The last piece I wrote was on the glutes and how to activate them to their full potential, I have now moved slightly further north to the SIJ. Onwards and upwards, I always say! Anyway, let’s get to the good stuff and by that I mean scientific, evidence based research! So the Sacroiliac Joint or SIJ, is essentially the connection of your sacrum (spine) and your pelvis (legs), so it’s kind of a big deal. Good thing the divine creator, or creator’s, (I don’t judge) adopted the old tradie motto, ‘if you can’t tie knots, tie lots’. The SIJ has a joint capsule, 5 thick ligamentous attachments, as well as 35 muscular attachments, making it tremendously stable! However, this message has been somewhat lost along the way and caused much controversy with the emergence of the ‘slipped or subluxed pelvis’. Some quack-titioners believe that in our day to day lives this fortress of connective tissue is able to shift out of place and thus cause pain. The SIJ can indeed be a source of pain, though in my experience not as commonly as people believe. In an attempt to dispel the myths and illusion Tullberg et al examined the capacity for manipulations to change the position, and thus any potential subluxation, of the SIJ. To achieve this they used highly sensitive measuring tools, capable of detecting movement in joints and then tested if manipulation or mobilisation from practitioners changed this position. The results showed that none of the patients experienced any significant change in position of their SIJ following treatment. They also found that the ‘positional tests’, used to quantify the degree of subluxation of the pelvis, were also unreliable. Unfortunately, the researchers did not suggest any patho-anatomical reasons for SIJ pain and dysfunction, which means there is more research to be conducted. They did however state that manipulation works, but in a way they could not measure during that study. Manipulation is just one facet of treatment options and a holistic, evidence-based approach should be adopted by all practitioners to ensure best clinical outcomes for patients. The take home message is, stop saying your pelvis ‘is out of place’, manipulation works, but not in the way it is commonly sold and the SIJ is more complex than simply cracking it back into place once in a while (or every 2 days or so, as some would have you believe). Hopefully, this either provides some clarity or allows you to question your beliefs enough to seek out more information. I’m always happy to try and help that process, so drop me a line if any questions have arisen! Yours in subluxation and relocation, Jack – The Roar Physiotherapist Side not: I myself use manipulation as a therapy, however this is only used in specific circumstances and never to resolve ‘subluxation’. Tullberg, T., Blomberg, S., Branth, B., & Johnsson, R. (1998). Manipulation does not alter the position of the sacroiliac joint: a roentgen stereophotogrammetric analysis. Spine, 23(10), 1124-1128.