WONDER WHY?

SACROILIAC 201: DYSFUNCTION AND MANAGEMENT

W O N D E R W H Y ?

Sacroiliac 201:
Dysfunction and
Management
A Biomechanical Solution
Richard L. DonTigny, PT

A B S T RA C T
A commonly overlooked, reversible biomechanical vulnerability of
the sacroiliac joints (SIJ) makes them subject to injury even through
minor trauma. When the sacrum is loaded with the superincumbent
weight, the pelvis is symmetrical and the line of gravity is posterior
to the transverse acetabular axis, the pelvis has limited motion and
the ligaments have a balanced tension. When the line of gravity
moves anterior to the transverse acetabular axis in order to lift,
bend or lower, or during pregnancy, the sacrotuberous ligament is
loosened, the ligamentous balance is disrupted and can result in a
dysfunction in anterior rotation of the innominates on the sacrum.
The innominates will rotate cephalad and laterally on the sacrum
and temporarily fixate. The resultant dysfunction will limit normal
movement and function of the SIJ and can result in what appears
to be a multifactorial etiology. Manual posterior rotation of the
innominates on the sacrum to the balanced position will restore
normal function and provide immediate relief of pain. Recurrence
is controlled by simple specific corrective exercises. Instability can
be corrected by proliferant injections to the long and short posterior
sacroiliac ligaments and the pubic symphysis. This is probably the
long sought mechanism of idiopathic low back pain syndrome.

a commonly overlooked, reversible, biomechanical

dysfunction of the sacroiliac joint as the mechanics of
idiopathic low back pain syndrome and its appropriate
management.
Onset

When standing, the pelvis is symmetrical, the sacrum is

loaded and ligamentous tension is in balance. No muscle
power is necessary to maintain the position of posterior
pelvic rotation. Other than some slight movement in the
sacroiliac joint (SIJ) in flexion and extension, there is
essentially no motion in the joint.
The most critical support necessary to maintain the
balanced sacro-innominate relationship when leaning
forward is a strong voluntary contraction by the
abdominal muscles. (See Figure 1.)2, 3, 4 The SIJ is stable
in posterior rotation, but vulnerable to injury with an
anterior innominate rotation.

Journal of Prolotherapy. 2011;3(2):644-652.

KEYWORDS: biomechanics, dysfunction, gait, low back pain, pathology, sacroiliac
joint.
Figure 1. Active abdominal support holds the pelvis in
posterior rotation to maintain the ligaments in balance
when leaning forward.

Int r o duct i o n

When it comes to idiopathic pain in the low back, we all

see essentially the same thing. In 1982 White suggested
It may well be that idiopathic backache will be found
to be caused by some condition that is a subtle variation
from normal. Otherwise, we probably would have found
the cause already. If back pain were caused by a highly
unusual condition, then fewer people would suffer from
this disorder.1 It is the purpose of this paper to describe
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If the balanced sacro-innominate relationship is not

maintained, when leaning forward to lift, bend or lower,
the line of gravity will shift anterior to the acetabula and
will cause the innominates to rotate anteriorly on the
sacrum on an acetabular axis. The pelvis will also rotate
anteriorly with a protruding abdomen or with advanced
pregnancy.

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WONDER WHY? SACROILIAC 201: DYSFUNCTION AND MANAGEMENT

D y sfunct i o n o f t h e S I J

Rents in the Joint Capsule: The vertical innominate

shear on the sacrum at the PIIS with this dysfunction in
anterior rotation may occur with fixation and cause rents
in the joint capsule with leakage of contrast media to the
lumbosacral plexus, to the root of the fifth lumbar nerve
and into the body of the psoas muscle.5 Cysts may form
on the margins of the joint. The long posterior sacroiliac
ligament suffers a direct stretch6, may undergo a viscoelastic failure of the collagen or may become torn or
avulsed from its attachment to the PSIS. (See Figure 2.)3, 7

Figure 2. The dysfunction in anterior rotation alters tension

in various ligaments.

Ligamentous loosening: The dysfunction in

anterior rotation will loosen the iliolumbar ligaments,
destabilizing L4, 5-S1 increasing shear and torsion shear
to the discs.8, 9 This is probably the most likely cause
of disc disease. Anterior rotation will also loosen the
sacrotuberous ligament, destabilizing sacral function and
the pelvic diaphragm. The loose iliolumbar ligaments
and increase in the lumbosacral angle are precursors of
spondylolisthesis.
Primary Painful Points: A sudden release of the
balanced position will result in a vertical shear of ilial S3
on the sacral S3 segment at the PIIS. This painful point is
always present with SIJD, but it is commonly overlooked.
The PIIS is immediately lateral, slightly distal and deep to
the PSIS at the juncture between the ilial and the sacral
origins of the piriformis and the gluteus maximus. This is
the cause of piriformis syndrome. Simply by identifying
this primary painful point at the PIIS the practitioner can
make a positive diagnosis of dysfunction of the SIJ.

Muscle Separation: The gluteus maximus, piriformis

and the iliacus all have origins on the sacrum and the ilia.
This vertical shear at the sacral axis stresses these dual
origins and causes extra-articular painful points at the
PIIS and distal to the PSIS. (See Figure 3.) As the sacral
origin of the gluteus maximus stabilizes the sacrum when
leaning forward, if the innominate bone rotates anteriorly
on the sacrum, this muscle separation is enhanced.

Figure 3. As the sacral origin of the gluteus maximus

stabilizes the sacrum, the dysfunction in anterior rotation
can cause the ilial origin to separate on a line to the greater
trochanter.

The sciatic nerve exits the pelvis just beneath the piriformis
and not infrequently penetrates it. Pain and spasm in the
piriformis can cause non-disc sciatica.
I remember one 65 year-old woman whos sacral origin
of her gluteus maximus was so badly separated from the
ilial origin it was palpable and rolled painfully under her
ischial tuberosity when she sat. I could do nothing for her
and I could not find any physician who believed that she
had a dysfunction with her SIJ or a muscle separation.
She eventually died without relief. A vertical shearing at
the PSIS from the dysfunction on the conjoint origin of
the gluteus maximus can cause pain into the trochanter,
down the iliotibial band and into the lateral capsule of
the knee.
Changes in Leg Length: When the innominates rotate
anteriorly they rotate over the acetabula causing the
legs to appear longer than previously or, if just on one

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side, for the crest to be higher on that side and the pelvis
asymmetrical. (See Figure 4.) An asymmetrical dysfunction
will cause an asymmetrical pelvis with a long leg on one
side. A bilateral symmetrical dysfunction will cause both
legs to be longer than previously. A dysfunctional SIJ can
cause asymmetrical development. An apparent long leg does
not cause pelvic asymmetry. The pelvic asymmetry causes the long
leg. The leg length will always shorten with correction and the pelvis
will be symmetrical.

Similar neurological changes can be caused by a stretch of

the spinal nerve roots.11 Nerve roots are more vulnerable
to stretch than peripheral nerves.11 During elongation the
cross-sectional area is reduced with deformity of axons
and blood vessels.11 The elastic limit of nerve roots is
reached at 15% elongation when a total mechanical block
occurs.11
Dorsal root ganglia are more susceptible to stimulation
than axons12; therefore, sensory changes may be more
common than motor defects.
Traction on nerve roots may produce a lancinating pain.13
Stretching the muscles is counter productive. Correct the
SIJ and muscle tension normalizes.

Figure 4. Note the difference in height of both the ASIS and

PSIS. Note that with anterior rotation the SIJ moves more above
the acetabula causing an apparent long leg. Note also with
anterior rotation that the lumbosacral angle is increased, as is
shear to the disc.

Abdominal Pain: Abdominal pain at Baers sacroiliac

point is not uncommon and the general lack of recognition
of this point is responsible for unnecessary abdominal
surgery. This point is on a line from the umbilicus to the
anterior superior iliac spine, two inches (5cm) from the
umbilicus.14, 15 This point can be found on either side, as
opposed to McBurneys appendicitis point, which is two
inches from the ASIS and is only on the right. Pain at
Baers point can be relieved immediately with correction3, 15
or injection into the SIJ.16 (See Figure 5.)

Some years ago I was doing scoliosis screening for the

school system. I noticed a seven year-old boy with a
lumbar curve whos mother told me he was scheduled for
surgery to be stabilized. He had no complaints of pain,
but his pelvis was asymmetrical. I gently corrected an
existing dysfunction of the SIJ. Immediately, his pelvis
became symmetrical and the lumbar curve straightened. I
showed his mother how to correct his pelvis. The problem
resolved and the surgery was cancelled.
Muscle and Nerve Stretch: Posteriorly as the
innominates rotate up and over the acetabula the ischial
tuberosity moves cephalad stretching the biceps femoris
and the sciatic nerve. (See Figure 4.) This may cause a genu
recurvatum or a non-disc sciatic or both. Anteriorly the
ASIS move caudad stretching the nerve roots and the
iliopsoas muscle. (See Figure 4.)3, 4 Clinical implications
of spinal nerve root compression have been well
documented10 and appear to point to disc degeneration
as a causative factor.

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Figure 5. On a line from the umbilicus to the ASIS, Baers

sacroiliac point is two inches from the umbilicus and
McBurneys appendicitis point is two inches from the ASIS.

I recall a female patient with a four-year history of low

back and abdominal pain. She had both ovaries removed
without relief. She was referred to me and was free of
both low back and abdominal pain immediately with
correction of both of her SIJs. The loss of her ovaries
was unnecessary and caused her no paucity of disrespect
for her attending physician.

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Muscle Inhibition: Dorman found a positional

inhibition of the gluteus medius when the innominate is
held in anterior rotation.17 Dananberg found an inhibition
of the peroneus longus with SIJD causing a functional
hallux limitus.18 The hip flexors may suffer a positional
inhibition when the pelvis is in anterior rotation.
Dysfunctional loading: As the pelvis functions to
decrease loading to the femoral head you can expect
loading to be increased with dysfunction. This can cause
microfractures in the subchondral bone and roughening
of the joint surface with eventual arthritic changes.
Dysfunctional loading can increase back pain and cause
pain up and down the back and legs. Limitation of normal
pelvic movement with dysfunction can increase shear and
cause instability at the pubic symphysis. When a patient
with an arthritic hip has a replacement, in order for the
leg length to be equal following surgery, any existing
dysfunction should be corrected prior to surgery.
Neck pain: Fukushima found that subluxation of the
suboccipital joint provokes severe neck pain and that
intra-capsular or pericapsular injection into the SIJ can
give immediate relief of neck pain. He recommended
that therapy should be initiated to the SIJ dysfunction to
relieve neck pain.19
Secondary Slippage: Although primary dysfunction is
a cephalad and anterior rotation at S3 with S1 rotating
caudad, a secondary slippage may occur at S1 and give
the appearance of a posterior dysfunction or an upslip
with a short leg on the more painful side. I cannot stress
strongly enough that this secondary slippage is clinically insignificant.
The dysfunction must be treated as a bilateral anterior rotation of
the innominates anteriorly on the sacrum at S3. Correction is only
with a manual movement in posterior rotation of the innominates on
the sacrum.
Assessment

Correction and confirmation: I have found that

SIJD is essentially always caused by an anterior rotation
of the innominate bones cephalad and laterally on the
sacrum with a pathological release of the balanced
position. Simply identifying the associated painful points
at the PIIS and PSIS can make a diagnosis. These points
are extra-articular. An intra-articular injection into the
intact capsule will become encapsulated and will reach
those points only if there are tears in the capsule.

The AAOS admits to finding a firm diagnosis in low

back pain only about 15% of the time.20 This is probably
because their tests are not appropriate to this dysfunction
and compels them to miss the diagnosis about 85% of the
time. I have not found conventional tests for low back pain
to be helpful because they generally have an unsatisfactory
inter-rater reliability of only about 25-30%.21, 22
Murakami, et al. compared periarticular and intraarticular
injections for diagnosis of dysfunction of the sacroiliac
joint.23 Using periarticular injections in 25 consecutive
patients with SIJ pain they found that it was effective in all
patients. In a comparable group, intraarticular injections
were effective in 9 of 25 patients. An additional 16 patients
who had no relief from the initial intraarticular injection
were all relieved from a periarticular injection.
The improvement rate after periarticular injection was
96% compared to 62% for the intraarticular injection.
They concluded that for SIJ pain periarticular injection is
more effective and easier to perform than the intraarticular
injection and should be tried initially.22
Correction is simply the restoration of the position
of ligamentous balance by manually rotating each
innominate bone so as to cause it to move caudad and
medially on the sacrum. This can be done with a traction
correction, pulling the leg at about a 45-degree angle of
PSLR (See Figure 6.); or by a direct rotation, by grasping
the innominate and rotating it posteriorly so as to cause
the posterior aspect of the innominate to move caudad
on the sacrum. (See Figure 7.) The patient can be taught
to self-correct either with a direct self-corrective stretch
(See Figure 8.); or with a strong isometric contraction.
(See Figure 9.)
The leg length will always appear to shorten with
correction. With correction, the long leg will get shorter
and the short leg will get shorter yet. The joint is very
tight and acts similar to a stuck drawer and you must
correct one side and then the other, 5-6 times on each
side, alternating each time and checking the leg length at
the malleoli, not until the legs are equal but until the leg
length no longer appears to shorten. Once full correction
is obtained the pelvis will be symmetrical, the legs will be
of equal length and the patient will be essentially free of
pain.

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Figure 6. The traction correction. First compare the length

of the legs at the malleoli. Stand to one side and gently grasp
one foot and ankle and lift the leg as high as comfortable
without pain. Put traction on that leg in the long axis. Put that
leg down and check the leg length again. You will probably find
that leg to be shorter than it was previously. Do the same with
the other leg. Continue doing this to each side, one side at a
time, alternating legs each time, until the leg length no longer
appears to change.
Figure 8. An alternate direct correction. With the patient
supine flex the hip and knee so as to bring the knee into the
ipsilateral axilla. This can be done in any of several positions.

Figure 9. Muscle energy corrections are a very powerful

method of correction and can also be done in a variety of
positions.

Inc i dence
Figure 7. The direct correction. With the patient supine,
put one hand under the ischial tuberosity and the other on
the posterior aspect of the iliac crest. Now pull up with the
underneath hand and push down with the other in such a way
as to move the posterior aspect of the innominate caudad and
medially on the sacrum.

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In 1928 Yeoman reported that sacroiliac arthritis was

responsible for 36% of the cases of sciatica.24 Davis and
Lentle used technetium-99m stannous pyrophosphate
bone scanning with quantitative sacroiliac scintigraphy in
50 female patients with ILBPS and found that 22 patients
(44%) had sacroiliitis. Eight of these patients (36%)

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had unilateral sacroiliitis and 14 (64%) had bilateral

sacroiliitis. Of the 22 patients with abnormal scans, 20
had normal radiographs.25 An outcome study in 1969 of
145 consecutive patients with pain in the low back, 116 or
80% were found to have an anterior rotation dysfunction.
Of these, 63 (54.5%) were bilateral. Treatments averaged
5.9 per patient. Relief was frequently dramatic.26
In 1992, Shaw reported on 1,000 consecutive cases of
low back pain using changes in apparent leg length and
movement of the pelvis from asymmetry to symmetry to
correctly identify and treat the dysfunction of the sacroiliac
joints. He found that 98% of all patients had at least some
degree of SIJD and his surgical incidence for herniated
discs dropped to 0.2%.27 Shaw has been ignored. More
recently Borowsky and Fagen have suggested that SIJD is
far more common than is generally thought.28
M a n a g ement

If the pain is acute I will correct both SIJs, instruct

the patient in self-correction and tell them to continue
correction every two to three hours all day long for at
least three days. The body makes some accommodation
to the dysfunctional posture and it takes some time to
accommodate to the corrected posture. Correction is
always by a manual flexion of the innominates on the
sacrum and will cause the PSIS to move caudad and
medially on the sacrum. This has been demonstrated on
x-ray2 (See Figure 10.) and by measurement.29
On the second day I have the patient demonstrate to
me how they think I told them to do the corrections. I
have found that patients can be quite inventive and may
need to be re-instructed. There is no point in doing the
corrections improperly. If the patient has no pain by the
third day he is discharged to continue with his corrections
as necessary.
If the patient has chronic pain I do the same thing for
the first three days. I also do some gentle contract/relax
stretching as tolerated. If treatment is necessary after
ten days I will put them in a lumbosacral support with
instructions to put it on when lying supine on the support,
doing corrections and then fastening the support. If the
support is put on when the patient is erect and uncorrected,
the support will only hold them in the uncorrected
position. I like the lumbosacral support because of the
accompanying instability at L4, 5-S1.

Figure 10. Before and after x-rays demonstrating movement

of the PSISs caudad and medially on the sacrum with
correction.

Moderate instability responds to Prolotherapy to the long

and short posterior sacroiliac ligaments and to the public
symphysis if it is unstable. If you use a shotgun technique
and Prolo all of the ligaments, the joint might tighten
in the dysfunctional position, which can be extremely
difficult to correct. Similarly, if you Prolo the iliolumbar
ligaments before the sacroiliac joints are stable, you might
not be able to correct the dysfunction. Prolotherapy may
not be effective if the long posterior sacroiliac ligament
has been avulsed from the PSIS, or if it is shredded or if
it has undergone extreme viscoelastic failure.
I have found that injections of Sarapin are excellent for
the relief of trigger point pain along the iliac crests and
around the trochanters. This is a non-steroidal, sterile
aqueous solution of soluble salts of the volatile bases from
Sarraceniaceae (pitcher plant).
Severe joint instability may require surgical fixation, but
the joint must be in a corrected position first. Also, if
the joint is fixated you will negate its function as a force

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couple and loading forces will probably be increased to

the femoral head. Forces that cause asymmetry will be
blocked posteriorly and transmitted anteriorly to the
public symphysis. An attempt to preserve function with a
ligamentous repair might prove to be a better option.
I will caution you against the traditional method of
manipulation of a dysfunction of the sacroiliac joint
whereby the patient is side-lying and the operator pulls
back the shoulder and shoves forward and downward on
the pelvis strong enough to cause cavitation in the joint.
This movement can open the joint at which time the
innominate bone may rebound giving you a correction,
but there is an inherent danger in this.
Consider, the iliolumbar ligaments are on slack and the
lower lumbar discs are vulnerable. The long posterior
ligament is on tension and vulnerable. Such manipulation
can tear the annulus and extrude disc material as well
as avulse or shred the long posterior SI ligament from
its attachment to the PSIS causing a chronic instability.
Prolotherapy will probably not help this and it may
require a ligamentous repair.

Figure 11. Before correction the patient could not fully

lie down. Her pelvis was asymmetrical and the right leg was
shorter than the left.

C a se S tud i es

Case 1: I was called to radiology where I found a 68 yearold woman with acute pain in the low back and unable to
lie flat for an x-ray. She was x-rayed in that position. The
right leg appeared shorter, the pelvis was asymmetrical
and the right SIJ was not congruent. (See Figures 11 & 12.)
I then did a gentle correction of both SIJs. Immediately
her pelvis became symmetrical, the leg length was equal
bilaterally; she was free of pain and discharged.
Case 2: A 76 year-old woman with a chronic unstable
SIJ for many years. Her husband was able to correct
her with excellent relief, however relief was transient.
I had advised Prolotherapy some years ago, but none
was available in her state. She was finally treated when
proliferant injections became available locally. At the first
session she had injections of Sarapin to numerous trigger
points along the crests and around both trochanters
with excellent relief of pain. She had five sessions of
Prolotherapy specifically to the long and short posterior
sacroiliac ligament, about two to three weeks apart,
before she was stable. She continued on her corrective
exercise program until that time and now is essentially
free of pain.

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Figure 12. After correction the pelvis was symmetrical; the

legs were of equal length and the patient was without pain.

Case 3: A 23 year-old female injured her low back when

she slipped and fell hard on her buttocks while at work on
January 23. She was referred for evaluation and treatment
on January 24 and was in acute pain. She had no numbness
or weakness in the legs and PSLR was negative bilaterally.
Changes in apparent leg length demonstrated a bilateral
anterior SIJD, worse on the right. Measurements of
movement of the PSISs on the sacrum29 demonstrated
a movement inferiorly and medially of 2.5 cm on the
right and 1.6 cm on the left with correction. This was
a substantial injury and probably involved some tearing
of the anterior capsule of the SIJs. She was free of pain
following correction, but had a chronic joint instability.
She was instructed in a corrective exercise program.

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Mobilization of the SIJs to the balanced position always

gave excellent relief of pain, but the relief lasted only a
few days. A lumbosacral support helped some.
The attending physician referred the patient to a
neurologist with these findings in April, who also found
involvement of the SIJs on a CAT scan. The neurologist
referred the patient to an orthopedic surgeon specializing
in sports medicine in May. He told her that she was too
flexible to have a serious problem, that her problem was
a lack of fitness, that she could become fit simply by
riding an exercise bike, and discontinued further physical
therapy.
Case 4: A 49 year-old man strained his low back at
work on February 3, while lifting a water cooler and was
referred for evaluation and treatment on February 7. He
stood and walked with his trunk laterally deviated to the
right and complained of pain over the right SIJ. This pain
was increased with leaning forward, sitting, and coughing
or straining. There was no weakness or numbness in either
leg. PSLR with the left leg increased pain in the right SIJ,
which indicated a possible anterior rotation on the right.
PSLR on the right increased the pain on the right side,
which indicated a probable clinically insignificant slip
at S1 on the right. There was no leg pain with PSLR.
Observed changes in apparent leg length with correction
demonstrated a bilateral anterior SIJD. The patient was
free of pain following correction and instructed in a
program of corrective exercises.
He returned on February 8 and was markedly improved
and doing his exercises properly. He did well until
February 16, when he came in complaining of pain in
the left SIJ. He had a high PSIS and a high iliac crest on
the left when standing and an apparent long left leg when
supine. Flexion of the left innominate on the sacrum
equalized the leg length and the patient was again free of
pain. Follow-up one month later found him to still be free
of pain and continuing his exercises.
Case 5: Email from a chiropractor:
Hello,
Im not sure if you are still checking these e-mails but I wanted to
take a moment and write you on how your very simple sacroiliac
movement has ended several years of chronic and severe lower back
pain. I fell off a barstool about three years ago and ever since then
have had severe pain in my right SI joint that sometimes would radiate

down my leg. NSAIDs were the only way for me to get temporary
relief. I did approximately 60 spinal decompression treatments
because the MRI showed a disc bulge at L5/S1 (the bulge was on
the left!). If anything thespinal decompression treatments made me
more sore. To say I was desperate would be an understatement. I
was under the assumption that my condition was caused by internal
disc disease and that the pain was due to the release of chemicals
into the surrounding tissue as the disc degenerated. As a chiropractor
who also owns a multidisciplinary clinic I tried everything. Friday I
was reviewing your website andtried the simple motion several times
on each leg while lying on my bed. It seemed the pain decreased. I
was sure this was only in my head. Being desperate I continued the
exercises several times that day. Saturday I woke up, again with no
pain.I put up all my Christmas lights climbing on a ladder all day
long, stopping occasionally to do the movement. This is Monday still
no pain. I am shocked and in disbelief !
Immediately, today I began teaching your movement to all our
patients and to all the doctors that work for me. Could it be that
simple? I wonder how many people I have personally misdiagnosed
with herniated/bulging discs that really had sacroiliac problems?
Sinceyour procedure is noninvasive and puts no torque on a lumbar
disc I am implementing it as part of my general protocol for all our
lumbar disc patients, as I see it there should be no contraindications
in the patient doing this.
Do you have any comments on correlation between the sacroiliac
problem and lumbar disc disease? In the past Ive done quite a bit
of HVLAand honestly believe itcan aggravate herniated disc...
butyour maneuver,I believe, is very safe.Im not too sure about
diagnosing the condition,but honestly what harm does it do to just
get the patients doing the movement.
Again thank you. Im still in disbelief, but Im very happy to be free
of my chronic pain.
C o mments

My corrections are not spinal manipulations. There is

no high or low speed thrust necessary or desirable. No
jerking or popping is expected or sought. This is a precise
skill and as with all skills, my method takes some time to
learn and to perform. The skilled practitioner can have at
least 85-90% of consecutive patients free of pain within
about 10-15 minutes.
I rediscovered this dysfunction in 1965. This is what I
have found thus far.

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I am grateful to Dr. Hauser for this opportunity to

present this research on the sacroiliac joint. I hope others
will continue and improve on my biomechanics and my
method.
For more information and illustrations on the sacroiliac
joint, its function, dysfunction and management. I invite
you to visit www.thelowback.com. A CD with over 650
slides and 150 illustrations is also available. If you are
interested in a workshop for your group or facility, please
contact me. n

Refe r ences

1. White AA. Introduction. White AA, Gordon SL (eds): American

Academy of Orthopaedic Surgeons Symposium on Idiopathic
Low Back Pain. St. Louis, MO, CV Mosby Co. 1982, p 2.
2. DonTigny RL. Dysfunction of the sacroiliac joint and its
treatment. Journal of Orthopedics and Sports Physical Therapy.
1979;1:23-35.
3. DonTigny RL. Pelvic Dynamics and the S3 Subluxation of the
Sacroiliac Joint. CD-ROM, DonTigny, Havre, MT registered
2001, continually revised to 2010.
4. DonTigny RL. Anterior dysfunction of the sacroiliac joint
as a major factor in the etiology of idiopathic low back pain
syndrome. Phys Ther. 1990;70:250-265.
5. Fortin JD. Sacroiliac joint injection and arthrography with
imaging correlation. In Lennard TA (ed) Philadelphia. Reprinted
in Vleeming A et al (eds) Fourth Interdisciplinary World Congress
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