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Prolotherapy for Sacroiliac Joint Laxity

Using the prone posterior iliac glide test, the practitioner can clinically detect instability of the sacroiliac joint and confirm restoration of stability following prolotherapy.

I met Dr. R.C. Sweeting at the annual meeting of the American College of Osteopathic Sclerotherapeutic Pain Management group last year where he was an attendee. Dr. Sweeting is an orthopaedic surgeon in British Columbia, Canada, with 37 years experience in the treatment and assessment of various orthopaedic conditions. A special interest of Dr. Sweeting has been manual musculoskeletal testing and the non-surgical treatment of low back and pelvic conditions. Over the past 6 years, he has focused on the treatment of ligamentous laxities with prolotherapy which has been particularly helpful in non-surgically resolving pelvic instabilities. The following article is an excellent, concise assessment of the mechanics of sacroiliac joint laxity, Dr. Sweeting's examination to diagnose this problem, and case reports of treatment using prolotherapy.

Following Mixter and Barr's description of the herniated lumbar disc and it's subsequent excision, the possible involvement of the sacroiliac joint as a source of low back pain has tended to be overlooked. However a review of 1294 patients presenting with low back pain by Bernard and Kirkaldy-Willis determined that 22.5% of these patients had symptoms originating in the sacroiliac joint.1 It would seem that interest in the sacroiliac joint as a source of low back pain would appear to be undergoing a resurgence with the recognition of ligament strains—generally with a fixed mal-position after injury or, alternatively, demonstrable instability of the joint. For the latter, women in their childbearing years would appear to be particularly susceptible following rear-end motor vehicle collisions.


At the moment of impact in a motor vehicle accident—with the driver sitting and restrained by seatbelts—the leg muscles contract thus extending the knee in an attempt to stop the forward momentum of the torso (see Figure 1). The forces then travel posteriorly along the line of the femur towards the acetabulum resulting in a torsional moment along with a posterior component being exerted on the sacroiliac joint. This may well cause partial ruptures in the sacroiliac ligaments.

Figure 1.Direction of force during bracing for a collision.

Last updated on: December 27, 2011
First published on: May 1, 2009