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This page consists of research and rationale of SI biomechanics, malfunction & pain generation, and bibliography.
Prior to 1934, when Mixter & Barr discovered lumbar disk herniation, the sacroiliac joint was thought to be the major source of low back pain. (3, 59,60) At about that time, concern was diverted to surgical remedies for discs which, although providing dramatic relief in some cases, have proven to be limited in relieving many low back complaints.
With the recent emergence of biomechanical science, the sacroiliac joints are again considered to play a pivotal role in the total musculosketal complex. (22, 62-64)
The sacroiliac joints are two of the most important support centres of the body, positioned where the body's weight transfers from the spine obliquely through the pelvis to the legs. (55-57)
The base of the spinal column, the sacrum, is supported at it's attachment to the iliac bones of the pelvis solely by strong ligaments that make up the sacroiliac joints. Within these ligaments are nerves which control and orient the body's posture. (61) Sprain of these ligaments causes instability (looseness) which leads to muscle spasm, pain and postural imbalances throughout the body. (8-10, 31, 61)
Referred pain patients patterns from the sacroiliac joint can involve the entire back and may run down the front, side or back of the leg to the outside of the foot. (2, 8, 29, 31, 37-43, 45, 46) One key finding, is that pain is usually worse on one side of the body. (4, 8, 11-12, 15-18) During the healing process, instability can result in compromised function and frequent reinjury.
Studies conclude that the sacroiliac joints are important sensors of large force streams between the trunk and legs in which the largest muscles of the body are involved. In this respect, the sacroiliac joint functions as a multi-directional force transducer. (8, 20, 30-33, 45, 50-52, 54)
The Serola Sacroiliac Belt is designed to compress and support the sacroiliac joints, thereby relieving stress and instability at these weight bearing joints. Just as importantly, it is not so tight that it is restrictive. Excess or insufficient motion can adversely affect the entire musculoskeletal system. (31) The Serola Sacroiliac Belt, by providing the correct balance of resistance and resilience, re-establishes the joint's natural motion.
Because of the stability the Serola Sacroiliac Belt gives to the base of your spine, strength is increased throughout your back, hips and legs and your chances of injury are lessened considerably during work or play.
The sacroiliac joint is 20 times as susceptible to compression and twice as much to torsion as lumbar discs; (8, 29, 47, 49, 66) these are the forces encountered in forward bending, lifting and twisting.(8)
Numerous studies have shown that the sacroiliac joints are the major factor in low back pain. (2, 12, 35, 52) In fact, sacroiliac joint dysfunction has been demonstrated to be the primary bio-mechanical cause of lumbar disc degeneration. (2, 35)
Other studies have shown that, because all pelvic joints loosen during child bearing, use of a sacroiliac belt will most likely prevent associated pain during and after pregnancy. (20, 21, 25, 36)
Sacroiliac joint dysfunction can result from repetitive or sudden stress upward through the legs or hips, as in skating, bowling, or hard braking during a car accident. Torsion, as with golfing, tennis, or side impact can also be a cause of SIJD. (29)
Geometric and force parameters have been used to develop a biomechanical model of the lumbar-pelvic-leg complex that demonstrates that a correctly positioned belt will reinforce stability to the sacroiliac joint and thus aid transfer between the trunk and legs. (11, 20, 21, 25, 28, 29)
This can be demonstarated by using the "Serola Challenge:"
- Test the strength of any muscle. One easy test is to have a sitting person raise a foot off the ground and you push down on the thigh.
- Fasten the Serola Sacroiliac Belt securely on the person.
- Retest the muscle strength.
RESULT: The difference in strength is due to the support. The extra strength indicates that the person may have an unstable sacroiliac joint and that much of their available muscle strength is going into splinting around the joint .
As with any joint, sacroiliac instability causes reactive muscle splinting (Arthokinetic Reflex) (8-10, 31, 53, 61, 67-72) that can be measured as weakness.(30) Because most major muscles of the body attach to the bones that make up the sacroiliac joint, (7, 22-24) the weakness caused by their splinting can be found throughout the trunk, hips, and upper legs as these muscles create a self bracing effect on unstable sacroiliac joints. (7, 11, 13, 14, 19-21, 25, 32, 35, 65) But the weakness is only apparant. In fact, the muscles are not actually weaker, but called on to do two things at once, stabilize the sacroiliac joint and resist the examiner. The Serola Sacroiliac Belt, by helping to stabilize the sacroiliac joint, allows the muscles to use more of their efforts in resisting the examiner. This principle can be applied to any situation that requires effort, including work, sports, or play. The person will function better and safer while wearing the Serola Sacroiliac Belt.
Q. Why not use a lumbar belt?
A. : Unlike large, bulky lumbar support belts which give mainly muscular support, the slender Serola Sacroiliac Belt gives specific support to the muscles and ligaments of the SI joints. Lumbar belts, by taking the place of weak trunk muscles, further the muscular weakness by promoting disuse atrophy; for this reason, lumbar belts should be worn only when performing a specific task. The Serola Sacroiliac Belt, on the other hand, strengthens the supporting muscles by allowing them to function normally, permitting constant use of the belt whilst giving the wearer greater comfort and flexibility throughout the day.
To use an analogy : a column of stacked blocks is only as stable as its base. With instability, the column weakens. Putting a support band around the blocks that are beginning to fall would not be as effective as supporting the base. Wearing a lumbar belt instead of a sacroiliac belt is often a very similar analogy. Research published by Maurits van Tulder Ph.D., conducted a systematic review of the use of lumbar belts for the Cochrane Reviews (Spine 2001) (62) concluding they were not effective for preventing LBP & neither was there evidence for prevention of recurrent problems. Studies carried out by the US Air Force over 6 years showed a reduction in low back pain cases, but a serious increase in their severity, leading to an overall increase in compensation payments.
BIBLIOGRAPHY FOR THE SEROLA SACROILIAC BELT
- Mixter WJ, Barr, JS: Rupture of the Intervertebral Disc with Involvement of the Spinal Canal. N Engl J Med 211:210-215, 1934
- Shaw JL: The Role of the Sacroiliac Joint as a Cause of Low Back Pain and Dysfunction. First Interdisciplinary World Congress on Low Back Pain and its Relation to the Sacroiliac Joint. Univ CA San Diego pp 65-80, 1992
- Goldthwaite J, Osgood RB: A Consideration of the Pelvic Articulation from an Anatomical, Pathological, and Clinical Standpoint. Boston Medical Surgery Journal 1905; 152: 593-601
- Bourdillon JF: Spinal Manipulation. Ed3 London, England, William Heinemann Medical Books, Ltd., 1982
- Don Tigny RL: Function and Pathomechanics of the Sacroiliac Joint: A Review. Phys Ther 1985; 65:35-44
- Daly JM, Frame PS, Rapoza PA: Sacroiliac Subluxation: A Common, Treatable Cause of Low Back Pain in Pregnancy Fam Pract Res. 1991; 11:149-15
- Lee D: The Relationship Between the Lumbar Spine, Pelvic Girdle and Hip. First Interdisciplinary World Congress on Low Back Pain and its Relation to the Sacroiliac Joint, Univ CA San Diego, pp. 463-478, 1992.
- Brenard TN Jr, Cassidy JD: The Sacroiliac Joint Syndrome; Pathophysiology, Diagnosis, and Management Raven Pres Ltd. NY, 1991
- Vleeming A, Van Wingerden JP, Snijders CJ, Stoeckart R, Stijnen T: Load Application to the Sacrotuberous Ligament; Influences on Sacroiliac Joint Mechanics. Clinical Biomechanics(c) Butterworth & Heinemann Ltd 1989
- Korr IM: Proprioceptors and Somatic Dysfunction Journal OAO 74: 638-650, 1975
- Paris SV: Differential Diagnosis of Sacroiliac Joint from Lumbar Spine Dysfunction. First Interdisciplinary World Congres on Low Back Pain and its Relation to the Sacroiliac Joint. Univ CA San Diego pp 313-326, 1992
- Cibulka MT, Delitto A, Erhard RE: Pain Patterns in Patients with and without Sacroiliac Joint Dysfunction. First Interdisciplinary World Congress on Low Back Pain and its Relation to the Sacroiliac Joint. Univ CA San Diego, pp.361-370, 1992
- Vleeming A, Stoeckart R, Snijders CJ: The Sacrotuberous Ligamnent: A Conciptual Approach to its Dynamic Role in Stablizing the Sacroiliac Joint. Clin Biomechanics Copywright (c) Butterworth & Heinemann Ltd
- Van Winerden JP, Vleeming A, Snijders CJ, Stoekasrt R: The Spine-Pelvis-Leg Mechanism; With a Study of the Sacrotuberous Ligament. First Interdisciplinary World Congress on Low Back Pain and its Relation to the Sacroiliac Joint, Univ CA San Diego. pp147- 148, 1992
- Wells PW: The Examination of the Pelvic Joints. Grieve GP: Modern Manual Therapy of the Vetebral Column. Churchill Livingstone. Edinburgh, 1986, P.591
- Ramamurti CP: Orthopaedics in Primary Care. Baltimore, MD., Williams and Williams Co., 1979
- Grieve G: Common Vertebral Problems. Churchill Livingstone. Edinburgh, 1983
- Stoddard A: Manual of Osteopathic Technique. London, Hutchinson, 1959
- Stevens A: Side Bending and Axial Rotation fo the Sacrum Inside the Pelvic Girdle. First Interdisciplinary World Congress on Low Back Pain and its Relation to the Sacroiliac Joint. Univ CA San Diego, pp.209-230, 1992
- Snijders CJ, Vleeming A, Stoekart A: Transfer of Lumbrosacral load to Iliac Bones and Legs, Part 1 - Biomechanics of Self-Bracing of the Sacroiliac Joints and its Significance for Treatment and Exercise. First Interdisciplinary World Congress on Low Back Pain and its Relation to the Sacroiliac Joint. Univ CA San Diego pp.233-254, 1992
- Snijders CJ, Vleeming A, Stoeckart R: Transfer of Lumbosacral Load to Iliac Bones and Legs. Part ll - The Loading of the Sacroiliac Joints when Lifting in a Stooped Posture. Univ CA San Diego pp. 255-271 1992
- Greenman PE: Sacroiliac Dysfunction in the Failed Low Back Pain Syndrome. First Interdisciplinary World Congress on Low Back Pain and its Relation to the Sacroiliac Joint. Univ CA San Diego pp.329-352 1992
- Greenman PE: Clinical Aspects of Sacroiliac Function in Walking. Jorunal Clinical Medecine1990
- Mitchell FL Structural pelvic Function. Acadamy of Applied Osteopathy Yearbook1965 Vol2 P178
- Mens JMA, Stam HJ, Stoekart R, Vleeming A, SnidjersCJ: Peripartum Pelvic Pain: First Interdisciplinary World Congress on Low Back Pain and its Relation to the Sacroiliac Joint. Univ CA San Diego pp.233-254, 1992
- Vleeming A, Buyruk HM, Stoekart R, Karamursel S, Snidjers CJ: Biomechanical effects of Pelvic Belts. American Journal of Obstetrics and Gynecology, April 1992
- Lovejoy CO: Evolution of Human walking. Scientific American 1988
- Vleeming A, Volkers ACW, .Stoekart R, Snidjers CJ: Relation between form and function of the Sacroiliac belt Pt II, Biomechanical aspects : Spine1990 JB Lippincott & Co
- Fortin JD Sacroiliac Joint Dysfunction: Biomechanics, Diagnosis and rehabilitation, Journal of back and Musculoskeletal Rehabilitation 1993
- Mooney V.: Can we measure function in the sacroiliac joint. First Interdisciplinary World Congress on Low Back Pain and its Relation to the Sacroiliac Joint. Univ CA San Diego pp.233-254, 1992
- HeaschJ, Aisenbray JA, Guarinao J, : Manual therapy evaluation of pelvic joints using palpatory and articular spring tests. First Interdisciplinary World Congress on Low Back Pain and its Relation to the Sacroiliac Joint. Univ CA San Diego pp.233-254, 1992
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