Sacroiliac Joint Pain
Pelvic Malalignment
The chart below is from Timgren et al, and outlines the changes seen on examination with pelvic malalignment.[1]
Innominate | A. Posterior rotation | B. Anterior Rotation |
---|---|---|
Iliac Crest | Elevated โ | Elevated โ |
ASIS | Elevated โ | Depressed โ |
PSIS | Depressed โ | Elevated โ |
scapula | Depressed โ | Elevated โ |
leg | Longer โ | Shorter โ |
10-15mm lift | Increased crest difference โ | Reduced crest difference โ |
Spinal curvature | C type scoliosis | S type scoliosis |
C0-C1 function | Symmetric rotation in flexion | Restricted rotation in flexion |
All changes are in reference the ipsilateral side.
Rising of the crest upon anterior SI rotation is paradoxical, and its explanation cannot be reduced to a two-dimensional model.
Schambergerโs rule of the five Ls, which relates to the side of the anteriorly rotated innominate: โLeg Lengthens Lying, Landmarks Lowerโ (supine vs long sitting) [2]
Those patients showing pelvic asymmetry caused by dysfunction of the SI joint received one of two treatment options: (1) high-velocity and low-amplitude thrust technique applied through the ankle on the side of the dysfunctional SI joint or (2) restoration of symmetry by the selfembracing muscle energy technique. In this procedure, a patient resists thigh extension, alternating on both sides, to produce a corrective rotational force on the pelvis. Both methods have been described in detail elsewhere.3,12 The estimation of asymmetry as described was repeated after the corrective treatment.
Manual Therapy
Alignment can be reacquired through various means such as muscle energy techniques, and mobilisation with movement.
Mulligan Techniques
The most common malalignment is anterior rotation. This can usually be easily corrected with a mobilisation with movement technique. The sacrum is stabilised, the innominate is rotated, while the patient extends in lying.
Anterior Innominate Side Bending in Lying
Posterior Innominate Extension in Lying
Anterior Innominate Flexion in Standing
Posterior Innominate Side Bending in Standing
Muscle Energy Techniques
References
- โ Timgren J1, Soinila S. Reversible pelvic asymmetry: an overlooked syndrome manifesting as scoliosis, apparent leg-length difference, and neurologic symptoms. J Manipulative Physiol Ther. 2006 Sep;29(7):561-5.
- โ Wolf Schamberger. The Malalignment Syndrome 2nd Edition. Churchill Livingstone. 2012