- Mind Map View
- Introduction to Musculoskeletal Integration Theory
- Chain of Events
- Muscular Adaptations
- The Nutation Lesion
- SIJ Innervation
Chain of Events
The Serola Theory
A new, unifying model for understanding, treating, and preventing many musculoskeletal injury and pain syndromes
Chain of Events
Normal Structure & Movement
- The sacroiliac joint is the core structure of the musculoskeletal system.
- Positioned at the center of movement, shock absorption, and load
transfer between the upper and lower body, the sacroiliac joint
functions as a regulator of pelvic and trunk muscles and directly
influences posture and spinal segmental stability.
- Instead of functioning as a wedge, the sacrum functions as a cone with
the articular surfaces curling around the edges.
- Shock absorption and rebound constitute the two primary innate movements of the body, of which nutation and counternutation are the major subset, directly involving the core.
- All muscles that attach to the sacrum or innominates directly act,
through various attachments and vectors, to move the sacroiliac joints;
this movement is coordinated throughout the musculoskeletal system.
- The muscles can be divided into either nutators or counternutators.
- The interplay between these two patterns governs all normal and
dysfunctional musculoskeletal movement.
- Connective tissue (including ligaments) and muscles suspend all bones
of the body in a tensegrity network such that pressure at any point,
through either pulling or pushing, is immediately transferred
throughout the structure.
- The sacrum is pulled around the non-weight-bearing axial sacroiliac
joints in a pivoting motion, within the context of nutation and
- This configuration allows the large anterior/posterior motions of gait to
transfer to flexion/extension in the innominates, with components of
lateral flexion and rotation, then translate to the sacrum, curl around
the sacral edges, and pull the sacrum into nutation and counternutation,
which travels up the spine, where nutation/counternutation are
recognized by its components of flexion/extension, lateral flexion, and
- Simultaneously, energy is transferred from the spine to the legs,
providing a synchronized muscular force, assisted by gravity, which
facilitates energy transfer and maximizes performance.
The Sacroiliac Nutation Lesion
- A normal sacrum is suspended by ligaments.
- Excess nutation inducing force sprains the ligaments.
- The sacrum is forced beyond its normal range of nutation.
- Ligaments tear, the joint separates, & fluid enters joint space.
- Spinal Instability.
- The sacrum drops and wedges between the ilia, resulting in aberrant
- Sacral movement changes from smooth gliding to a wobbling pattern
with compressive, rotary, and shearing forces.
- Instead of healing, the body adapts.
- The normal mechanism of force transference becomes compromised.
- As a tensegrity structure, in which ligaments and muscles share
responsibility for maintaining joint tension, the muscles must take on a
greater role when the ligament is insufficient.
- The structural framework shifts to distribute gravitational and muscular
forces in a manner that avoids overloading the injured ligament.
- Ligamento-muscular compensation patterns include activation of
counternutation muscles and inhibition of nutation muscles on the
lesioned side with reciprocating muscular reactions on the contralateral
- A large mass of ligaments causes considerable muscular reaction, even
at low levels of stress.
- Muscular coordination is compromised for joint stability.
- Smooth power transmission will be disrupted, resulting in decreased
power, endurance, and coordination.
- Imbalance occurs between the tight counternutation muscles and
inhibited nutation muscles on the injured side, which is magnified by the
imbalance between the injured side and the non-injured, or less-injured
- Because most of the muscles from the head to the knees attach to either
the sacrum or innominates, they become directly involved, and the
effect is transferred throughout the kinematic chain.
- Movement patterns are changed.
- Chronicity develops through positive feedback loops.
- Eventually, poor balance and postural control may develop into
abnormal posture, altered gait, and disturbed joint motion patterns
throughout the structure.
- The pelvis will torque, the spine will twist, the extremities will rotate,
and joints will move in recognizable asymmetrical patterns.
- Muscles distant to the pelvis can become involved, affecting distant
- Degenerative osteoarthritic changes follow, beginning with surface
roughening, developing into a central ridge and groove, and resulting in
erosion, plaque formation, fibrotic changes, loose connective tissue
strands, amorphous debris and, possibly, fusion.
- Due to poor blood supply, ligaments heal poorly, if at all, so the joint may
remain hypermobile and degenerate indefinitely.
- The patient suffers more from the compensation pattern than the
- Pain and weakness may occur in any tight or inhibited muscle,
dependent on use.
- Treatment involves stabilizing the sacroiliac joint, then decompressing
the compensating structural alterations, and returning the spinal curves
- Structural alterations may occur.
Overcompensation Patterns include:
- P/A View
- Lateral Views
- Spinal-Pelvic Syndromes
o Pelvic Torsion
o Leg Length Inequality
o Disc Herniation
o Spinal Subluxations
o Lateral Canal Stenosis/Nerve Root Impingement, e.g.
o Facet Syndrome
o Straight Back Syndrome
- Associated Syndromes
o ACL Sprain
o Medial Meniscus
o Lateral Patellar Tracking
o Hip Degeneration
o Pudendal Nerve Entrapment
o Piriformis Syndrome
o Contralateral Shoulder Dysfunction
o Thoracic Outlet Syndrome