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108 m a s s a g e & b o d y w o r k n o v e m b e r / d e c e m b e r 2 0 1 6 technique MYOFASCIAL TECHNIQUES Working with Sacroiliac Joint Mobility By Til Luchau Does the sacroiliac joint move a little or a lot? Experts generally agree that, in spite of being one of the most stable joints in the body, the sacroiliac joint (SIJ) does have at least a little movement in normal activities. There is much less agreement, though, about how much movement is good, with published descriptions of "normal" (asymptomatic) SIJ motion ranging from 1 to 8 millimeters of glide and from 1 to 18 degrees of rotation. 1 And does the amount of SIJ movement relate to pain? And if it does, is more or less movement better? There is also very little agreement about these questions, with one study citing up to 30 degrees of non-painful SIJ rotation (in warmed-up gymnasts), while another study found almost no SIJ movement in subjects with SI pain. 2 Conventional wisdom says the painful SIJ is most often on the more mobile side. Thus, improving the stiffer side's mobility could redistribute the movement load more evenly and help relieve the "hypermobility" or "laxness" of the painful side. In my own manual therapy practice, this approach seems to help many clients, though others (including, occasionally, myself ) seem to benefit more from the opposite approach (working on the already-more-mobile side). These 1 2 3 The interosseous sacroiliac ligament (violet) showing its relationship with the posterior and anterior sacroiliac ligaments (tan) and the sacroiliac joint's articular cartilage (white). Image courtesy Primal Pictures, used by permission. The Interosseous Sacroiliac Ligament Technique uses light pressure to feel for left/right differences in the SIJ's ligaments. Image courtesy Advanced- Trainings.com. The interosseous sacroiliac ligament (violet) is the main structure that resists distraction (gapping) of the sacroiliac joint. Artist: Henry Vandyke Carter, from Gray's Anatomy of the Human Body (1918). Public domain.