Massage & Bodywork

NOVEMBER | DECEMBER 2016

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C h e c k o u t A B M P 's l a t e s t n e w s a n d b l o g p o s t s . Av a i l a b l e a t w w w. a b m p . c o m . 109 exceptions to biomechanical predictability suggest there are probably many factors involved in SI pain (for example, joint hydration, proprioception, pain perception phenomena, etc.) beyond movement laxity or stiffness. Given these considerations, in our Advanced Myofascial Techniques seminars and training videos, our current working hypotheses (supported by both our practice observations and others' formal research 3 ) are that: • The amount of SIJ movement does not seem to correlate very well with clients' pain (people with pain can have either very mobile or very immobile SIJs). However, • Pain does seem more common in those with large differences between left and right SIJ mobility; and, • Strategically, when there is a difference in stiffness between the two SIJs, inviting more movement on the less-mobile side is an effective way to begin addressing SI and related pain, with the consideration that, • If pain does not improve after working the less-mobile side, the complementary approach (working with the more-mobile side with an aim to increase nonpainful proprioception, joint hydration, etc.) is the logical next step, as this can often relieve pain when the opposite approach doesn't. The SIJ's balance of stiffness and mobility can be affected by a great many soft-tissue structures, most obviously the numerous SI ligaments (the strongest in the body) arrayed around the SIJ (Image 1); and by the many myofascial structures that cross the SIJ (the piriformis, gluteus maximus, and sacral multifidus muscles; the thoracolumbar fascia, etc.). For simplicity, I'll describe just one technique here, and focus on one of the many structures that can influence sacral mobility. THE INTEROSSEOUS SI LIGAMENT TECHNIQUE The interosseous SI ligament (Image 3) is the primary structure that restrains gapping of the SIJ; it is also tensioned by posterior glide of the ilium against the sacrum (Image 5). Its short fibers are just behind the SIJ capsule, deep to the posterior SI ligaments (Images 3, 5). Although there is some disagreement about the role these ligaments have in pelvic pain (one argument being that because they are so strong, they are unlikely to be strained or sprained), these dorsal structures are the most richly innervated of the sacral ligaments, and have many sensory nerves and mechanoreceptors. 4 Their rich innervation may help explain why studies show that the SIJ can be the main source of nociception (pain-triggering signals) in 14–22 percent of all low-back pain. 5 Using gentle pressure to compare left/ right posterior movement of the ilia in the Interosseous Sacroiliac Ligament Technique. Image courtesy Advanced- Trainings.com. The posterior direction of the practitioner's gentle pressure (arrow) distracts the SIJ and tensions the interosseous sacroiliac ligament (violet) as well as the posterior sacroiliac ligaments (tan, bottom). Image courtesy Primal Pictures, used by permission. The Interosseous Sacroiliac Ligament Technique starts with very light pressure (10 grams or less), so as not to provoke pain or to overshadow the sensitivity needed for the client and practitioner to feel any subtle mobility and sensitivity differences between left and right SI joints. Apply very light pressure to each side in turn, and ask the client about the sensation; if pain-free, gradually increase the pressure on the less-mobile side, repeating the test at various angles. Sustain gentle pressure and encourage your client to relax for several breaths when pain relief or mobility restrictions are encountered. This will often shift SIJ pain, and help with associated low-back or sciatic pain. Image courtesy Advanced-Trainings.com. 4 5 6

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