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Why your pelvis is not out of place

Posted by Nicholas Dang on
Why your pelvis is not out of place

If you’ve seen a physiotherapist, chiropractor or osteopath, they might’ve assessed your sacroiliac joints, like this:

 

After testing, they might’ve diagnosed you with sacroiliac joint dysfunction and purported that your pelvis is unstable, out of place, or moving incorrectly.

Here’s why you shouldn’t listen to them…

Sacroiliac joint dysfunction is a common diagnosis made by some clinicians, often with their hands. This ‘dysfunction’ usually refers to abnormal movement of one or both of the two sacroiliac joints that link the lower spine to the pelvis.

Abnormal movement of the sacroiliac joint (SIJ) is frequently blamed for low back pain and buttock pain. However, the biological plausibility of this idea has been challenged for more than a decade.

Contrary to what you might’ve read or heard, the SIJ is an inherently stable structure.1

The SIJ typically only moves a minute amount.

How little?

SIJ movements are so small that detecting them with your hands is virtually impossible. To do so with accuracy and reliability, you need to use radiostereometric analysis (X-rays).2,3 In some studies of people with persistent SIJ pain, it’s been shown that the SIJ only moves 1° or less on average.3,4

You can’t accurately measure SIJ movement with your hands, even if your clinician thinks that they can. Clinical tests to assess this movement are unsupported by contemporary evidence.5,6

The SIJ doesn’t even move more in people with SIJ ‘dysfunction’. People with and without SIJ pain both have very small SIJ movement.1

Pain is multidimensional and is more related to tissue sensitivity rather than tissue damage or joint dysfunction.

TL;DR: Your pelvis doesn’t go out of place that easily. Be sceptical of anyone who claims otherwise.

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References:

  1. Goode et al. (2008) (PMID: 19119382)
  2. Kibsgård et al. (2012) (PMID: 22695864)
  3. Sturesson et al. (2000) (PMID: 10685486)
  4. Kibsgård et al. (2017) (PMID: 28582642)
  5. Klerx et al. (2020) (PMID: 31744776)
  6. Alexander et al. (2020) – The validity of lumbo-pelvic landmark palpation by manual practitioners: A systematic review
  7. Image from Hungerford et al. (2007) (PMID: 17472953)
  8. Image from https://commons.wikimedia.org/wiki/File:807_Pelvis.jpg

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