Siem Reap, Cambodia
Wednesday 12th June 2013
Ever since watching a documentary on the discovery & subsequent archaeological conservation, restoration & preservation of Angkor Wat, in my late teenage years, I have been planning to travel to the Siem Reap Province in Cambodia.  Angkor Wat is the largest religious monument in the World, built by a Khmer King in the early 12th century & today, thanks to extensive ongoing private & UNESCO funded projects, the history of the area continues to be uncovered.

Fortunately, Buriram is only a 5 hour drive from the ancient temple across the Thai/Cambodian border & so this period of consultancy has provided me the perfect opportunity to fulfil my long-standing dream.  A 5 hour drive...should all go to plan, or a complete mission if you drive one hour in the wrong direction from your start point, miss the border opening times, attempt but fail to achieve numerous other border crossings, be stopped from taking your car across the border, before finally jumping in a random taxi where the driver considers the journey an opportunity to take his young family on a road trip!

Despite all the trials & tribulations of the journey, the site of the ancient civilisation lived up to all expectations & despite the popularity of the landmark to the tourist masses, I never once felt inundated with holiday makers, which is likely due to the vast footprint of the site.  The fact that the Cambodian hosts are some of the friendliest people I have ever had the pleasure to meet has just added to the magic of the experience.

However, after spending several hours at the wheel, a night sleeping in the car & a rather uncomfortable journey in an aged Toyota taxi, my lower back & pelvis are less than delighted with the adventure.  Fortunately, some relief has been afforded by the Cambodian massage I had this evening, which involved several elements of Thai massage with some Shiatsu-style techniques & Chinese massage components mixed in.  Exactly the attention my aching body needed!  Following that up with some time in the pool, I then conducted a few self treatment techniques to mobilise my sacroiliac joints & realign my pelvis to relieve the remaining feeling of tension in my right posterior thigh..

A few weeks ago, I stumbled across a great blog article on Athletics Weekly, which was authored by sports physiotherapist, Mark Buckingham, advising athletes on the influence the pelvis has on the hamstrings & how certain dysfunctions can be effectively self-managed.  Although I have never actually met Mark, his reputation in athletics circles is well established & after a couple of conversations, I referred several of the non-funded athletes to his clinic whilst I worked for British Athletics.

Buckingham, M. (2013).  The pelvis: a joint problem.

Read what Mark has to say below:

The pelvis:  A joint problem

There is a common claim in a physiotherapy practice: “It’s my hamstring, it’s tight and will not let go – just at the top.”

Other remarks are: “My leg does not come through very well” or “It’s like running in treacle!”

The main reason for this is a problem in the pelvis and the sacroiliac (SI) joint. The pelvis is made up of three bones – the sacrum in the middle and an ileum on each side. The SI joint is found at the back where the two iliums attach on to either side of the sacrum. It is unusual in that it is two irregular surfaces of bone that are held together by a thick fibrous skirt.

There is little motion, five degrees maybe, as the leg comes from behind to in front. However, it is the top end of a long lever, the leg. Physics tells us that a small amount of motion at one end of a lever has a large e?ect at the other. If the SI joint becomes jammed and does not move the effects on the leg are dramatic.

Main symptoms

» Tightness in the upper hamstring

» Tightness in the gluteal or buttock region

» Possible soreness in the lower back, but not often

The history is often not clear. There is rarely an ‘ouch’ moment. However, episodes in my experience are often caused by:

» Fast downhill running

» Running with a poor core and the pelvis tipping forwards

» Lack of form at the end of a hard session

» A hard stumble or trip 


This is always difficult. Your physio should look at the pelvis motion with bending forwards and sideways and then with single leg lifts – knee to chest. They should be looking at the back of the pelvis and noting how the bones move.

There is often an ‘apparent’ leg length discrepancy – tested in lying and sitting. This is often confused with an ‘actual’ leg length change and I have seen many athletes with heel wedges put in place for what is a normal leg length. This does not help.

There are 24-odd different types of pelvis dysfunctions and you need to be experienced to diagnose them properly. There is, however, a very common dysfunction seen in runners. This is where the ileum (the outside bone) becomes rotated forward on the sacrum (the central bone). It is too subtle to describe in an article like this and requires an experienced physio to diagnose.

The majority of these problems require mobilisation of the SI joint by a physio who is used to dealing with runners. This is done by side lying or on your back and usually involves pressure through the pelvis with the knee towards the chest. There are several ways to do it though, and the following exercises are designed to help this condition. They will not hurt you if it is not the problem. Try them for a few days and if there is no improvement then seek help. Once the pelvis has been mobilised follow the instructions given by your physio which will be similar to these exercises. 

Hug your knee to your chest and hold tight around the knee (as above). Push hard with your leg into your hands for 10 seconds, then relax, pull it tight again and repeat. The pressure comes from your hip and bum. You are not straightening the knee. This can be done sitting or lying and needs to be repeated hourly about 15 times. The object is to use your bum muscles to mobilise the sacroiliac joint. You will not feel much apart from strain in the bum.

When sitting, cross the foot of the hip to be stretched to the outer side of the other knee (see below). Hug the bent knee with the opposite hand (so if it is your right hip to be stretched, put the right foot to the left of the left knee and hug the right knee with your left arm).


Place a tennis ball or hard cricket/hockey/dog ball in the buttock and lean towards it. Fiddle with the exact position, somewhere between the outer hip bone and the bone you sit on.

Look for the most painful spot and then work the ball into it for a couple of minutes. The object is to loosen the deep gluteal muscles which go into spasm whenever there is a sacroiliac joint dysfunction. 

The image above shows the direction to bend –away from the symptomatic side. You are more effective if you hold your core in really tight, tipping the pelvis backwards. This focuses the stretch into the area of the back – 45 seconds, three times and several times a day.

Using a roller or a can, roll on the upper hamstring through the tight areas, keeping the back as straight as possible – two minutes, three times a day.

Can I run?

This is the big question, and the answer is yes! Running actually helps to mobilise a sacroiliac joint once it is moving properly, if it is not, then it will irritate it.

Try the above, but if in doubt, please seek help. These conditions can linger for many months undiagnosed and are simple to treat.


I hope you find Mark's article as informative as I did & if so please click on the link below to read more on the topic on the Athletics Weekly site: 

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