- Mind Map View
- The Serola Theory Mission
- Introduction to Serola Theory
- Chain of Events
- Muscular Adaptations
- The Nutation Lesion
- SIJ Innervation
Incidence of SIJ Lesions
Harris & Murray  stated that 20 of 37 athletes studied had a chronic stress lesion of the sacroiliac joint, and 13 of these also were unstable at the symphysis pubis, showing an association between the two areas. Further, they state that 58% of footballers and 100% of other athletes who were referred for symptoms of groin or lower abdominal pain had radiographic evidence of symphysis pubis abnormalities. Of these athletes, 34% of the footballers and 63% of the other athletes had instability at the symphysis pubis. Interestingly, the higher the athletic level, the more common were the lesions.
Davis & Lentle , using 99m stannous pyrophosphate bone scanning with quantitative sacroiliac scintigraphy found that 44% of women with low back pain had sacroiliitis, of which 36% were unilateral and 64% were bilateral. Ninety percent of those women with abnormal scans had normal x-rays.
Schwarzer et al. , studied patients with pain below the level of L5, using diagnostic blocks, and found that in 13% to 30% of patients with non-specific low back pain, the sacroiliac joint was the main cause of the pain. Further, 9% to 21% of people studied had both leakage of fluid through anterior capsular tears and pain relief from the block. They concluded that “the sacroiliac joint is a significant cause of low back pain in patients with chronic low back pain and warrants further study.” Additionally, they found that groin pain was the only pain symptom that distinguished patients with sacroiliac joint dysfunction from other forms of low back pain.
Bernard & Kirkaldy-Willis  found that, in a study of 1293 patients, the sacroiliac joint was the primary cause of low back pain in 22.5% of patients. Also, he mentions findings of coexisting lesions occurring in 33% of the patients with combinations of sacroiliac joint dysfunctions and any of the following: facet joint syndrome, lateral and/or central spinal stenosis, spondylolisthesis, muscle trigger points, or herniated nucleus pulposus.
Shaw  stated “In our study of 1,000 consecutive patients with low back pain, 98% had a mechanical dysfunction of the sacroiliac joint as a major cause of their LBP.”
Mierau  found that the sacroiliac joints were reported to be a common cause of low back pain in school children.
In a study of 368 new patients, Sembrano  found that up to 25% of low back pain was found to be coming from the hip or sacroiliac joints.
In a review of the literature, Cohen  estimates the prevalence of sacroiliac joint pain to be between 15% to 25% of low back pain patients.
DeJarnette  found 8 out of 10 will have symptomatic weightbearing sacroiliac instability. He states that “No individual reaching the age of puberty escapes some damage to this weightbearing sacroiliac joint”.
When one considers that an estimated 80% of the population will experience back pain sometime in their lives, as suggested by Berquist-Ullman  Kelsey  and Panjabi , with mostly temporary resolution, serious consideration should be given to this simple biomechanical approach, because it offers a unifying way to tie the entire musculoskeletal system together, based on innate movement through nutation and counternutation patterns.
Since the ridge and groove, or other degenerative changes, occur in almost every specimen over 50 years of age, [8, 13-29], the Serola Theory suggests that it is reasonable to assume that the sacroiliac joint nutation lesion is a pervasive part of the human condition and may be a major factor in many musculoskeletal dysfunctions.
In my own clinical experience, I found that almost every person who came into my clinic for back or hip pain had some degree of sacroiliac dysfunction, whether alone or in combination with another lesion.
1. Harris, N.H. and R.O. Murray, Lesions of the symphysis in athletes. Br Med J, 1974. 4(5938): p. 211-4.
2. Davis, P. and B.C. Lentle, Evidence for sacroiliac disease as a common cause of low backache in women. Lancet, 1978. 2(8088): p. 496-7.
3. Schwarzer, A.C., C.N. Aprill, and N. Bogduk, The sacroiliac joint in chronic low back pain. Spine, 1995. 20(1): p. 31-7.
4. Bernard, T.N., Jr. and W.H. Kirkaldy-Willis, Recognizing specific characteristics of nonspecific low back pain. Clin Orthop Relat Res, 1987(217): p. 266-80.
5. Shaw, J.L. The Role Of The Sacroiliac Joint As A Cause Of Low Back Pain And Dysfunction. in The First Interdisciplinary World Congress on Low Back Pain and Its Relation to the Sacroiliac Joint. 1992. San Diego.
6. Mierau, D.R., et al., Sacroiliac joint dysfunction and low back pain in school aged children. J Manipulative Physiol Ther, 1984. 7(2): p. 81-4.
7. Sembrano, J.N. and D.W. Polly, Jr., How often is low back pain not coming from the back? Spine (Phila Pa 1976), 2009. 34(1): p. E27-32.
8. Cohen, S.P., Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment. Anesthesia and Analgesia, 2005. 101(5): p. 1440-53.
9. DeJarnette, M., Sacral Occipital Technic Notes 1984. 1984: self published.
10. Bergquist-Ullman, M. and U. Larsson, Acute low back pain in industry. A controlled prospective study with special reference to therapy and confounding factors. Acta Orthopaedica Scandinavica, 1977(170): p. 1-117.
11. Kelsey, J.L. and A.A. White, 3rd, Epidemiology and impact of low-back pain. Spine (Phila Pa 1976), 1980. 5(2): p. 133-42.
12. Panjabi, M.M., A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction. European Spine Journal, 2006. 15(5): p. 668-76.
13. Sashin, D., A critical analysis of the anatomy and the pathologic changes of the sacro-iliac joints. The Journal of Bone and Joint Surgery, 1930. 12: p. 891.
14. Solonen, K.A., The sacroiliac joint in the light of anatomical, roentgenological and clinical studies. Acta Orthopaedica Scandinavica. Supplementum, 1957. 27(Suppl 27): p. 1-127.
15. Kapandji, I.A., The Physiology of the Joints. Vol. 3. 1977: Churchill Livingstone.
16. Wilder, D.G., M.H. Pope, and J.W. Frymoyer, The functional topography of the sacroiliac joint. Spine, 1980. 5(6): p. 575-9.
17. Bowen, V. and J.D. Cassidy, Macroscopic and microscopic anatomy of the sacroiliac joint from embryonic life until the eighth decade. Spine, 1981. 6(6): p. 620-8.
18. Beal, M.C., The sacroiliac problem: review of anatomy, mechanics, and diagnosis. Journal of the American Osteopathic Association, 1982. 81(10): p. 667-79.
19. Bellamy, N., W. Park, and P. Rooney, What Do We Know About the Sacroiliac Joint. Seminars in Arthritus and Rheumatism, 1983. 12(3).
20. Vleeming, A., et al., Relation between form and function in the sacroiliac joint. Part II: Biomechanical aspects. Spine, 1990. 15(2): p. 133-6.
21. Vleeming, A., et al., Relation between form and function in the sacroiliac joint. Part I: Clinical anatomical aspects. Spine, 1990. 15(2): p. 130-2.
22. Walker, J.M., The sacroiliac joint: a critical review. Physical Therapy, 1992. 72(12): p. 903-16.
23. Vleeming, A., et al., The role of the sacroiliac joints in coupling between spine, pelvis, legs and arms., in Movement, Stability, and Low Back Pain, A. Vleeming, et al., Editors. 1997, Churchill Livingstone. p. 53-71.
24. Harrison, D.E., D.D. Harrison, and S.J. Troyanovich, The sacroiliac joint: a review of anatomy and biomechanics with clinical implications. Journal of Manipulative Physiological Therapeutics, 1997. 20(9): p. 607-17.
25. Kampen, W.U. and B. Tillmann, Age-related changes in the articular cartilage of human sacroiliac joint. Anatatomy and Embryology (Berlin), 1998. 198(6): p. 505-13.
26. Porterfield, J. and C. DeRosa, Mechanical Low Back Pain: Perspectives in Functional Anatomy. 2nd ed. 1998: W B. Saunders Company.
27. Oatis, C.A., Kinesiology. The Mechanics and Pathomechanics of Human Movement. 2004: Lippincott Williams & Wilkins.
28. Haldeman, S., et al., eds. Principles and Practice of Chiropractic. 3rd ed. 2005, McGraw-Hill.
29. Rosatelli, A.L., A.M. Agur, and S. Chhaya, Anatomy of the interosseous region of the sacroiliac joint. The Journal of Orthopaedic and Sports Physical Therapy, 2006. 36(4): p. 200-8.