Massage Therapy Journal Spring 2024

22 • Massage Therapy Journal

T he hip and the lumbar spine are intimately pain. But there’s another joint in between the two—the sacroiliac joint (SI)—that can play an important part in both dysfunction and helping a client get relief. connected, and I always work on them both when a client has trouble with either hip or low-back

Considering the pelvic region more broadly and thinking of the SI joint as the link between the leg and the spine can give us clarity around both what might be causing a client’s issues as well as how we can bring them some relief. Massage and the SI Joint: Relieving Hip and Low-Back Pain To better understand the role SI joint dysfunction plays in pain, as well as how massage therapy can help reduce symptoms, let’s review some basic structures in the pelvic region and how they function, starting with the ilium. Consider the ilium the scapula of your leg. Like the shoulder blade, the ilium’s main movement is to turn around its own center like a wheel, allowing your leg to rise and fall. In the shoulder, this motion is called the “upward and downward rotation of the shoulder blade.” When talking about the ilium, we refer to this motion as the “flexion and extension of the SI joint.” Flexion occurs when one ilium spins toward a tucked pelvis, helping you lift your knee higher. Extension is when the ilium spins the other way and arches, causing the leg and torso to lock together so a person can balance on one leg. Now, it’s true that the the SI joint doesn’t move much, but its ability and freedom to move are important. If the hip and SI joint aren’t flexing well, which is common in clients with hip and low-back issues, tucking the whole pelvis to get the knee into the air becomes necessary, which puts strain on the low back and can lead to lumbar spine problems. That’s why keeping the hip—and the SI joint—working well is so critical. Amazing, right? So what does that mean for massage therapists? You can help your clients so much by addressing SI joint dysfunction during a massage session. SI joint motion is often discussed as only passive because, with the exception of the pelvic floor muscles, there are no muscles that pass directly from the pelvis to the sacrum. But that’s not really true. The stabilizing pelvic floor and several hip joint

Here, we’ll discuss why considering if a client’s SI joint is involved in their hip or low-back pain is important, as well as strategies massage therapists can use to help their clients improve stability and mobility, as well as relieve pain.

Flexion occurs when one ilium spins toward a tucked pelvis, helping you lift your knee higher. Extension is when the ilium spins the other way and arches, causing the leg and torso to lock together so a person can balance on one leg.

A Broader Perspective: Making the SI Joint Connection Before the 20th century, anatomists assumed that the sacrum and pelvis operated as a single bone. Now we know that the SI joint does indeed move and its dysfunctions create significant problems, not only pain but also alignment. When thinking through how I can help a client experiencing pain related to the SI joint— as well how I can address pain in the whole pelvic region—I like to think of the ilia as the “Mousketeer Ears” of the pelvis and, further, a part of a person’s leg. Think of it this way: I picture the sacrum at the end of the spine as a fishtail and the ilia as the start of the client’s leg, all the way up to the iliac crest and anterior superior iliac spine. You might be wondering: How is that helpful?

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