Sacroiliac Joint Anatomy

Sacroiliac joint anatomy takes you on a little tour of the pelvis.

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.

Spine and pelvis

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.

Sacroiliac joint anatomy

Where is the Sacro-iliac Joint?

Location of the sacroiliac joint

The Pelvis - a ring of three bones

The human pelvis

Sacroiliac Joint Anatomy

CT scan

CT scan of sacroiliac joints

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. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I have left alone. After seven treatments his pain and stiffness is 50 percent better, and he is happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti-inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He is doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost pain-free. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he is well pleased; sixty-five percent better after three treatments.

5. Mr T is a wise man; he has taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily stroll has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift; he has a short leg.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. X-rays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65-year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88-year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done. 

10. Mr X is a 71-year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a few months ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

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

12. Mr D is a 38-year old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he could not sleep on that shoulder.

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 should not be treating the elderly most medical sites state but that is so much bunkum.

Have a problem that is 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 percent of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there is 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 a DC does.

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