Richard DonTigny, PT:
"Here is the mind blower. In 1982 the American Academy of Orthopaedic Surgeons met in Toronto
specifically to address LBP. They established criteria for testing and for the interpretation of
those tests. They assumed that the SIJ was so strong as to be immune to injury through minor trauma
and paid scant attention to it. They also reported that 'in spite of thorough examination they could
establish a firm diagnosis less than 15% of the time.
What they did not seem to realize is that when you use their recommended tests and interpret those
test in the recommended manner that you will be compelled to miss the diagnosis over 85% of the
time! It's not that they are not an intelligent group, but they just have not considered all of
the evidence."
Link
Dr. Maciej Dluski:
"The theory of the YUMEIHO method is grounded on the fact, that over 95% of people have had
incorrectly positioned pelvis since their birth. Most often it means, that one ilium is placed
higher than the other. The limb on the higher ilium side is comparatively shorter."
Yumeiho
Lisa Mancuso, M.D., Hugh S Thompson, M.D, George A. Bitting, M.D.
"The sacroiliac joint is a commonly overlooked cause of lower back pain. Recent studies have
found that Sacroiliac dysfunction was the cause, or a major component, in a high percentage
the cases of mechanical back pain. Dysfunction in the sacroiliac joint not only causes back
pain but also may mimic pain seen in lumbar disc herniation or a facet joint with pain referred
into the buttock and thigh."
Link
Physical Therapy for Sacroiliac Joint Dysfunction, By Therese Southworth, PT
"Symptoms of SI joint problems can vary and may include low back pain, buttock pain, thigh pain, sciatic pain, and pain with prolonged sitting or lifting. SI joint pain may be brief or last a long time. Researchers theorize that pain associated with the SI is the result of the bone on one side of the joint sliding out of position, thereby forcing
the muscles and ligaments that keep the bones aligned to overcompensate, which in turn causes pain. The longer a malalignment exists, the more likely muscles are to spasm and tissue damage to occur. In some cases, the pain associated with malalignment can travel beyond the area of the SI joint into the lower back or leg. In most cases, SI joint injury is the result of trauma, repetitive motion, or simply straightening up from a stooped position. In addition, a postural problem such as pelvic inclination (tilt) and/or excessive lumbar lordosis (curvature) is a commonly associated condition."
Link, sivu 22
Rehab and the Sacroiliac Joint, Kim D. Christensen, D.C., D.A.C.R.B., C.C.S.P.
"Primary SI dysfunction arises from trauma such as blows, falls on the buttock, or from attempts to save oneself
from falling. Knocking the SI joints out of place can affect the structural integrity of the entire spine. The SI
joints themselves are held in place by small ligaments, which can be stretched out of position if there is a
traumatic dislocation. The whole pelvic girdle can be tilted to one side in the aftermath of a traumatic injury.
Tissues in the area become inflamed and muscles spasm, pulling on the hip bones and rotating them out of place."
Link
Protonics method:
"In a normal person the spine sits on top of a neutrally positioned sacrum (central portion of the
pelvis) and has a slight lordosis (arch forward). When the pelvis is anteriorly rotated the sacrum
is tipped forward and the rest of the spine has no choice but to follow suit. Rather than fall over
forward, the body compensates for this excessive forward tilting of the lower spine by tilting
backward at some point higher up the chain. This creates a large increase in the amount of curvature
(lordosis and scoliosis) of the lower back. This deep curvature of the back can result in extreme
pain and various problems including muscle spasms, pinched nerves, and possibly damage to the
intervertebral discs."
Protonics
Greg Spindler:
"One side (usually the left) is rotated forward and then the other side is rotated back. This
creates the unstable pelvic condition while under weight-bearing stress. As a result, the sacrum
is off-center and tipped which initiates a direction for the scoliotic compensation (the curvature)
to begin. The bottom line is, not treating the pelvic area puts limits on relieving scoliosis
conditions."
Link
Greg Spindler:
"In scoliosis conditions, the common trend is that the illium-sacrum relationship is not even while
standing (weight-bearing support). How the sacrum sits between the pelvic bones is the key to
alignment of the spine."
Link
Postural Restoration Institute
"The left pelvis is anteriorly tipped and forwardly rotated. This directional, rotational influence
on the low back and spine to the right, mandates compulsive compensatory movement in one or more
areas of the trunk, upper extremities and cervical-cranial-mandibular muscle. The greatest impact
is on rib alignment and position, therefore influencing breathing patterns and ability. It is very
possible that respiratory dysfunctions, associated for example with asthma or daily, occupational,
repetitive, work positions, can also influence pelvic balance and lead to a compensatory pattern of
an anteriorly tipped and forwardly rotated pelvis on the left."
Link
Hungerford B, Gilleard W, Lee D. Altered patterns of pelvic bone motion determined in subjects with posterior pelvic pain using skin markers. Clin Biomech (Bristol, Avon). 2004 Jun;19(5):456-64.
"Posterior rotation of the innominate occurred with hip flexion in control subjects and pelvic pain subjects as previously reported in the literature. On the supporting leg, the innominate rotated posteriorly in controls and anteriorly in symptomatic subjects."
Link
R. Gunzburg, F. Balagué, M. Nordin, M. Szpalski, D. Duyck, D. Bull, C. Mélot, Low back pain in a population of school children, European Spine Journal, February 19, 2004
"A total of 392 children aged 9 were included in the study. - The prevalence of LBP was high. No gender difference was found. A total of 142 children (36%) reported having suffered at least one episode of LBP in their lives."
Link
N. H. Harris and R. O. Murray, Lesions of the Symphysis in Athletes, Br Med J. 1974 October 26; 4(5938): 211–214.
"A chronic stress lesion in the iliac component of a sacro-iliac joint was found in 20 out of 37 athletes, and 13 of them had instability at the pubic symphysis."
Link
Al-Eisa E, Egan D, Deluzio K, Wassersug R. Effects of pelvic skeletal asymmetry on trunk movement: three-dimensional analysis in healthy individuals versus patients with mechanical low back pain. Spine. 2006 Feb 1;31(3):E71-9.
"While the groups did not differ in the total range of lumbar movement, the LBP group exhibited significantly higher asymmetry in the principal motion."
"subtle anatomic abnormality in the pelvis is associated with altered mechanics in the lumbar spine. We suggest that asymmetry of lumbar movement may be a better indicator of functional deficit than the absolute range of movement in LBP."
Link
Lund T, Nydegger T, Schlenzka D, Oxland TR. Three-dimensional motion patterns during active bending in patients with chronic low back pain. Spine. 2002 Sep 1;27(17):1865-74.
"Chronic LBP patients exhibited motion patterns altered from those of the normal population. Specific differences were observed in coupled axial rotation during lateral bending movement, in the symmetry between flexion and extension, and in the symmetry be tween right and left lateral bending."
Link
Al-Eisa E, Egan D, Deluzio K, Wassersug R. Effects of pelvic asymmetry and low back pain on trunk kinematics during sitting: a comparison with standing. Spine. 2006 Mar 1;31(5):E135-43.
"This study shows a link between pelvic
asymmetry and altered trunk motion in sitting position.
We suggest that people with LBP may have a distinct
compensatory mechanism, secondary to pelvic asymmetry,
which puts the lumbar spine under higher stress."
Link - Whole paper
Gomez TT. Symmetry of lumbar rotation and lateral flexion range of motion and isometric strength in subjects with and without low back pain. J Orthop Sports Phys Ther. 1994 Jan;19(1):42-8.
"the magnitude of ROM asymmetry was significantly greater for the LBP subjects "
Link
Al-Eisa E, Egan D, Deluzio K, Wassersug R. Effects of pelvic skeletal asymmetry on trunk movement: three-dimensional analysis in healthy individuals versus patients with mechanical low back pain. Spine. 2006 Feb 1;31(3):E71-9.
"This study demonstrates objective differences in patterns of lumbar movement between asymptomatic subjects and patients with LBP. The study also demonstrates that subtle anatomic abnormality in the pelvis is associated with altered mechanics in the lumbar spine. We suggest that asymmetry of lumbar movement may be a better indicator of functional deficit than the absolute range of movement in LBP."
Link
Karski T. Recent observations in the biomechanical etiology of so-called idiopathic scoliosis. New classification of spinal deformity--I-st, II-nd and III-rd etiopathological groups. Stud Health Technol Inform. 2006;123:473-82.
"How does scoliosis develop? Our explanation is as follows. Asymmetry of movement of the hips during gait provokes asymmetry of loading and asymmetry of growth of both sides - left and right - and the gradual development of scoliosis. In I-st epg, the scoliosis is a secondary compensation for deformities in the pelvis and spine. The II-nd epg is linked to a permanent standing posture maintained on a free right leg during the first years of life. The III-rd epg comprises of patients from the boarder groups of I-st and II-nd epg."
Link
82,7 %:lla oli epäsymmetriaa lantiossa!
Pelvic Bone Asymmetry in 323 Study Participants Receiving Abdominal CT Scans, Maziar Badii, Sonya Shin, William C Torreggiani, Bojana Jankovic, Paul Gustafson, Peter L Munk, John M Esdaile, Spine. 2003 Jun 15;28:1335-9
"172 of 323 (53.3%) had a smaller right hemipelvis (mean asymmetry = -3.0 mm). A total of 95 of 323 (29.4%) had a
smaller left hemipelvis (mean asymmetry = 2.1 mm)."
PubMed
Krawiec CJ, Denegar CR, Hertel J, Salvaterra GF, Buckley WE. Static innominate asymmetry and leg length discrepancy in asymptomatic collegiate athletes. Man Ther. 2003 Nov;8(4):207-13.
"Results showed that forty-two subjects (95%) demonstrated some degree of static innominate asymmetry. In 32 subjects (73%), the right innominate was more anteriorly rotated than the left. "
Link
Timgren J, 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.
"Acquired postural asymmetry of the sacroiliac joint may be a neglected cause of several neurologic and other pain-related symptoms that can be relieved by a simple and safe treatment."
Link
McGregor A, Anderton L, Gedroyc W. The assessment of intersegmental motion and pelvic tilt in elite oarsmen. Med Sci Sports Exerc. 2002 Jul;34(7):1143-9.
"those with either current or previous LBP presented with a hypomobility of their spine which appeared to be compensated for by increased pelvic rotation."
Link
Badii M, Shin S, Torreggiani WC, Jankovic B, Gustafson P, Munk PL, Esdaile JM. Pelvic bone asymmetry in 323 study participants receiving abdominal CT scans. Spine. 2003 Jun 15;28(12):1335-9.
"172 of 323 (53.3%) had a smaller right hemipelvis (mean asymmetry = -3.0 mm). A total of 95 of 323 (29.4%) had a smaller left hemipelvis (mean asymmetry = 2.1 mm). "
Link
Incidence of sacroiliac joint malalignment in leg length discrepancies, Schuit D, McPoil TG, Mulesa P., J Am Podiatr Med Assoc. 1989 Aug;79(8):380-3.
"Structural leg length, functional leg length, and sacroiliac position were determined for each subject. The
results indicate a high incidence of leg length discrepancies within the sample, and also a fairly high incidence
of asymptomatic sacroiliac joint malalignment when leg length discrepancies are present."
PubMed
Kingma I, van Dieen JH, de Looze M, Toussaint HM, Dolan P, Baten CT. Asymmetric low back loading in asymmetric lifting movements is not prevented by pelvic twist. J Biomech. 1998 Jun;31(6):527-34.
"Assuming that asymmetric loading of the low back is more strenuous to the spine than symmetric loading, the current results indicate that even small deviations of a lifting movement from the sagittal plane can explain an increased risk of low back disorders."
Link
We deal here chiefly with lesions of the innominate bones. They are more frequent than lesions of the pelvis as a whole, and are relatively more important. The general indications of innominate lesion, which would lead one to examine for such displacement, are backache, sciatica, pain or lameness in the limbs, limping or unequal gait, pelvic disease, female disorders, etc.
The lesions of the innominate commonly met with are:
I. The innominate displaced forward or backward.
II. The innominate displaced upward or downward.
Link
Posterior rotation of the innominate, as measured using skin markers during weight bearing in controls may reflect activation of optimal lumbo-pelvic stabilisation strategies for load transfer. Anterior rotation occurred in symptomatic subjects, suggesting failure to stabilise intra-pelvic motion for load transfer.
Link
Results showed that forty-two subjects (95%) demonstrated some degree of static innominate asymmetry. In 32 subjects (73%), the right innominate was more anteriorly rotated than the left.
Link
Excessive anterior rotation of the ilium can potentially lead to anterior hip pain due to impaction from the acetabulum, as well as a tight piriformis with SIJ and sciatic nerve irritation. Sciatic nerve irritation can create ectopic impulse generation increasing hamstring muscle tension and thereby reducing stretch-shortening agility. Furthermore, the geometry of the anteriorly rotated ilium reduces the ability of the gluteus maximus to contract properly. Add, SIJ irritation then quite frequently, the upper gluteus maximus will become tight and go into spasm whilst the lower gluteus maximus is completely inhibited. Either scenario will alter the timing of gluteal : hamstring activation in favour of the hamstring. Lack of inferior gluteus maximus contraction together with reduced relaxation time of the hamstring muscles will lead to premature fatigue and risk of injury in the hamstrings. The anteriorly rotated ilium also places strain on the L4 lumbar vertebrae by rotating it contralaterally, which may stretch the L4/5, L5/S1 nerve root. Such irritation can not only lead to excessive pain but also to more subtle changes in adverse neural tension (ANT) resulting in calf and hamstring tightness, reduced dorsi flexion and hence reduced hip extension during stance phase. Similarly, the ANT can lead to excessive forefoot strike with it's inherent risks for lateral ankle stability. The latter scenario will have an impact on the timing between the erector spinae, inferior gluteal and superior hamstring muscles.
Link
reduced hip flexion range of motion especially on the left, a hypomobile or 'blocked' left sacroiliac joint with a posteriorly rotated ilium
Link
A herniated disc might occur at the same time (often at the L4-5 level because of a ligament between the vertebra and the SI joint) causing concomitant true sciatica. The herniated disc is usually recognized and surgically treated but the pain does not resolve because of the concomitant sacroiliac strain! This is a scenario that I have encountered many times in clinical practice.
Link
Pain from a blocked joint can be referred to lower back, buttocks, hip, groin, thigh, calf and lower part of abdomen.
Link
A sacroiliac subluxation is difficult to correct, because the joint is practically without normal movement. The pelvis tends always to resist any appreciable movement in its joints, therefore the physician must devise ways of securing leverage to directly affect these joints without transmitting his corrective leverage through the very movable sacro-vertebral joint above or the hip joint below. This is a difficult condition to fulfill.
Link