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Key Points: Interosseous Sacroiliac Ligament Technique Indications • Sacroiliac joint (SIJ) pain or irritation. • Low-back pain—14–22 percent of low-back pain seems directly related to sacroiliac (SI) issues. • Sciatic pain (buttock and/or posterior leg pain), since the sciatic nerve passes just anterior to the SIJ; and piriformis, etc., can be SI ligament synergists. Purpose • Increase nonpainful proprioception. • Balance left/right SIJ mobility. • Improve intra-articular hydration of the SIJs. Instructions • Beginning with a very light touch (no more than 10 grams of pressure at first) over the anterior superior iliac spine, compare the perceived posterior mobility (resilience or stiffness) of the left and right ilia (Images 2, 4, 6). • Ask proprioceptive questions such as "What difference do you feel, left to right?" Or, "I feel this side move more, this side move less. What do you feel?" Help the client distinguish any pain (often, but not always, on the more mobile side) from the sensations of stiffness. • If 10 grams of pressure does not cause pain, gradually increase pressure, continuing to ask for the client's proprioceptive report. • Press with one hand, while the other hand stabilizes the client's pelvis, so as to isolate posterior movement of the ilium at the sacrum, rather than rock the entire pelvis from side to side. • Vary the angle of your pressure slightly, feeling for outward, upward, and inward mobility of one innominate against the sacrum, monitoring for movement restrictions, sensitivity, or relief from pain. • If pressure relieves pain, wait with sustained pressure for several breaths, encouraging the client's relaxation and refined proprioception. For More Learning • "Pelvis, Hip & Sacrum" or "Advanced Ilia and SI Joints" in the Advanced Myofascial Techniques series of workshops and video courses. • Advanced Myofascial Techniques, Volume 1, Chapter 13 "The Sacroiliac Joints" and Chapter 14 "The Ilia" (Handspring Publishing, 2015). Our technique for working with the interosseous SI ligaments borrows its inspiration from a common orthopedic test—the SI distraction or "squish" test. Although there is some controversy about this test's objective inter-rater reliability (as there is with most movement-palpation tests), we employ it not so much as an objective test, but instead as one technique for increasing evenness of left/right joint mobility, and (especially) increasing our clients' subjective proprioception through the technique's novel sensation and focused attention. These two goals (more options for movement and refined proprioception) often result in less pain (which itself is a subjective rather than objective phenomenon). As you practice this simple but effective technique for working with SI pain (using the instructions and considerations outlined in the Key Points sidebar), keep these two goals in mind. Notes 1. H. M. Buyruk et al., "Measurements of Sacroiliac Joint Stiffness with Colour Doppler Imaging: A Study on Healthy Subjects," European Journal of Radiology 21, no. 2 (December 1995): 117–21; Diane Lee, The Pelvic Girdle: An Integration of Clinical Expertise and Research, 4th ed. (Edinburgh: Churchill Livingstone, 2011): 61–2. 2. G. L. Smidt, "Innominate Range of Motion," A. Vleeming et al (eds.) Movement Stability and Low Back Pain: The Essential Role of the Pelvis (Edinburgh: Churchill Livingstone, 1997): 187–1911; T. J. Kibsgård et al., "Radiosteriometric Analysis of Movement in the Sacroiliac Joint During a Single-Leg Stance in Patients with Long- Lasting Pelvic Girdle Pain," Clinical Biomechanics 29, no. 4 (April 2014): 406–11. 3. L. Damen et al., "The Prognostic Value of Asymmetric Laxity of the Sacroiliac Joints in Pregnancy-Related Pelvic Pain," Spine 27, no. 24 (December 2002): 2,820–4. 4. K. R. Grob, W. L. Neuhuber, and R. O. Kissling, "Innervation of the Sacroiliac Joint of the Human," Zeitschrift für Rheumatologie 54, no. 2 (March–April 1995): 117–22. 5. D. W. Polly and Daniel Cher, "Ignoring the Sacroiliac Joint in Chronic Low Back Pain is Costly," ClinicoEconomics and Outcomes Research 8 (2016): 23–31. Til Luchau is a Certified Advanced Rolfer, the author of Advanced Myofascial Techniques (Handspring Publishing, 2016), and a member of the Advanced-Trainings.com faculty, which offers distance learning and in-person seminars throughout the United States and abroad. Contact him at info@advanced-trainings.com and Advanced-Trainings.com's Facebook page. MYOFASCIAL TECHNIQUES 110 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 Watch Til Luchau's technique videos and read his past articles in Massage & Bodywork's digital edition, available at www.massageandbodyworkdigital.com, www.abmp.com, and on Advanced- Trainings.com's Facebook page. "Interosseous Sacroiliac Ligament Technique"