The Biomechanical Implications of Sacroiliac Joint Dysfunction

Sacroiliac Joint Dysfunction (SIJD) is a common source of chronic low back pain which may be experienced by an individual while performing leaning-forward actions (such as lifting or bending) that move the centre of gravity anterior to the acetabular axis.

The sacroiliac joint refers to a diarthrodial synovial joint, with hyaline and fibrocartilage covering the sacral and ilial surfaces of the joint. The main function of this joint is to support the upper body and to lessen the impact of ambulation.

As described by Cohen et al., the ligamentous structure comprising the sacroiliac joint – anterior sacroiliac, dorsal sacroiliac, sacrospinous, sacrotuberous and interosseus ligaments – prevents separation of the joint and movement of the pelvis along the various axes of the sacrum.

The collective function of the ligaments involves maintenance of bracing during weight transference from the torso to the lower extremities. It is also worth noting that the primary function of the sacroiliac joint is supportive in nature with limited motion.

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Dysfunctionalities within the sacroiliac joint mainly impact the function of the vertebrae above the sacrum with pelvic malalignment often found in patients due to a unilateral anterior tilt of the pelvis; pelvic anterior tilt increases disability in the movement pattern of the pelvis and can cause pain as well.

Cho and Yoon highlighted the importance of identifying foot mechanical features that contribute to anomalies in pelvic movement and using foot orthotics for modification of gait patterns in order to reduce aberrant foot kinematics.

For this purpose, the authors recruited thirty subjects with chronic low back pain and sacroiliac joint pain. The aim was to identify how an orthotic intervention could aid in changing patients’ gait patterns, particularly by correcting a functional leg length discrepancy.

A significant decrease in sacroiliac joint pain was observed after the intervention, with stability in the pelvis and spine and a concurrent reduction in mechanical stress; the orthotics compensated for the functional leg length discrepancy and enabled the patient to walk with reduced mechanical stress on the sacroiliac joint.

A hyperpronated foot induces excessive medial femoral rotation in the lower extremity leading to changes in the pelvis, spine and sacroiliac joints.

As a consequence of this, the iliopsoas shortens and the spinal column rotates contra laterally, increasing the sacral base angle and lumbar lordosis. These contribute to subluxations of the joints.

This makes the consideration of asymmetrical changes in foot alignment essential while addressing pelvic and lower back dysfunction due to consequent changes of the pelvis and pelvic torsion.

MASS4D® foot orthotics help to support the feet in their optimally corrected posture to minimise compensatory abnormal movements of the pelvis and promote postural alignment to decrease excessive stress on the sacroiliac joint.

These orthotics can be added to treatment modalities that consist of individual strengthening exercises for the subdivisions of the gluteus medius, which play a vital role in lateral pelvis stabilisation. 

With improvements in gait mechanics and muscle strengthening, chronic pain associated with sacroiliac joint dysfunction and foot postural disparities can be alleviated with significant corrections in foot posture and optimal re-alignment of the musculoskeletal system.

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