Sacroiliac Joint Mobilization


 

Even if they are considered among the very stable and strongest parts of the human body, the sacroiliac joints (SI) perform minimal range of motion, which is restricted only to gliding action as the person flexes and walks. These joints may have a synovial membrane and are joined by strong anterior and posterior ligaments, but sacroiliac joints have the tendency of going stiff and lock as the person ages. Any irregular motion, such as twisting or bending, infection, osteoarthritis, trauma, stress fractures, or inflammation may cause pain to the sacroiliac joint. The process of childbirth can also cause pain in the sacroiliac joint. So what is sacroiliac joint mobilization?

What is Sacroiliac Joint Mobilization

One of the many procedures that can be applied to sacroiliac joint pain is mobilization, a sacroiliac joint mobilization procedure that involves application of force across the joint and putting the joint in better alignment.  The basic idea here is to make the ilium into flexion and to activate the joints. It is usually done by a physical therapist, chiropractor, or a physician who is especially trained in manipulative medicine. There are different commonly used sacroiliac joint mobilization techniques a therapist may perform on a patient to help promote flexible movement at the joints, such as:

Forward and Backward Shift of the Pelvis.  This forward and backward sacroiliac joint mobilization technique body movement aims to mobilize the pelvic girdle and increase elasticity of the inferior hip joint capsule.  To do this, the patient is made to sit on top of treatment table with his legs open. The therapist sits in front and places his hands on patient’s posterior part of pelvic girdle and shifts his pelvis in backward and forward motion.

Self-Mobilization of Sacroiliac Joint. This self-help sacroiliac joint mobilization activity aims to mobilize the patient’s lower lumbar spine through side flexion and rotation. To perform this technique, the patient is made to be in a crawling position with both knees and hands on the treatment table.  He then hangs one knee over to the edge, as his ipsilateral foot is placed on heel of other foot, and then slowly returns to the crawling position. While performing this process, the patient has to relax his body so that his pelvis will slopes down obliquely from ilium and mobilize his sacroiliac joint on supported side. He must repeat this procedure with his other knee.

Posterior Iliac Dysfunctions Forward Rotation. This sacroiliac joint mobilization technique aims to correct innominate the rotation dysfunction using the iliopsoas, particularly if patient experiences posterior and inferior PSIS; anterior and superior ASIS; flexion positive standing test; apparent shortenings of the legs in supine position, and; restriction or hypermobility in innominate rotation of anterior. To perform this technique, the patient is required to lie in supine position with his leg that needed mobilization extended over to treatment table’s edge, while the therapist stands on the side away from the leg that require mobilization. The patient is then required to push the patient’s leg hanging freely up against the therapist’s hand with his utmost force, while the latter gives firm resistance to contraction for up to 10 seconds. This process is repeated up to four times. Then, either the therapist or patient now stabilizes and flexes the other leg.  The therapist proceeds by placing his hand caudal over the patient’s thigh to help push the patient’s hip to further extension; while his cephalic hand is positioned at the patient’s PSIS to push it upward so that the innominate forward rotation on patient’s sacrum is increased.

Counteract of Posterior Iliac Dysfunctions Using Self Mobilization. This sacroiliac joint mobilization technique is aimed at correcting the dysfunction of posterior iliac by hip extension passively in supine or prone position.  In the prone position, patient flexes his knees all the way up even as his hands reach and pull his feet down against his buttocks.  While in the supine position, the patient must let one of his legs hang over the treatment table while the other leg is folded up from the knee.  Both positions should be held for about 2 minutes.

Backward Rotation for Anterior Iliac Dysfunction. This sacroiliac joint mobilization technique is used to correct the posterior innominate rotation dysfunction, which manifest in the patient showing signs of superior and anterior PSIS; inferior and posterior ASIS; positive standing flexion test; apparent lengthening of leg in supine position, and; innominate posterior rotation. To perform this technique, the patient folds his knee and rests his ipsilateral foot on the treatment table while the other leg is left hanging over the edge.  The therapist stands on the side of the leg to be mobilized. His cephalic hand supports the patient’s ASIS as his caudal hand clasps the ischial tuberosity.  Then he leans forward putting his weight against the patient’s folded knee and moves the leg to create a backward rotating motion of the innominate on the patient’s sacrum.  The patient is then required to resist the force exerted by the therapist with a sustained utmost contraction up to ten seconds.  This process must be repeated 3 to 4times allowing the hips to flex only but not to extend.

Counteract  Self Mobilization Anterior Iliac Dysfunction.  This sacroiliac joint mobilization technique which can be done in standing, supine, or standing bending forward position is meant to correct anterior iliac dysfunction.  In the standing position, the patient rests his foot on a table, leans forward, and wrapping his arm around his knee, he presses it against his underarm.  This process can be repeated many times a day, especially before going to bed to alleviate the strain on the affected ligaments.

Meanwhile, in the supine position, the patient pulls one knee at a time and presses it against his chest.  In the standing bending forward position, the patient rests a foot on a chair, bends forward from the waist, and hangs both arms down.

These are but a few of several mobilization exercises that a sacroiliac joint sufferer can perform to alleviate his pain. It should be noted, however, that sacroiliac joint mobilization do not require fast thrusts; otherwise the therapist defies his purpose.  It is even more effective when done on tissues that are warmed up first, and; although it takes time to be adept in doing joint mobilization of the low back, its potential benefits to the patient can be immeasurable.