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Sacroiliac Joint Pain: Considerations for Acupuncture Treatment



So let’s go ahead and get that. Pearls these nuggets these wonderful protocols to be able to use for sacred iliac, joint pain and dysfunction.

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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.  Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Hello, everyone. Thank you very much for attending our lecture on the sacred iliac joint. My name is Matt Callison. I’m here with my colleague, Brian Lau. Hi, thank you very much to the American acupuncture council for having. Brian. And I were talking about the upcoming module two low back hip and groin for this sports medicine acupuncture certification program.

That’s in September. And we’re thinking about different ideas of what we could be able to present. Because sacred iliac joint pain that would be presented at September and November is so prevalent with many people with different lifestyles. And we thought it would be a good idea to share with you some of our experiences.

As experiences at different points and different things that we can be able to use for releasing sacroiliac joint pain and dysfunction. What we’re doing is actually just going to be providing you in this short period of time, just a slice of the pie of things that can be used to help to reduce pain and the sacred early, actually, there is quite a few more things that you have to take a look at, but that would end up taking quite a few days to be able to go through all of that.

So let’s go ahead and get that. Pearls these nuggets these wonderful protocols to be able to use for sacred iliac, joint pain and dysfunction. So the next slide there, if we could. Go to is it’s such a crazy common injury for people and it can be able to come and go can actually really be recalcitrant for a number of different people as well is sacred iliac, joint pain, and the sacroiliac joint and the tissue surrounding that is usually the innocent bystander.

If from the different postural and muscle imbalances that are causing a total. Our torsion, a strain within the post here, sacred iliac ligaments, and also the that are just over that sacred iliac joint. So the sacroiliac joint does have a very small amount of motion, but again, it’s the innocent bystander from different pelvic imbalances and muscle.

And with those muscle imbalances come channel imbalances. And with that then comes challenge bounces within the associated channels. So this is something for us to be able to take a look at as an acupuncturist. Let’s go ahead and present some real gems here that we can be able to instantly take pain away from the sacroiliac joint and not just needling local.

So the next slide, please.

This is a bit of an overview, so we could use the innovations of L four L five at the Wachovia, Josh G points as well as you be 31 and 32. You be 33 would also be a choice. That’s just easier to find. You’d be 31 at 32 Bali out points. So this would be where we could actually affect the. We’ll also talk about points along the internal pathway of the call bladder that can be used as its own separate treatment protocol as well.

And of course, local needling in the sacred iliac joint region. And the reason why I say not into the sacroiliac joint is because it’s very difficult to get an acupuncture needle into that small little crevice of the sacred iliac joint. It’s something that I think as professionals, we should never say.

To anyone that were actually neatly into that joint, we would actually need some kind of digital imaging in order to guide us to go in there. So it’s just important that we have our language straight, especially if we’re going to be discussing to medical doctors or chiropractors or physical therapists, we’re stimulating the tissue around the Secor iliac joint, helping to decrease pain.

Then after that, we’ll get into some important motor points and also some tissues like the sacred tuberous ligament that are associated with the urinary bladder and kidney. So let’s go ahead and start right off. I think the next slide, please. This is a repaid. This is some, these are some points that you can use consider when you are needling locally underneath that PSIS for the sacred iliac joint pain is the innervation site to that joint.

So walk to a jig points at L four L five needle, those bilaterally as usually for the past. For needling, those points also, you be 31 and 32. I don’t really need all those bilaterals, but you could normally I would be needling just the side of the effected SSI joint. So you’d be 31 and 32 good combinations with local needling that you can use that in addition to, let’s go to the next slide point combination here of gallbladder 29, which is. Motorpoint or the superior motor point for the tensor fascia Lata. You can also use gallbladder 30, or I prefer the piriformis motor entry point. And I’ll discuss why in just a second. That would be with your SIJ needle technique and then also do one.

So why are we using this point combination? Let’s take a look at the internal pathway. So that image on the right, this is from Royston Lowe’s book of secondary or ordinary. I think it’s called secondary to. Printed in the 1980s, you can see from gallbladder 29, Brian, I don’t know if you’re have a cursor, if you could be able to point that out.

So gallbladder 29 on the hip there, we can see from that primary branch 29 will then go to gallbladder 30. That’s as we know into the buttock region, there’s an internal pathway that goes from gallbladder 29 down deep across the PSIS and communicate. Seemingly with the steak really act joint and its tissues, because the next point is that it communicates with, as you be 31 30, 2 33 and 34, the Bali alpha points, then that internal pathway goes down to two one, which is really quite interesting when we look at the pelvic floor.

So we’ll have a quick discussion on that, which is a very quick from that do one. Then the internal pathway arises and goes back up to the surface at gallbladder 30. This is the reason why we could use gallbladder 29, where the internal pathway begins before it goes to the sacroiliac joint. We could also use do one would be a good choice because of the ligament that had a cost to Jill ligament is the seam of the left and right pelvic floor.

So it has a lot of communication within that region. We could also use gallbladder 30 there because that’s where the internal pathway comes up and arises at gallbladder 30 personally, I prefer to use the piriformis motor entry point in this case, the reason why is because of its influence within that region has a really strong stabilizing effect for the sacrum itself.

When I’m using gallbladder 38, I’m actually thinking about trying to stimulate that sciatic nerve when there is true. SIADH. So I’m using that for a little different purpose or also with ease and gallbladder 30, just on a side note, it’s an excellent point for tonifying chia. Something to be able to mock up, you can use that with 36.

So back to the sacroiliac joint pain, gobbler 29, where the internal pathway exits from gallbladder 30 is where it comes from the deep, after going to the Bali Al points and the secretary iliac joint region to do one resurfaces at gallbladder 30. So you could use that point or the piriformis motor entry point.

That’s a nice combination. And you would tie in those needs. Those local needles around that area with gallbladder 41 is sad. Job five being the master income fluent points for the diamond mine young way has a strong effect on the civic really act joint that we demonstrate quite a bit with Gillette’s test in the smack pro.

All right. So that’s a standalone. However, you could use that with the L four and L five watch OCI points, or you’d be one and you to help tie in that internal pathway and also the innovation. It’s a solid treatment. So let’s go into, I think the next one, Brian is going to take over and start talking about the urinary bladder and kidney.

Yeah. So this would just be a, something to consider an add into the treatment. If we just get an overview of the urinary bladder and kidneys and new channels, translation for the sinew channels. We have a partial list on the left for the urinary bladder. So a new channel and a partial list on the right for the kidney sinew channel.

I say partial, cause it’s only taking us up to the lumbar spine. These channels would continue. But I’m just glancing at that image. We can notice a couple things. First of all, the urinary bladder sinew channel is going to go posterior region through the glute max hamstring tendons. We’ll talk about a couple other structures, but they’re going to form and unite at the posterior.

Part of the sacrum with the posterior sacred iliac ligaments. So that’s something right there. So it’s going to have an influence on the sacred iliac joint. Through the posterior second is really act ligaments, the kidneys, send new channels, going to dive deeper, anterior to the sacrum, to form the ligaments on the anterior portion of the sacred.

So those channels run fairly close to each other, running up the leg and thigh, and then diverged at the pelvis. Kidney channel can be sending a channel going into the pelvic floor, anterior to the sacrum urinary bladder, posterior to the sacrum. And they’re going to have quite an influence on the balance of the sacrum.

So we’re not going to necessarily have to treat every structure listed in. But we’ll highlight a few specific ones and we can look right now and notice on the left, we have the sacred tuberous ligament as part of the urinary bladder sinew new channel. This is the ligament that goes from the issue of tuberosity to the sacrum, a major structure that supports the sacrum.

So if I’m bending forward, that’s going to prevent my sacrum from basically popping out of the joint. It’s a very supportive structure on the sacrum, the piriformis part of the urinary bladder send you to. Blue max, which would be important. We’re not going to talk about it as much today, but we’ll highlight that line from the hamstrings, especially the biceps for Morris into the sacred tuberous ligament, and influenced also by the piriformis.

And then one last structure on the urinary bladder is one that would not be super obvious for a lot of people is Fronius long in the prone in general, the peroneal group, it’s very lateral. It looks like it’s on the gallbladder channel. It’s a lateral branch of the urinary bladder sinew channel. I’m going to put my cursor on it and run up through here.

The gallbladder channel would run just anterior to this. So this is a lateral bland branch of the. Urinary bladder channel. It’s going to go up to the fibular head and then link very strongly with the biceps for Morris. And then up through there and to the sacred tuberous ligament and the posterior sake really act ligaments.

That’s a key structure that we’re going to be working on that whole line in this. And we’ll talk about that in this presentation. And then the kidney send new channel. Just isolate one structure and that’s part of the pelvic floor, which has a big influence on the sacred iliac joint. That’s the issue of Cox.

So let’s move forward and look at those. Brian, yeah. Can you go back to that slide? I just want to offer one thing. I remember something that you and I have taught in the past when we’re talking about acupuncture as an assessment. So when the patient is laying prone and you can palpate underneath that PSIS and they have a certain amount of pain when you’re palpating in that region.

It’s usually the peroneus long as sometimes it’s the biceps for Morris, but it’s also the protein as long as it’s a real go-to muscle to go ahead and treat that motor entry point and see if that’ll decrease. The SSI joint pain usually does by a good 50%. So remember that combination, the Proteus longest the biceps femoris, and of course, going into this particular tuberculous.

But the peroneus longus is one point that can really take a lot of pain away from the sacred iliac joint, which is wonderful to be able to do so you can see patients have a lot of confidence. You as a practitioner, when you use one needle and you decrease their pain substantially. Thanks, Brian.

Yeah, sure. Yeah. This would functionally would really help support the SSI joint during gait, cause as you’re walking in heel strike, those muscles would start firing and help help. Whole mechanism that supports and pulls down and blocks, maybe that’s the right term, but supports stabilizes.

That’s sort. I was looking for help stabilize the sacred iliac joint, especially in running and walking type activities. So it’s really tied into the balance of the sacroiliac joint closure of the joint. That’s awesome. That’s great. Performance and sacred tubers ligaments are are ones that we’ll look at a lot.

And this slide This is a complex topic. When we get into the movement of the sacroiliac joint, I’m not going to go into super detail with it. Cause you have to, if you’re interested, you can look up nutation and counter nutation. It’s a long process to describe it and it can get very bogged down in the mechanics.

But simply speaking as you’re walking and running, you have one leg going forward and one leg going back in the innominate bones follow that there’s going to be a rotary rotation type motion in the denominator. You can picture the leg that’s swinging back is going to influence one that side. Let’s say, it’s my right leg.

That’s swinging back. This is going to influence that right side into an anterior tilt the pelvis. Whereas the leg that moves forward the forward leg is going to influence the innominate bone on that side of a D my left side in this case is going to go into a posterior tilt. And then as the gait changes in the leg switch, that’s going to go back the other way.

There’s going to be this kind of rotational type aspect through the innominate bone. That’s going back and forth. And even just from the get-go, you’ll notice with people that there is going to be a cemeteries in that. And maybe one side, it goes really easily. And the other side, not so well. So that’s going to set up the potential for things like say curly act, joint pain.

The sacrum has a particular movement in that rotation that is helped and supported by the guy wires of the parapharmacy and sacred or tumors. That’s going to prevent the sacrum from just being locked to that innominate bone movement. And it’s going to create this nutation and counter nutation motion this swaying and nodding of the sacrum.

And that’s what kind of creates the sacred joint movement. It’s a very small movement, but it’s an important movement. So we’re there to help support and guide the sacrum and its movement within that rotary movement of walking and. So it’s very important in the balance and stability and movement of the sacroiliac joint.

Because these are such key structures that holding onto the sacrum and supporting the sacrum and guiding the sacrum, it makes sense to make those part of the treatment. Paraform MIS via treating via the pair of farmers, motor entry point and the sacred tuberous ligament are very key structures that you can just include in treatment for Sacre iliac joint pain, but.

Ways you can use assessment to help determine when they’re going to be most effective manual muscle test postural findings. There’s a test for the sacred tuberous ligament that we use that we help feel for when it’s over bound and preventing and locking the movement. So those can help guide it, but they’re really key structures for this whole dynamic.

So let’s talk about piriformis motor point. This is from from Matt’s book the motor point, you actually having both the sports medicine acupuncture book, but also the Motorpoint index for the location. That point is halfway between you’d be 53 and you’d be 54. That’s how it’s described in the motor point index.

But easier to teach when we’re teaching this motor point for location is to find the PSIS. Let me get the cursor there. Find the borders of the PSIS lower border, upper border medial lateral get right in the middle of the PSIS. That’s going to be one of your points. Next point is going to be where’d my cursor go.

There we go. It’s a little hard to move on this due to, we know we’re due to his and draw a line between middle Brian. Yeah. Do we have a video for this next? It might be easier just to watch that video because the cursor is having a harder. Okay. Yeah, we can do that. Yeah. It’s hard to control the cursor cause it’s a kind of a small window, so yeah.

And it just describes it in the video. So let’s just go for that. Okay. We’ll do so I think it’s the next slide. Yeah,

we’re looking at the lateral side of the hip and identify the piriformis and loader entry. So first let’s go ahead and feel for due to then also for PSI. So we’ll take three fingers. I feel for that PSIS superior Porter, inferior border medial Porter, lateral border. And I just arrived for the middle of that.

PSIS I feel duty. Yeah, from the middle of the PSIS to do too, we’re going to divide that in half. So there’s a line drawn from the middle of the PSIS to due to being the hiatus of the sacrum. Divide that in half on that line. Okay. So then now this point, the halfway point, you’re now going to go perpendicular to the line until you feel the edge of the sacrum from the edge of the sacrum.

We’re now going to follow that line, just continue. One more SU identifying the PSIS inferior border fingers, medial border superior border, and lateral border go right into the middle. Take the other hand to the sacral Cox show injunction, which would be due to the hiatus of the sacred and the PSIS the highest of sacrum.

Divide that in half. There’s going to be a line here. So divide that. From that line now drop perpendicular line paid out till you feel the edge of the sacrum from the edge of the sacrum. Just one more soon out and you’ll then locate the piriformis. Motorpoint approximately one sort away from the lateral border around the sacred.

This was soon.

Next slide. Alright, so you guys, the continuation of that video actually does show the needle going in, but it’s just it’s a perpendicular needle with a three-inch, going into the depth about two inches. For those people that have studied with us before, that this is also the piriformis motor point is an empirical motor point that softens the urinary bladder 10 region.

So it’s really quite useful with a cervicogenic headaches when needling for sacred iliac, joint pain, and dysfunction. So always a good idea to needle bilaterally the period before. When you’re using manual muscle testing, it’s very common to have one piriformis be weak, and then the other one would actually be strong or a locked short position.

So it’s always good idea to be able to needle both piriformis. Brian, you wanna just keep going on the secretary of this ligament or do you want to keep take over.

All right. So in combination, as Brian was talking about earlier is the guy wires for the sacrum would be your sacred tuberous ligament. And also by that a performance, we just covered now with the sacred tuberous ligaments, a very prominent, dense tissue, easy to find just off of do to. So if you divided due to, and the issue of tuberosity in half and did a cross fibers for your cross fibering, where that ligament is, it’s a very.

Ligaments about the size of your pinky. Very dense. However, it does have some flexibility. So when you find some Oscher points within that region, you can see it. The red arrow that’s on the left is going to perpendicular with the sacred tuberous ligament. That’s how you want to palpate it. That’s how you want to needle it.

Usually in the middle sections where you’re going to find some Osher points I’m using an inch and half. You might need three and she knows depending on the size of the person’s bum but it shouldn’t happen to two or two and she will usually go right in that area. Needling that bilateral late is usually a good idea with sacred iliac joint pain as well.

Now there’s going to be another muscle, the next slide part of the pelvic floor being the issue of Cox and GS muscle, the issue of Cox GS Brian, let’s see if we can get the cursor. I know it’s really channel. To do that, that right-hand side, that issue is going to be located under the sacred tuberous ligament.

So you can see the cutaway on the right hand side of the image. And the cutaways, you can see the sacred tuberous ligament and also the sacred spinus ligament and where the pointer is right now is the underlying issue of Cox a G as part of that pelvic floor. So the same way that you would needle the sacred tuberous ligament going right into that dense ligament, if you took a three inch needle and threaded that up underneath the sacred tuberous ligament scraping, basically the.

Of it. The needle would probably be brushing against the sacred spinus ligament as well. The next tissue is going to be an issue of Cox and GS. This is a game changer for sake, really act joint pain. And there’s a number of different reasons why we need them in this muscle as well for the lower ciao complaints.

But for right now, let’s just keep on the sacred iliac joint. You can consider the issue of Cox, of GS as part of the pelvic floor and also Guidewire to help to stabilize. So needling the district Cox, a gas is very safe. However you can see that caution is advised on the left-hand side there. This technique really should be needled by experienced practitioners with excellent knowledge of anatomy.

You need to have really good command of your needle technique and know where the point of the needle is going at all times with this. Inadvertently go too far internal, you could affect internal organs. And that would not be a good idea whatsoever because of the risk of infection. This is a wonderful point to be able to use for just for experienced practitioners only.

All right. What do we have next? We’ve got now the local needling, right? The local needling for the sacroiliac joint pain in the secure sacroiliac joint region has been around for decades. There’s different ways of going about needling it, the way that we teach it in the smack program is to get the upper two thirds of that sacred iliac joint, where mostly where the pain is and divide that into four quarters.

From that PSIS the medial border. You move out just medial, just about once someone may be three quarters of a stone in order to take a finger to press underneath the PSIS, which is the roof of the sacroiliac joint. So that finger is going to go just underneath that. PSIS toward the secretary iliac joint, and you’ll divide that into four different vectors or four different angles.

So it always good to ask the patient does vector. How does that feel? That better be as you move down a little bit, how does that feel? Vector? See, it should move down just a little bit more. How does that feel? And of course, vector D and they’ll tell you let’s see, they’re going to be, what’s common.

It’s usually a and C could be B and D. So whatever those are you go ahead and take your inch and half needle and start threading that underneath the PSIS in the direction of the CIC. Really? Actually, there’s a great local. Technique to be able to use in combination with the other points that we have used, or at least some selection of different points that we’ve have talked about.

Great to be able to combine these needle techniques. After all the needles have been pulled out with the following myofascial release technique. This is something that we teach in our sinew channel myofascial techniques, class. This is also another game-changer to help, to reduce the tension within the tissues of the sacred early actuate and also the glute Maximus.

Brian, do you want to take it away? Now? We have a video for this one. It’s a pretty simple technique. I’ll let the video show it, but it’s, I’m working on the boundaries, the borders and attachment sites at the sacrum. It’s an easy technique just as loosen that a lateral border of the sacrum and help free the sacroiliac joint.

And you can modify it based on somebody in a posterior tilt or an anterior tilt. You can basically. Bring the leg up and you’ll see this in the video. It can like a crawl position to help bring that more anterior tilted pelvis into a posterior tilt and influence it out of that position pretty well.

Or you can move in the other direction for somebody in a posterior tilt to influence that and take it more into an anterior position. We’ll see that in the video.

so we’ll be working on the attachment. So the glute Maximus, especially the sacral attachments and just the spreading and moving softening the attachments along this. Very nice technique. We can adapt the technique to somebody who has a posterior and anterior tilt. This model. We have an anterior tilt, but I’m an exaggerate.

The anterior tilt. You can imagine with that, that it’s going to be much more effective if I move that tissue away from the sacrum. Yes. But also downward and help encourage more posterior. Or they took the pelvis. Conversely, if somebody has posterior tilt your pelvis under. And in that case, if you were working in that same direction, it’s going to encourage them more into a posterior tilt than the RDR.

So it would make more sense to come from a different angle and help lift the tissue to help encourage more anteriority to the pelvis. So we can adapt that general direction, but in both cases are moving the tissue away from the sacrum, either away and down lateral and down or lateral enough. So we’ll start with.

Lateral and downward, is that a little bit at the edge of the table? My side is towards her, so I can gently let my body sink in for them tissue using the elbow. Also a little bit of the proximal hole. Now I go right to the sacral attachments, think perpendicular and then spreads slightly lateral just to distract the tissue away from the sacrum and inferior.

I might have the. Gently and slowly tuck the pelvis under just the small movements, adequate

relax, slightly downward, another area of the tissue and under move, that movement that you’re doing, you can help them talk, but all of us under.

They generally talk under


I’m from instances you might, especially with an anterior tilt, you might add to the technique I put in the patient into sort of a crawl position. And you can see in this position, that’s going to encourage even more of a posterior tilt the pelvis so it can do similar technique. You’re comfortable.

Cellular technique with them in this position. And the position itself is going to encourage more of a posterior tilt

and I might hold a little longer in this particular position.

All right.

We have a QR code here for the new program that just started. We’ve the sports medicine acupuncture has been going on. This is jeez, what cycle is this mat now? 13, 14, but this is a updated version of it where we’ve added significantly to the. So for more information you can access the QR code.

That class has just started. I just actually returned from San Diego two days ago. So I’m still on California time. But that was for not for this, but the class just started this past month for module one module two will be in. You can start at any time, low back hip and pelvis. It’s a really pocket one.

It’s great. Yeah. It’s starting in September.

And Matt, why don’t you talk about this? Sure. Yes. So we are crazy enough to be able to put on a symposium because the field needs it. So ACA sport education we’ve gotten together, we’ve decided that the field really needs to be able to have a sports orthopedic acupuncture type of supposedly. So it’s something that should be happening hopefully every single year.

We’ve got a great speakers. This is going to be coming up in March 30th, April 1st in 2023. I’m here in San Diego. If you want any information there, just go to sew as So app as is the acronym for the title of the simple. The civic sports and orthopedic acupuncture symposium or so, so as the next slide, I’m not going to get into all these introductions.

You guys can go ahead and check that out. Check that out. That’s also going to be on. So as, theme is going to be mild fascial assessment and treatment. We’ve got some great people here. I can’t wait for this symposium. This is going to be a lot of fun. We also have recordings through loss of OMS.

That’s going to be available. Under the online CE use 75% of the smack program is going to be online, is online. And Brian and I are also working on an acupuncture anatomy series. You see there on the upper left. So as major and quadrant slump, And then if you want, if you like the way our education is, then you know, this get connected, we’ve got Facebook, we’ve got YouTube, our sports acupuncture Facebook page is really quite popular.

That’s a great one. To be able to ask some questions, you get a lot of knowledgeable people that are trying their best to be able to give their experiences with it. It’s a good Facebook feed as for sure. Brian, is there anything you want to add to that? Nope. I think. Okay, so next week, Sam Collins for me here.

Oh, that’s right next week. Sam’s going to be here. That’s awesome. Thank you so much to the American acupuncture council for having us, it’s really wonderful. Brian, it’s always a pleasure to be able to be hanging out with you and talking about medicine. It’s great. Thanks very much. So then we’ll see you next time.

Thanks everybody right. Bye. Bye.