Tiger Woods once credited a therapist ‘popping his sacroiliac joint into place’ for a return to golf. As per similar articles doubting some structural diagnoses I question whether anything popped at all. I also question whether beliefs such as this affected him in the long term he never came back the same and has had well charted history of back pain. Could his therapists diagnosis be causing this?
The Sacroiliac joint (SIJ) is the joint between the ileum bone of the pelvis and the sacrum which sits at the base of the spine (tailbone). Although the SIJ is a joint what we know is that it actually moves very little. One study showed even in hypermobile individuals it moves at most 8mm. For most of us it probably only moves 2-3mm. In short it is a very stable structure due to its shape and it is further bound several super strong ligaments and a vast musculature network.
Even despite this small amount of movement I can still just about believe this might cause pain. However assessing it in my opinion is impossible. Could you realistically feel something move 2-3mm when it lies under skin, fat and other soft tissue? Can you read braille through sirloin steak? Can you see it move 2-3mm by observing bony landmarks? In my opinion you can’t and the evidence would support my stance with several studies proving this.
Assessment for SIJ problems can get very complex but basically boil down to if it is moving too much, too little or is out of place one side vs the other. Personally I don’t think you can measure these. Studies have shown two different therapists frequently come up with different conclusions on the same individual proving the tests are unreliable.
The complexity of the assessment gives its proponents credibility. Surely a complex assessment and diagnosis must mean it’s right. My argument would be the polar opposite simplicity is often the best way. The more complex we make things the more unreliable they are likely to be. The other great buy-in for people who use the SIJ diagnosis is that pain is often felt in this area. The vast majority of patients with lower back pain report pain in the area of the SIJ. However we know from other joints in the body that pain location does not always marry up with damage location or damage at all.
Treatment of the SIJ often involves manual treatment sometimes several treatments to realign the pelvis or get it 'unlocked or unjammed'. In truth no study has shown that we can physically move the joint, certainly not long term. It takes 2000 newtons of pressure to stretch the ligaments of the SIJ even the burliest of therapists would probably only be able to generate 350 newtons.
Furthermore even if we could move the SIJ is it really sensible to consider something out of place or indeed jammed when the maximum amount of movement is only a few degrees or millimetres. I would argue not. As per always each and every one of us are built differently and it may be our normal that we don’t move on one side or one side is higher or more rotated than the other. I would hazard a guess for every person with the specific SIJ ‘abnormalities’ with pain there would be someone with the same problem with no pain. Thus is it something that needs treating?
But what about when my therapist corrected my (or my friends, aunts, or great grandads, childs cousins) pelvic alignment and got better? Well we know SIJ therapy has and will continue to improve people symptoms however this does not mean this is due to the therapists movement of the SIJ. It is much more credible that what has occurred is the back story and manipulation has reduced the nervous and immune systems sensitivity and lowered pain (see pain article and how treatment works articles). Nothing to do with correction of an SIJ upslip.
So if there is improvement why does it matter? It matters more than you think. Poor belief patterns such as believing the problem is due to the SIJ being out of alignment and needs manual therapy to correct will naturally lower your confidence in your body, it will lower your self-efficacy and in turn lead to a much more likelihood of reoccurrence and ongoing issues (see why it matters how treatment works article)
In summary the SIJ is a very strong structure. I can agree it may well be a source of pain if overloaded. However simply put without significant trauma and disruption to the ligaments there is no way it pops out or gets jammed. The amount of movement in the joint is miniscule and despite what any therapists tell you there is no way this can be palpated or observed. I would strongly question any therapist who tells you otherwise, especially if they would like to see you multiple times to ‘pop it back in’. Get booked in today for an honest assessment if you believe you have a SIJ related issue.