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Sacroiliac Blog Comments by       Jerry Hesch, MHS, PT

August 11, 2009 this is taken from a blog on a bodywork site in response to a post on leg length inequality and a radiographic study.     Comment by Jerry Hesch, MHS, PT just now  Erik et al,

RE: RADIOGRAPHS AND THE ILIUM, SACRUM
It is difficult to accept radiographs as being able to determine rotation of the ilium on the sacrum. radiographs cannot determine intra-articular mobility of the sacroiliac joint. The illia can move in 3-dimensional space being connected to the sacrum. "By comparing sagittal-plane femoral-head height and sacral base angulation, the authors concluded that innominate bones rotate around the sacrum (iliosacral tilt)." A person with a fused sacroiliac joint could still present in the same manner as the study population. One must always give consideration to the biomechanics of the pelvis and a unit when considering mechanics of the sacroiliac. Research has invalidated some of the sacred dogma regarding the sacroiliac. Most of the Osteopathic's belief system regarding the mechanics of the SIJ go back to Fred Mitchells SR's 1958 article. The use of radiographs for looking for leg length inequality cannot always distinguish between true and functional leg length differences. In addition to the testing you describe for functional leg length asymmetry, it is also worthwhile to check articular mechanics of the subtalar joint, the talocrural and the tibio-fibular articulation. These articulations can present with treatable dysfunctions that also influence leg length inequality. This is a rather brief reply to a complex topic. Will post more current scientific references in the near future.


Best Regards
Jerry Hesch, MHS, PT
The Hesch Method, Hesch Manual Therapy