We frequently think of muscles as being the foundation of our body’s movement patterns. The condition of muscles is very significant relative to effective joint movement. Less considered yet extremely important to proper movement patterns is the status of the sacroiliac joint. Daily on the PGA Performance trailers we encounter numerous cases of lower back pain. Pain and dysfunction related to the spine is common. However the sacroiliac joint is often overlooked.
The sacroiliac joint is primarily responsible for stability. It is demanded upon to dissipate loads from the trunk to the lower extremities. Relative to the lumbar spine, the sacroiliac joint can withstand only one-half of the torsional load. Likewise the SIJ can withstand only one-half of the axial compression load that the lumbar spine can tolerate. Regarding mobility, the sacroiliac joint can: 1) move into flexion-extension 2 degrees, 2) sagittally rotate 4 degrees, and 3) is capable of 2 mm of translation.
Poor repetitive swing patterns over a long period of time can weaken the extensive arrangement of sacroiliac ligament fibers. The overuse demands of the golf swing with a leg that is shorter than the other only magnifies the stress on the lower back. The sacroiliac joint is directly affected since the loads on the pelvis are disproportional in a neutral static posture. Add dynamic compression and torsional stresses, shearing forces and prolonged flexion, and the demands on the ligament and capsular structures of the joint breakdown. All lead to nociceptive responses that will limit the golfer's performance. Studies have shown that 21% of sacroiliac injuries are due to repetitive stress.
It is estimated that 15-20% of all lower back pain is from the sacroiliac joint. Diagnostically, the presence of groin pain may be the only referral pain pattern to differentially diagnose it from lower back pain. Also, the two risk factors of leg length discrepancy and prolonged repetitive exercise involving hours of swinging a golf club allow consideration of sacroiliac dysfunction. Although the posterior ligamentous structures involve an intricate arrangement of attachments that provide an extensive support system to the SIJ, the demands of the golf swing from impact to follow through can disrupt stability. Add a leg length discrepancy and the demands on the ligaments increases exponentially.
Although not as common as lower back pain in the golf world, sacroiliac pain has to be on the radar of any specialist working on golfers. Its pain pattern is allusive and can mimic hip pathology. Often restoring complete stability is not possible due to the duration of onset and difficulty in isolating its stabilizing components with exercise. Periodic intervention is typically necessary to maintain structural alignment, mobility and strength. The excessive demand sacroiliac dysfunction places on lumbar spinal stability and hip mobility are always a concern. Consequently sacroiliac sprains present an enormous challenge to the PGA and amateur golfer in performing an efficient swing. The sports medicine specialist must address many factors to maintain and improve this key area to provide a foundation for efficient musculoskeletal function.