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There are probably more differences of opinion amongst osteopaths as to how to deal with dysfunction of the sacro-iliac articulations than for any other area of the body. There are multiple theories of movement directions and type of lesioning. I have attempted to simplify the issue into the two main types of lesioning positions of anterior and posterior rotation. This is not to say that other types of dysfunction do not occur, but to say that they seem to be fairly rare. Treating the sacro-iliac joint as a rotary articulation will deal with the vast proportion of joint problems of a mechanical nature without excessive complication and therefore uncertainty. It is possible for the sacrum itself to become distorted, as in life it is a somewhat flexible structure. It can produce apparent sacro-iliac dysfunction which is, in fact, due to sacral torsion. Some techniques for addressing this problem are included in this section. Others are more appropriate when considered with the lumbar spine, as the sacrum can sometimes be classed as a vertebral, midline structure. The principles of treatment, therefore, are those of spinal joints.

The sacro-iliac, or to be more accurate the ilio-sacral articulations have a very limited range of mobility. However, that mobility is often very easily induced, and therefore it is extremely easy to 'overlock' when trying to produce a specific force. Then, as no movement can be felt, even more force is used and pain, trauma and ineffective technique is the result. The sacro-iliac articulations respond far better to delicate, careful applications of force in very specific directions.

Special precautions include the elimination of pathological states in the bones themselves, and the possibility of inflammatory disorders. If the sacro-iliac dysfunction is recurrent the possibility of it being part of a postural compensation must be considered. Excessive recurrence and a sense of precariousness should alert the practitioner to the possibility of hypermobility. This, nevertheless, may manifest as recurrent locking.

14.1 • Articulation of sacro-iliac further side prone Find the approximate angle of the joint plane using your cephalic hand, and apply gentle pressure. The other hand takes the leg through a circumduction movement until a sense of potential for mobility is perceived through the applied hand. At this point of stressing the joint, a pressure along the line of joint movement is applied. The arc of movement in the circumducting leg when a sense of resistance from the sacro-iliac is reached will vary slightly from person to person. It is sometimes difficult to isolate the sacro-iliac movement from hip movement in this hold.

Tips: Most useful in patients who are not too acute and can lie prone. Least useful in acute cases, or in the presence of any lumbar disc syndrome where the position may be a problem. May be difficult in very large patients to reach across this far for small operators. Extra considerations: It is very easy to apply too much pressure with the cephalic hand, feel nothing, and therefore, press even harder. If a sense of movement cannot be felt, change angle or reduce pressure; do not increase force. Use of a pillow under the abdomen can aid comfort and finding the best angle for the joint.

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