediate shift in how her core felt during activation. Described it as discovering muscles she did not know she had. |
| Week 2 | SI joint pain reduced by approximately 50%. Could teach back-to-back classes without the usual flare-up. Pelvis holding its corrected position better between sessions. |
| Week 3 | DNS developmental positions progressing well. Started integrating new breathing and stabilization cues into her teaching. Students were noticing differences in their own practice. |
| Week 4 | SI joint pain minimal. Full teaching schedule resumed without modifications. Pelvic alignment stable on reassessment. |
| Week 6 | Pain completely resolved. Provocative SI joint tests negative. Teaching all formats including advanced reformer classes. Described this as transformative for both her personal practice and her teaching. |
Outcome
In six weeks, this Pilates instructor resolved three years of SI joint pain by learning something that changed her understanding of core stabilization entirely. Her existing core strength was not the solution; it was part of the problem. By retraining her deep stabilizing system through DNS, correcting the pelvic asymmetry with chiropractic care, and integrating proper diaphragmatic breathing into her movement patterns, the SI joint was finally able to stabilize. She has since incorporated DNS principles into her teaching methodology, reporting that her students are also experiencing better outcomes.
This case study represents a real patient treated at City Integrative Rehabilitation. Details have been modified to protect patient privacy. Individual results may vary.