Massage & Bodywork

January/February 2013

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(see Assess Your Own Ilia Mobility). This independent motion of the innominates is important because it: • cts as a shock absorber in A walking, running, and jumping. • ocks the sacroiliac (SI) joint into a L stable position in weight bearing. • ecycles the energy of gait by R loading and releasing the SI ligaments through spring-like recoil. Limitations in innominate mobility indicate SI joint restriction. When this movement is absent or asymmetrical, local symptoms can include low-back pain, SI joint pain, osteitis pubis (soreness at the pubic symphysis), hip pain, sciatic pain, restricted hip mobility, and more. Loss of movement (hypomobility) here has global effects, too, and can be related to knee issues, ankle overpronation, functional scoliosis, etc. (SI joints can also cause problems when they are hypermobile. For a discussion about working with hypo- and hypermobile SI joints, see Massage & Bodywork, November/December 2012, "Working with the Sacroiliac Joints," page 114.) The amount of innominate movement that should be considered normal is a subject of debate, ranging from a low of 2 degrees to a whopping 17 degrees of rotation at the SI joint.2 (As a point of reference, Images 1 and 2 show 10 degrees of rotational movement, or about the median value of the different published opinions.) Other studies suggest that side-to-side evenness is more important than the absolute amount of movement, with pelvic pain more common in individuals with asymmetrical SI joint stiffness.3 Preparation: Leg Dangling Releasing the resting tone of the musculature around the hip will help you be more specific and effective when you address the ligamentous SI joint limitations themselves. With a loose grip around your client's lower leg, gently lift the leg just off the table (Image 3). Don't lift so high that your client's pelvis tilts and pushes the lumbars into a deeper lordosis; lifting just a half-inch off the table is usually enough. Gently swing your client's knee from side to side, feeling for and encouraging release of any muscular holding or tension around the hip. With practice, you'll be able to sense and relieve restrictions throughout your client's body with this deceptively simple technique. Some clients will find it difficult to release a leg and let it hang. Be patient, coaxing the hip into an easier swing. If you find holding or tightness that doesn't release on its own, you can also address it with more direct techniques 3 The Leg Dangling Technique. Lift just high enough to swing the knee medially and laterally (into hip adduction and abduction). Use this motion to release the hip in preparation for specific work with the innominate and sacroiliac joint. Images courtesy AdvancedTrainings.com. All used by permission. Assess Your Own Ilia Mobility Here's a simple way to feel innominate bone movement in your own body: 1. While standing, place your hands on your hips, with your thumbs behind you on your left and right posterior superior iliac spine (PSIS). 2. Slowly lift one knee. Feel for the movement of each innominate bone (felt as motion of each PSIS independent of one another), as opposed to movement of the entire pelvis (felt as both hands moving together). 3. If unrestricted, as you lift your knee, your PSIS on the same (unweighted) side will drop slightly as the ilium goes into posterior torsion. 4. Compare left and right sides: side-to-side evenness is usually more important than the total amount of movement. Less PSIS drop on one side signals probable restriction of the sacroiliac joint (SIJ) on that same side (though if there is chronic SIJ pain, it is often on the other, more mobile side). You can adapt this simple assessment for use with clients by comparing the left and right PSIS drop as your client lifts each knee. Use the Posterior Torsion Technique (page 116) to release the less mobile side, and recheck. www.abmp.com. See what benefits await you. 115

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