Erik Dalton Analysis and Treatment of SI Joint Pain
In the early 20th century, sacroiliac joint syndrome was the most common medical diagnosis for low back pain, which resulted in that period being labeled the “Era of the SI Joint.” Any pain emanating from the low back, buttock or adjacent leg usually was branded and treated as SI joint syndrome. However, this medical mindset came to a screeching halt in 1934, when Jason Mixter, MD, published an article on the intervertebral disc lesion in The New England Journal of Medicine.1 His landmark report changed the popular understanding of sciatica and helped establish surgery’s prominent role in the management of sciatica at the time. Over the next few decades, discectomy surgery increased in popularity, causing many to define that period as the “Dynasty of the Disc.”
SI joint syndrome continued its fall from fashion due to the lack of reliable clinical studies confirming its very existence. Although many manual therapists quietly continued treating this disorder with some success, no one was able to put forward a convincing biomechanical theory explaining how the sacrum becomes stuck “crooked” between the two innominate bones. Physicians were hesitant and reluctant to envision a joint with so little movement causing so much pain, while manual therapists countered that its limited motion is vital to proper lumbar spine functioning.
So, the SI joint controversy raged until the late 1970s, when renowned manipulative osteopath Fred Mitchell Sr. introduced an innovative and practical biomechanical model that helped demonstrate normal and aberrant SI joint movement patterns occurring in most individuals2. Using muscles as levers to correct lumbopelvic restrictions, Mitchell’s muscle energy technique (although slightly flawed) spurred a renewed interest in the SI joint as a source of back pain. Figure 1 and Figure 2 demonstrate a modified muscle-energy assessment and correction routine for a painful left unilateral extended sacrum