SPORTS INJURIES
Pelvic, Hip, Groin and Low Back Pain
Both the pubic symphysis and sacroiliac joints are held together
by strong fibrous and ligamentous attachments. The pubic
symphysis is actually a disc. It is a fibrocartilaginous
disc that, like any other disc in the body, can be disrupted.
The pubic symphysis is also strengthened by the pubic arcuate
ligament and superior pubic ligament. The sacroiliac joint
also has extremely strong ligamentous attachments. These
consist of the iliolumbar, sacrotuberus, sacrospinus, and
anterior and posterior sacroiliac ligaments, which resist
downward and forward forces from the lumbar spine and upward
forces from the hip joint.
The sacroiliac joint is normally very stable with a limited amount of movement
because of this tight ligamentous support, but laxity can easily develop if the
ligamentous support is injured.
Injuries to these ligaments is a common cause of sciatica and chronic low back
pain. The sacroiliac joint is a true arthrodial (gliding) joint with hyaline
articular cartilage, synovial membrane, and a capsule. This has been forgotten
by modern orthopedics, who still believe the sacroiliac joint is rather immobile
and almost incapable of being injured.
Because the pubic symphysis and the sacroiliac joint are the only two joints
connecting the two halves of the pelvis, an injury to one can affect the other.
Thus, anyone sustaining injury to a sacroiliac joint should also have the pubic
symphysis examined. Many athletes with chronic low back pain could have been
easily treated if someone would have also examined the pubic symphysis, instead
of just examining the lower back.
The rather immobile sacroiliac joint is located between a fairly mobile lumbar
spine and a very mobile hip joint. The function of the sacroiliac joint is related
to both areas. The joint acts like a buffer zone that enables the forces to be
transmitted from the femur to the ilium to the lower back, as well as from the
lower back to the ilium to the femur. The absorption of forces in the sacroiliac
joint reduces the stress on the pelvis. It can easily be seen how the sacroiliac
ligaments are injured because they are, in essence, the primary shock absorbers
between the hip and lower back vertebrae. Any tackle, body smash, knee contusion,
or fall that transmits forces from the back to the lower extremity or vice versa
must travel directly through the sacroiliac ligaments.
The often-overlooked pubic symphysis plays a role very similar to that of the
sacroiliac joint by enhancing overall pelvic mobility. It also is the site of
attachment of the powerful adductor muscles, which move the leg inward, and the
abdominal muscles whose strength helps keep force off of the lower back and discs.
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