Key Points

• The sacroiliac joints (SIJs) move only slightly in the sagittal plane, but we can use this potential mobility to help with low-back, hip, gluteal, or pelvic pain, as well as pain or a feeling of stiffness in the SIJs themselves.

• The aim of this approach is not to increase joint range of motion, but rather to de-threaten the small movements possible at the SIJs and normalize the sensitivity of these sometimes-painful joints.

The sacroiliac joint (SIJ) is a thing of beauty. Its strange, graceful angles and curves draw the eye, hinting at subtle and mysterious functions. Nearly hidden between the massive bones they join, the SIJ’s interlocking shapes and strong surrounding ligaments balance the paradoxical demands of stability (as appropriate to its role as the vertebral column’s foundational joint) and mobility (since it is the meeting place between the limb-related movement of the ilia and the spine-related movement of the sacrum).

This joint does move, but just a little: Gross mobility is not its main purpose. Nor is range of motion our target in our Advanced Myofascial Techniques approach.  In fact, some clients’ SIJ symptoms can be worsened by overmobilizing these sensitive joints, even though pain is not, on average, more common in people with very mobile SIJs than in people with very immobile SIJs. So, instead of targeting joint mobility when clients report SIJ-related pain, sensitivity, or discomfort (experienced as low-back, hip, gluteal, or pelvic pain, as well as pain or a feeling of stiffness in the SIJs themselves), our therapeutic goal is to normalize the sensations and refine the client’s proprioception related to the adaptive movement these joints can provide. 

We accomplish these aims with gentle, patient techniques, combined with directed client attention, all in the powerful context that receiving pleasant touch provides. After this kind of work, your clients will typically experience a sense of lightness and freedom when walking, more experientially akin to lightly flying (Image 1) than to weight-bearing.

I wrote about working with rotational (horizontal plane) SIJ adaptability in “The Twisting Sacrum: Ilia Rotation Technique” (Massage & Bodywork July/August 2022, page 32). I’ll continue that theme here as we look at sagittal-plane SIJ adaptability. Adaptability at this joint includes the ability to allow and control both linear glide (like a standard SIJ squish-test assesses), and angular (rotating) motion at the SIJ surface (Image 2). 

This roughly sagittal-plane movement of the ilia is called different names in various traditions, including ilia rotation, sacral (or ilia) nutation, or ilia tilt. I’ll refer to it as ilia torsion in homage to the terms used in my early training at the Rolf Institute of Structural Integration. 

In the paired ilia torsion techniques (Images 3 and 4), we gently assess for position-related sensitivity or pain, and with our patient touch and gentle static pressure, encourage the client’s nervous system to reevaluate and shift any habitual protective thresholds. 

How do we know which of these techniques to use with a given client? Theoretically, according to accepted biomechanical models, posterior ilia torsion would encourage the SIJ’s bony shapes to lock together within their ligaments (form closure) and enable more SIJ stability. Conversely, anterior ilia torsion would theoretically allow for more SIJ mobility.² But in practice, we find it’s often helpful to use both techniques with nearly all clients, if applied gently only to the point of a comfortable sensation threshold.

There are many mechanisms at work in manual therapy, and we can’t discount the value of any of them: Biomechanics, joint hydration, stretch tolerance, contextual factors, and more are all likely contributors to the relief that clients consistently report after these techniques. When you teach your clients the self-care techniques in Image 5, and educate them about the importance of regularity and not overdoing it, your effectiveness in helping SIJ-related pain and discomfort will fly high.

Ilia Torsion Techniques

Indications:

• Sensitivity or stiffness felt in the sacroiliac joints, low back, pelvis, gluteals, or hip joints; or with flexing, extending, running, lunging, or stepping

Purpose: 

• Decrease sensitivity, refine proprioception, and increase options for sagittal plane (“torsion”) adaptability at the sacroiliac joints

Instructions:

1. Gently use the positions pictured in Images 3 and 4 to check for sensitivity, client-reported stiffness, or pain. 

2. Find the comfortable threshold for the client, where the sensation of interest is barely present and is still comfortably tolerable.

3. Encourage your client to breathe, relax, and give you feedback about the amount of pressure and stretch you apply. Linger until you feel a settling, relaxation, or shift, or until your client feels complete.

4. Repeat in both directions, on each side. 

For detailed discussions about working with the SIJ, check out episodes 3 and 74 of The Thinking Practitioner podcast with Til Luchau and Whitney Lowe, sponsored by ABMP.

Notes

1. H. M. Buyruk, “Measurements of Sacroiliac Joint Stiffness with Colour Doppler Imaging: A Study on Healthy Subjects,” European Journal of Radiology 21, no. 2 (1995): 117–22; Diana Lee, The Pelvic Girdle: An Integration of Clinical Expertise and Research, 4th ed. (Churchill Livingstone, 2011), 61–62; A. Vleeming et al., “Relation Between Form and Function in the Sacroiliac Joint. Part 1: Clinical Anatomical Aspects,” Spine 15, no. 2 (1990): 130–132.

2. Craig Liebenson, “The Relationship of the Sacroiliac Joint, Stabilization Musculature, and Lumbo-Pelvic Instability,” Journal of Bodywork and Movement Therapies 8, no. 1 (2004): 43–45.

Til Luchau is the author of Advanced Myofascial Techniques (Handspring Publishing), a Certified Advanced Rolfer, and a member of the Advanced-Trainings.com faculty, which offers online learning and in-person seminars throughout the US and abroad. He and Whitney Lowe cohost the ABMP-sponsored TheThinking Practitioner podcast. He invites questions or comments via info@advanced-trainings.com and Advanced-Trainings.com’s Facebook page.