Case Discussion: Athlete With Multiple Injuries – SI Joint Pain Limiting Unilateral Work
Hi everyone, I’d appreciate some input on a case I’m about to start working with. I’m beginning with a new athlete. I completed the TTT Movement Course, so I plan to apply principles from the Fives model, but I’d also like to open this up for discussion and hear additional perspectives on approach and progressions. She is 45 years old, previously competed in CrossFit, and her goal for the coming year is simply to return to consistent, enjoyable training without pain. Current issues: • SI Joint inflammation (Sacroiliac Joint) – at one point there was even concern about possible arthritis• Partial labrum tear in the shoulder – no pain in internal rotation, but external rotation is painful Movement observations so far: • She can perform most bilateral lower-body movements until the load becomes painful• Unilateral lower-body work is currently not possible (split squats, lunges, SL RDL, SL hip thrusts)• Running is not currently an option due to pelvic pain During the initial assessment I tried to identify a pelvic imbalance, but didn’t see any major asymmetry in the 90/90 testing. The pain during unilateral work appears to be immediate during execution, rather than delayed soreness. Programming-wise, I’m fairly confident in the overall direction. The template will likely emphasize: • Freedom / Variability / Self-Mastery• Isometrics and tempo work• Extensive hip and ankle mobility• Very controlled, foundational strength work I still need to complete my full movement assessment battery, including the additional tests I incorporated after the TTT movement course. My main questions: 1. Why do you think unilateral work might currently be such a major limitation here? 2. How would you approach progressing it back in? 3. Is there anything else you would consider prioritizing in this situation? I already have a general structure in mind, but I’d really appreciate hearing how others might approach a case like this.