Sacroiliac Joint Anatomy

Keywords; sacroiliac joint anatomy, chiropractic help, lower back and leg pain, pubic bone pain.



This is quite unlike any other part in the body; amongst other reasons because the SIJ surfaces are covered by two different kinds of cartilage.

Like all true joints, there is cartilage on both bones, but the articular faces have both glassy hyaline and spongy fibro cartilage surfaces that rub against each other.

No other joints in the body have this feature. There are also has many large ridges and depressions that fit together like the pieces in a puzzle.

Motion palpation is the key to the treatment of the SIJ. Whilst it's a controversial tool, the astute examiner can clearly palpate whether the SIJ is in motion or not. By placing one thumb on the sacrum, and the other on the ilium, and then asking the patient to raise the knee, it's not difficult to decide whether the joint is fixated or not.

Unlike most other joints, the sacroiliac joint anatomy is not designed for large movements. The rocking movements made with every step are in fact very small. This pelvic joint usually only moves about two to four millimeters during weight bearing and forward flexion. It is a viscoelastic joint, meaning that its major movement comes from giving or stretching.


Furthermore, it is common for the sacroiliac joint to become even more stiff and actually lock, usually due to injury, but also due to prolonged sitting, for example. This explains why manipulation is the treatment of choice for the very painful sacroiliac joint syndrome.

Orthopaedic surgeons, researching arthritis in knees and hips make the following statement: Mechanical factors, including joint instability and malalignment, contribute to the progressive degeneration that characterizes hip and knee arthritis. Would that apply to the sacroiliac joint? Yes, indeed.

Another factor is a difference in leg length. If one leg is shorter, the opposite sacroiliac joint tends to be fixated. Just how much constitutes a significant leg length inequality remains controversial, but my own opinion is that sometimes as little as two or three millimetres can be significant.

In some instances the lift should in the shoe, and if more than ten millimetres then in the sole.



Where is the Sacro-iliac Joint?

The Pelvis - a ring of three bones

Sacroiliac Joint Anatomy

CT scan

I spent a very fine hour and a half this week having dinner at a street cafe in the little Dutch town of Koudum. The long summer evening was enriched by this fine bronze. See the little triangle between her legs? That's the sacrum not a chastity belt; it makes up one of the three bones in sacroiliac joint anatomy.

This is the last of five copies. Roughly two thousand dollars if my memory serves me correctly and it's yours. Since the van Gogh debacle they now reward their artists handsomely.

Mobilization may also be useful for keeping the joint loose using certain specific exercises and stretches; they are an important feature of the rehabilitative phase of the treatment. Expect to be given exercises and do them faithfully if you want to get better and stay better.

The medical fraternity have for years denied that the sacroiliac joint is a movable joint. Finally, science has prevailed, and chiropractic philosophy has been vindicated. Reducing the malalignment in the joint, we believe, will reduce not only the pain in the joint, but also reduce progressive degenerative changes associated with all fixated joints.


Sacroiliac joint treatment is a vital part of the management of hip arthritis too.

There is without a doubt a connection between chronic fixations in the sacroiliac joint anatomy, and hip arthritis. Every case of hip arthritis that I find has a concommitent sacroiliac joint fixation. However, what we haven't yet discovered is whether the fixation causes the hip arthritis, or the hip arthritis the sacroiliac joint fixation. It's a chicken and egg situation; probably both occur.

What is also certain is that many cases of so called failed hip surgery are not surgical failures. The surgeon did a fine job, but because the sacroiliac joint fixation has not been corrected, chronic buttock pain continues.

Sometimes it's because the surgeon using poor technique created a leg length inequality. Post hip surgery, the Thompson drop technique is highly effective for treating the fixation and an orthotic in the shoe may be necessary to equate leg length.

Groin and pubic bone pain are common complaints and, in the female, it's an awkward condition faced in the chiropractic help clinic. It's best to take a companion with you as you will surely be required to remove your trousers. There are many possible causes of upper thigh discomfort, some related to sacroiliac joint anatomy, or even a Maigne's syndrome; that's a facet syndrome in the high lumbar spine.


Now a little anecdote from the chiropractic coalface.

A seventy year old woman consulted me this week for neck pain. Unconnected, she still has difficulty walking since a hip replacement 18 months ago. The surgeon insists that the hip is fine. Eureka; all four sacroiliac joint orthopedic tests were positive. More, there was a profound jamming of the sacroiliac joint on motion palpation.

I say unconnected. Could the still locked up sacroiliac joint be the underlying cause of her neck pain? Perhaps.

My advice is, before going for a hip replacement, give your chiropractor two months to work with your hip. It may save you the surgery, and freeing up the sacroiliac joint will make the surgeon's work so much more effective in any case.

Remember housewives, there's much to be done to prevent prostate cancer. Strong research repeated four times shows that men who eat a tomato a day have fifty percent less prostate cancer. Add the avocado and you reduce another nasty; benign prostatic hypertrophy.

Prostate cancer has a high tendency to spread to bone, especially the pelvis. Sacroiliac joint anatomy is important to everyone of us. See the so called ivory vertebra and metastasis in the sacrum?


If you have sacro-iliac joint anatomy pain, are a male and over 45, then your chiropractor will probably ask some questions about the health of your prostate. Prevention is the key.

Interesting research conclusively proves that a tomato a day decreases the risk of prostate cancer dramatically. Read more about Tomato Prostate …


A back pocket wallet and sacroiliac joint anatomy

Sitting on your wallet gives you a curvature whilst sitting, walking with a backpocket wallet pulls unevenly on your pelvis. BACK POCKET WALLET is worth a consideration of you are suffering from low back pain.

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Interesting challenges of the day

1. Mrs B has had one of the nastiest of conditions; vertigo caused by a disturbance in the inner ear. Falling repeatedly and vomiting she consulted her doctor but medication didn't help. After two sessions of the Epley manoeuvres she was 50 percent better. After two weeks she was 75 percent improved; no longer vomiting or falling. She's not enjoying the Brandt Daroff home exercises.

2. Mr S, a 48 year old man, has right low back pain, groin pain and a numb feeling in his lower leg when he sports. For six months he's been off football. He too has two problems; a very treatable lumbar facet syndrome and a very serious blocked artery in the groin; it's called intermittent claudication. Smokers beware.  

3. Mr S looks like the leaning tower of Pisa; he has a slipped disc at L5 making him lean towards the opposite side. It's called the postero lateral disc hernia; we'll fix it, but he has to stop for a week or two. Antalgias are serious so take them seriously. 

4. Mrs V too has  two conditions; a chronic low grade sciatica giving her an ache in the right leg, and a threatening Morton's neuroma. She's glad I'm back in Holland; chiropractic fixed it before, and we'll fix it again. 

5. Mrs W is one of the lucky ones, says her doctor. I agree. He says only 40% of patients with lumbar stenosis have a successful operation. We fixed a nasty slipped disc three years ago, but it came back two years later; the surgeon did a fine job but she has a weak ankle now giving her subtalar joint pain; it's routine stuff. 

6. I myself had an acute exacerbation of a femoral nerve lesion last year. One immediate treatment of the new strain by my colleague has fixed the pain in the lower back, but there's some residual numbness in the lower leg; no soaring tomorrow alas.

7. This lady is a 86 year old woman with a 63 scoliosis. Chronic lower back has been her lot in life but she's well pleased with chiropractic and comes for chiropractic help once a month; some conditions you can never cure.

8. She is an 78 year old woman, is doing remarkably well with a bad sciatica. But over 200 pounds she is not losing weight; in fact, gaining despite my suggestions. She's high risk for a stroke. I have referred her to a dietician to crack the whip.

9. A 61 year old man with upper cervical pain yesterday; it's not severe but also not getting better of its own accord. He's afraid it may turn very acute as when I treated him three years ago. Since then it's been fine. 

10. A 64 year old woman has had scheuermanns disease; it's left her with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment provides she come every six weeks or so for maintenance treatment.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.



Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?


Interesting questions from visitors

CLS writes:

Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

Your own unresolved problem. Pose a question

Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.


You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.

The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.