Symmetry of the pelvis versus the sacroiliac joint

This is a difficult and emotional topic. Some folks with low back pain have muscle guarding which causes their pelvis to be asymmetrical. Does that mean that their sacroiliac joints are misplaced and need an adjustment? NO! While some do feel better after a maneuver that enhances symmetry, it does not mean that the treatment corrected a sacroiliac joint  dysfunction such as the ilium moving on the sacrum and getting stuck. Some clinicians and clients believe that if they have difficulty keeping their pelvis symmetrical; that their sacroiliac joint is unstable. Some go through extensive strengthening and stabilization only to have their pelvic landmarks  remain uneven. What is at work here?  The pelvis moving in 3-dimensional space is a separate matter. If a person experiences the problem of continued  asymmetry, gets an adjustment, applies a very tight sacroiliac belt and still
has asymmetry with various tests; are they unstable in the sacroiliac joints?
NO! There are many things that contribute to the final posture and mobility of the pelvis. The above scenario speaks to this matter, this example may be in a client who has muscle imbalances, joint imbalances in the hip, the foot and ankle, the lumbar spine, upper back etc.

The latissimus dorsi muscle extends from the ilium to the upper arm and therefore upper arm asymmetry can affect pelvic posture.

The foot can do same.

Try this: Stand with your hands on the front of your pelvis, twist your lower leg so that your foot flattens (pronates) and then take it in the opposite direction as far as you can comfortable go.

What happens to the pelvis?
Next, have someone squeeze your hamstring muscles just above the knee, placing one hand in front and the other in the back of the thigh. Bend forward, then backwards, side to side, then twist left and right.

What happens to the pelvis?
Let me guess; it moves asymmetrically.  Now do the same tests on someone who has had a bilateral sacroiliac fusion. Same results! I presented on these concepts at a national and international conference in the early 90's. Other researchers have validated this, using markers inside the sacroiliac joint.
This is a complicated concept, so the best I can do is in little pieces.
How do I evaluate and treat the SIJ?

I evaluate the whole body and do so in various positions, such as fully flexed, fully extended. I evaluate and treat some far-away joints that are not painful, but that do not work properly. I treat foot and ankle, hip, pelvis, sacroiliac,  lumbar, all the way up to the neck. By the time someone is diagnosed with SIJD, they have several significant compensations throughout the body. All of these  should addressed at the very beginning, not 3 years later, not after they have  had some radical procedure done, etc.

Note: When I do find sacroiliac and symphysis pubis joint dysfunction, whether stuck, or unstable, or flavors in-between, I do treat it, very thoroughly. Many times it is the external structures that are painful causing referred pain or causing biomechanical dysfunction of the pelvis. Caution is key, and knowledge is power. I had a severe injury to my sacroiliac and symphysis pubis with instability. I fixed it using my method which I developed. I am very fortunate and hope to help others, especially by teaching other clinicians.

Probably enough blog for now! I will continue this thread from time to time. I advise caution when someone tells  you that your sacroiliac is unstable. Proceed cautiously. It is the only SIJ you have (one left and one right SIJ).

Jerry