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How to Explain SIJ Pain Without Using SIJ, Rotation, or Innominate
Many patients and clinicians believe that the body is more fragile and unstable than it really is. Using terms like pelvic rotation, going out of place, upslip and downslip are all outdated and tend to increase patient reliance on passive care. In this post, I go over how to explain SIJ Pain without using any pathoanatomical terms.
One of the most frequently asked questions I get at Modern Manual Therapy courses is, "How do you explain SIJ dysfunction without using rotation, out of place, etc?

Many clinicians, both novice and experienced are gravitating toward Pain Science Education, but cannot seem to fully commit. 
This is something you really can't dabble with. Click here to see 5 Outdated Clinical Explanations and Why You Should Not Use Them.
If you use a modern explanation for neck pain, why can you not do the same for the SIJ? Here are steps that Lorimer Moseley suggests that I use to Stop Thought Viruses
  • Challenge a concept
  • Provide an alternative concept
  • Provide evidence for a new concept
In this case you can use a video or education like in this Stop Thought Viruses Video
After you get them thinking, ask them something like

  • how much force do you think your PT/Chiro uses?
  • is it less than what is required to move the pelvic and tail bones after all other skin/muscles, etc are removed?
  • How long does a full body massage last?
  • do you think the hour long or more input from a massage lasts longer than a few quick impulses?
The important message here is that without education on self assessment and treatment, regardless of the mechanism (if they're not buying the neurophysiologic aspect), is that treatment must be reinforced with home movements/education to get lasting effects. 
The evidence for a new concept may be doing alternative treatments, or self treatments like a repeated loading strategy that enables them to self treat without any passive modality or manual therapy. 
Even if you have to use a manual therapy treatment, always relate it back to self treatment accomplishing the same effect (reducing alarm in the brain - good input = good output).
One of my final questions is

  • if I could show you a way to both assess and treat yourself, so that in many cases, you would not need either myself or any other clinician, would you want to learn that?
Most answer yes, and by then, regardless of the mechanism, most will choose saving $$ and empowerment, probably in that order.
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Dr. Erson Religioso III, DPT, FAAOMPT
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