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CHAPTER OBJECTIVES

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At the completion of this chapter, the reader will be able to:

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  1. Describe the anatomy of the bones, the ligaments, the muscles, and the blood and nerve supply that comprises the sacroiliac (SI) region.

  2. Describe the biomechanics of the sacroiliac joint (SIJ), including coupled movements, normal and abnormal joint barriers, kinesiology, and reactions to various stresses.

  3. Perform a detailed objective examination of the SIJ, including palpation of the articular and the soft-tissue structures, specific passive mobility tests, passive articular mobility tests, and stability tests.

  4. Evaluate the total examination data to establish the diagnosis.

  5. Describe the intervention strategies based on clinical findings and established goals.

  6. Design an intervention based on patient education, manual therapy, and therapeutic exercise.

  7. Apply active and passive mobilization techniques, and combined movements to the SIJ, in any position using the correct grade, direction, and duration.

  8. Describe the common pathologies and lesions of this region.

  9. Evaluate intervention effectiveness in order to progress or modify an intervention.

  10. Plan an effective home program and instruct the patient in this program.

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OVERVIEW

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The sacroiliac joint (SIJ) serves as the supporting base of the spine and as the point of intersection between the spinal and the lower extremity joints. The SIJ is the least understood and, therefore, one of the most controversial and interesting areas of the spine. Determining a diagnosis in this region is complicated by the biomechanics of the SIJ and its relationships with the surrounding joints, including the hip, pubic symphysis, and lumbar spine.

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Grieve1 has proposed that the SIJ, together with the other areas of the spine that serve as transitional areas, is of prime importance in understanding vertebral joint problems. This level of importance is perhaps surprising because isolated pelvic impairments are rare. However, findings for SIJ dysfunction appear to be common, and the literature is replete with intervention techniques aimed at correcting pelvic dysfunctions.211 This may be explained by the fact that, in addition to being able to produce pain on its own, the SIJ often can refer pain.12

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The level of interest surrounding this joint dates back to the Middle Ages, a time when the burning of witches was commonplace. It was noticed after these burnings that three of the bones were not destroyed: a large triangular bone and two very small bones. It can only be assumed that some degree of significance was given to the large triangular bone as it was deemed a sacred bone and was thus called the sacrum. It is unclear what significance was given to the two smaller bones, the sesamoid bones of the great toe.

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Despite these illustrious beginnings for the sacrum, it was not until approximately 100 years ago that significant attention was applied to the study of pelvic anatomy and function, and its relationship to low back and pelvic pain. At the start ...

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