Issue link: https://www.massageandbodyworkdigital.com/i/87297
use the SI Wedge Technique to get a more specific release. 6 The Sacroiliac (SI) Wedge Technique. Lift with fingertips just medially to the posterior superior iliac spine to form a gentle wedge (Image 7, arrows) into the SI joint. As the interosseous ligament (Image 7, orange) responds, the joint will open around your fingers. (Image 7 shows finger position only; client should be supine). Image 6 courtesy Advanced- Trainings.com, Image 7 courtesy Primal Pictures. All used by permission. 7 SI WEDGE TECHNIQUE Like the previous technique, the SI Wedge Technique can help reestablish normal mobility in a restricted SIJ. Try this variation when you find a restriction that doesn't respond to the SI Anterior/ Posterior Release Technique, or whenever you want a more specific release right at the SIJ. Use the PSIS as a starting place, but instead of moving medially onto the sacrum, curl your fingers around the medial aspect of the PSIS. Like the last technique, this one involves lifting with the fingertips from underneath; but instead of lifting on the sacrum itself, stay close to the ilia, and lift into the SIJ space in a laterally oblique direction (Images 6 and 7). As the name suggests, your fingertips will form a wedge right at the SIJ. This puts pressure into the spinal erectors, sacral multifidi, and posterior SI ligaments (all possible sources of SIJ pain). When you're in position, wait there; once the outer layers release, your client's pelvic structure will open and settle around your fingers. This opening is the result of a response in the strong interosseous SIJs. Alternatively, use two hands to assess and address both SIJs simultaneously (Image 8). Watch your body use, as this position can be more challenging than the one-sided version, though it does allow precise side-to-side comparison and a sense of side-to-side balance for your client. Having both sides worked in this way can be particularly relieving when the SIJs are irritated, perhaps because the bilateral pressure simulates the pressure of sacral multifidi contraction (which has been observed to be diminished in some cases of low-back pain). SIJ PAIN SIJ pain is frequently the result of an injury, such as a fall or auto accident. One peer-reviewed study showed that about three in five cases of SIJ pain can be traced to a traumatic injury.3 Hormonal changes and pregnancy can bring on SIJ pain, as can arthritis and inflammatory bowel diseases. A limp or gait impairment, for example from a knee or ankle issue, can also irritate the SIJ, usually on the opposite side. Asymmetrical forces on the sacrum, such as imbalanced sacrotuberous ligaments, iliacus, or rotators, can cause pain and irritation as well. SIJ pain is often felt by the sufferer to be directly in or superficial to the SIJ, though, because the joints are deep and large, pain related to the SIJs can be hard to locate precisely. SI pain can refer to the buttock, groin, hip, leg, or low back. In research involving blocking SI sensation with an anesthetic, the SIJs have been shown to be directly responsible for 15–21 percent of generalized low- back pain.4 It is likely that SIJs are indirectly responsible for an even greater percentage of back pain, since they play such an important role in spinal alignment and mobility. When there is pain or irritation felt at the SIJ, it is usually unilateral or asymmetrical, that is, worse on one side. As mentioned, SIJs can be problematic by being either immobile or hypermobile. Pain, sensitivity, and irritation can be felt on either the immobile or hypermobile side, though more severe and ongoing irritation is more commonly felt on the hypermobile side. Even though hands- on work is generally better at loosening than tightening tissue, we can still help hypermobile SIJs in a number of ways. Here are some considerations: 116 massage & bodywork november/december 2012