Massage & Bodywork

November/December 2012

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4 2 3 The sacrum (green) meets the ilium obliquely, so that anterior pressure on the sacrum will distract the sacroiliac (SI) joint. Purple arrows show hand placement for the SI Anterior/Posterior Release Technique on the anterior superior iliac spine and medial to posterior superior iliac spine. Feel through the sacral multifidi and feel for the sacrum to drift, analogous to pushing a boat away from a dock. Image 2 courtesy Primal Pictures. Used by permission. With your client supine, locate the posterior superior iliac spine (PSIS) on one side (Images 4 and 5). Move your fingertips just medial to the PSIS, but stay lateral to the body's midline. You'll be in position to lift the sacrum anteriorly on that side. Slowly, but firmly, lift with your fingertips. Keep some flexion at each finger joint, leaving your wrist and arm as relaxed as possible to protect your forearm from any strain. Feel through the sacral multifidi and erectors to sense the bony feel of the sacrum itself. Lift firmly and steadily, but gently. Rest your other hand lightly on the same side's anterior superior iliac spine (ASIS) in order to encourage that ilium to drop posteriorly. This anterior hand is much gentler and more receptive than the directive touch of the posterior hand. Since the pelvic girdle is built to transmit the force of gravity from spine to legs, it will respond to overt force from your hands by stiffening and stabilizing. Proceed slowly and lightly enough that you don't evoke this stabilizing response. Although it may feel like you are using too little pressure to have an effect, if you are patient enough, the client's experience can be dramatic. Use both hands to sense a slight posterior yielding of the ilium, and/or an anterior drifting of the sacrum. Although the exact amount of movement here is a subject of ongoing debate, computed tomography scans have shown 4–8 millimeters of PSIS motion here, even in the elderly.1 will be quite tangible to both you and your client. Imagine pushing a large boat away from a dock—at first there appears to be nothing happening, but then slight movement becomes apparent after a few moments (Image 3). The key is to wait for the release—often it takes 3–6 breaths to feel the drift happen—and then believe it when you feel it. Clients report sensations such as warmth spreading down their limb, an overall softening of the pelvis, or an easing of the low back. If clients report pain, it is likely a sign of joint irritation; in this case, back off to their level of comfortable tolerance. This technique is both an assessment and a release, so you can use it to compare and balance left and right SIJs. SI stiffness is highly variable between individuals, but is more even side-to-side in asymptomatic individuals.2 the sacrum is particularly stiff or slow to respond, you can If one side of 5 So even though it is likely to be small, this movement In the Sacroiliac (SI) Anterior/Posterior Release Technique, reach around the posterior superior iliac spine to lift the sacrum from below. The top hand on the anterior superior iliac spine is very light, encouraging the ilium to drop posteriorly and gently distract (open) the SI joint space. Images courtesy Advanced- All used by permission. See what benefits await you. 115

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