Houston Methodist. Leading Medicine

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A Breath of Fresh Air for People with Sacroiliac Joint Pain

People with sacroiliac joint (SIJ) pain account for nearly one third of all back pain sufferers. The SIJ is the connection in the low back where the sacrum and pelvis bones meet. Physical therapists have long known that people with SIJ pain move and breathe differently from the average person. New information makes these differences clearer.

Many muscles, ligaments, and other tissues connect the bones around the SIJ. The stability of this joint depends on these supporting structures. It is this stability that allows the body to safely transfer the mechanical forces of movement through the low back and pelvic areas. These forces can be measured to see if the transfer of load is working as it should.

The test used to measure this is the "active straight-leg raise" (ASLR). Lying down on the back, the patient lifts the leg about an inch off the floor or table. Patients with SIJ pain either cannot lift the leg or report a severe "heaviness" of the leg. Therapists know that if they apply pressure through the pelvic bones, the patient can lift the leg easier. Somehow this kind of compression gives the pelvis the stability it needs for movement.

At the same time, breathing changes significantly in patients with SIJ pain. These changes aren't always the same from person to person. They aren't even the same for one person changing from one position to the next. Sometimes the number of breaths goes up or down. Other times, the patient holds the breath during the ASLR. Therapists are using tests and measures like this to help show what's happening inside the body.

Stomach muscles, muscles used in breathing (such as the diaphragm), and muscles around the sacroiliac joint all work together. By coordinating their actions, these muscles can help stabilize the low back-sacroiliac area. When these muscles are disrupted, breathing changes, and the patient is unable to complete the ASLR.

Therapists can use this information to find ways to gain better control of the muscles around the sacroiliac joint. Improving the coordination of the stomach muscles with the diaphragm may help relieve sacroiliac joint pain.


Peter B. O'Sullivan, PhD, et al. Altered Motor Control in Subjects With Sacroiliac Joint Pain During the Active Straight-Leg-Raise Test. In Spine. January 1, 2002. Vol. 27. No. 1. Pp. E1-E8.

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*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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