Introduction
Sacroiliac joint (SIJ) pain is a rather common pain symptom experienced by patients. Among them, pregnant women are more affected. When I was in Physio schools, I was taught that we could treat SIJ pain by mobilizing it. But right now, we have to stop and think about the reason behind it!
It is controversial to talk about the SIJ mobility because there are some articles reporting that the joint was fused, which means that it is immobile, whereas I was taught that it is a movable joint with an amplitude confined to two to four degrees (Learn more). There are a lot of assessment and treatment techniques targeting at restoring SIJ mobility. Somehow they work. Is it a myth that we can mobilize the joint or we are mobilizing something else?
Anatomy
Our SIJ is a joint formed by two hip bones and a sacrum. This joint is essential to support our whole upper body when we are upright, including sitting, standing, walking, and so on. Compared to other animals, our SIJ is not as mobile as theirs. This means that our SIJ is a very stable body part. With that small amplitude of movement, I suspect that we cannot mobilize the joint that much for treatment? In fact, we are moving something else and it is the whole pelvic fascial system indeed.
The fascial system of pelvic
Our whole body is wrapped around by a soft tissue system called fascia. I am sure that some of you have heard about it already. There are different layers and it provides a habitat for our nerves, blood vessels, lymph vessels, and other tissues to adhere to.
There are also a lot of ligaments wrapping around our SIJ to provide extra stability and they are well innervated. If there is a fascial restriction or fascial pull acts onto the ligaments, it can cause pain. It is interesting that we can treat such pain syndromes via ‘joint’ mobilization. In my point of view, we mobilize the fascia but not the joint and we obtain a good treatment result.
Traditional mobilization technique vs my ways of treatment
There are techniques that are used to mobilize an SIJ such as nutation of a hip bone relative to the sacrum. Even if this method is feasible, I would like to say that we are potentially moving the fascia rather than the joint itself.
Moreover, from my experiences, I found out that mobilization of the fascia at the SIJ was not enough to treat the SIJ. I had to mobilize the fascia around the whole pelvic to achieve a good result.
There are a few areas I would treat when I am dealing with SIJ pain
The fascia around the ASIS, groin area, iliac crest, PSIS, and along the SIJ, inferior lateral angle, ischial tuberosity, greater trochanter, and the shins are all the locations I will target while treating SIJ pain.
Whether you use a tool like IASTM or you use your hands to get the fascia to loosen up, you will get the result once you get it done.
Direction matters
From my observation, I found out that fascia is somehow restricted in various directions and it is completely individualized. There is some patients’ fascia that couldn’t be moved posteriorly while the others are the opposite. And there are also some restricted medially. Based on the direction of restriction, I will use soft tissue mobilization techniques to remove the barrier until I can get the facial freedom back in all directions. The arrows on the picture below show the direction I usually work on my patients.
I share my opinion with all of you because I want to get more feedback from others who are trying to use my method, and from there we can build up another route of treatment for those who unresolved chronic SIJ pain.