Issue link: https://www.massageandbodyworkdigital.com/i/1464088
L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 27 SI joint dysfunction can produce tenderness in the soft tissues of the lower lumbar, gluteal, or upper sacral region. When palpated, active myofascial trigger points in the lumbar or gluteal regions can often reproduce the client's pain as well. Despite pain or tenderness that might be felt in the area, lack of pain with palpation does not necessarily indicate absence of SI joint dysfunction. If pain is not reproduced with palpation, it could be because the irritated contact surfaces of the SI joint are not being reached. The anterior SI ligaments or the contact surface between the sacrum and ilium are examples of regions not easily accessible to palpation. Some clues about possible SI joint dysfunction may show up with basic range-of-motion evaluations in the hip and pelvis region. Pain may occur with several active motions of the hip or lumbar region, including trunk flexion or extension, as well as hip flexion, abduction, or extension. In rare cases, pain occurs from adduction or rotational movements of the hip. In many cases, the same motions may be uncomfortable with passive movement if the joint is stressed sufficiently. In other cases, the role of muscles or gravity loading may make active movement painful when passive movement is not. Due to the location of attachments of the lower lumbar erector spinae group in the SI region, pain may be felt with resisted extension of the lumbar spine. Due to fascial continuities in the region, pain could also be felt with resisted flexion, extension, lateral rotation, or abduction of the hip. There are a number of special orthopedic tests designed to evaluate SI joint dysfunction. However, recent research studies have shown that none of these tests has a high degree of accuracy. Greater accuracy can be achieved when using several of them together, but clinicians are now moving away from focusing on these evaluation procedures to identify SI joint problems. SI joint dysfunction is a primary problem of mechanical force loading at this complex joint. As a result, massage has limited direct impact on how those forces load the joint or how alignment of the joint can be adjusted. However, we also now recognize that pain complaints in any region of the body are not the simple result of alignment or mechanical problems in many cases. Rather, they may include complex issues of neural sensitization, fear of movement, mechanical stress, and a host of other factors that may all contribute to the existing complaint. It is this complexity of factors that provides an opportunity for massage to be an effective intervention for SI joint pain. As we saw earlier, numerous muscles span the region, and tension forces transmitted through myofascial tissues across this area may be contributing to the aggravating force loads. A wide variety of massage techniques applied to the lumbar, gluteal, and lower extremity regions can help reduce symptoms, resolve dysfunctional mechanics, and contribute to improved functioning for our clients. There is no specific treatment protocol right for each client. Therefore, it is important for the practitioner to identify what approaches decrease pain or discomfort in order to choose the most appropriate strategy. Notes 1. Donald A. Neumann, Kinesiology of the Musculoskeletal System, 3rd ed. (St. Louis: Mosby, 2016). 2. A. Vleeming et al., "The Sacroiliac Joint: An Overview of its Anatomy, Function and Potential Clinical Implications," Journal of Anatomy 221, no. 6 (2012): 537–67, https://doi.org/10.1111/j.1469-7580.2012.01564.x. Whitney Lowe is the developer and instructor of one of the profession's most popular orthopedic massage training programs. His text and programs have been used by professionals and schools for almost 30 years. Learn more at academyofclinicalmassage.com. TECHNIQUE Leg-length discrepancy and SI joint dysfunction. 5 Pelvis tilts to opposite side Higher pelvis on this side Side with longer leg