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Dr. Serola’s Dos & Don’ts for the Sacroiliac Joint

Sacroiliac Joint (SIJ) dysfunction is becoming more frequent than ever. Dr. Rick Serola suggests the following tips to avoid opening the sacroiliac joints and/or stressing the sprained ligaments of the SIJ:

  1. Do Not Bring the Knee Across the Midline. For example, crossing the legs while sitting by placing the knee of upper leg on the opposite leg. However, crossing the ankle or lower leg over the opposite knee while sitting is okay.
    While lying in bed; do not let the knee of the upper leg touch the bed. Rest the upper knee either on or behind the lower knee or, better yet, place a pillow between your knees.
  2. Follow the 90 Degree Rule. The prohibited actions will cause the sacral base to rotate forward and the ilia to rotate relatively backward, opening the SI joint. With knees straight, do not flex the trunk to, or past, a 90 degree angle with the legs.

    With the knees bent, do not flex the knees closer than a 45 degree angle between the legs and chest. This should be remembered when tying shoes because most people bring their knee to chest during that action. Bringing the foot up to the trunk is okay if they bring the knee out to the side.

    When tying shoes, do not bring knee to chest.  Both arms should go inside of knee.

    Bringing the foot up to the trunk okay if the knee is out to the side.

  3. No Trunk Twisting Past 25 Degrees or to the point where mild tension is felt in the low back. This action causes the sacrum to rotate away from the ilia.
  4. No Extending the Back Past Neutral. For example, you can do back strengthening exercises, but you should not bend backward at the waist past neutral; this action causes both the sacral base and ilia to rotate forward, but the lumbo-sacral area becomes compressed, and this causes the sacral base to go farther than the ilia, opening the joint.

  5. No Hanging by the Arms or Feet. No lumbo-pelvic traction, with the exception of the Sacrotrac because its pull is from the sacrum. Hanging and conventional lumbo-pelvic traction pull the ilia and spine apart, stressing the SI ligaments.
  6. No Heat on the Low Back. When the SI ligaments sprain (tear), the joint separates a little, and fluid enters into the SI joint. Rather than tear in the middle, the ligaments separate from the joint surfaces. The fluid keeps the joint surfaces apart and prevents the ligaments from re-attaching to the bone. Heat increases blood flow and increases the fluid within the SIJ, which magnifies the lesion. Ice is fine at 20-minute-intervals every hour for three hours or more.


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